Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 481 - VIRGINIA RADIATION PROTECTION REGULATIONS › Part XIV - Radiation Safety Requirements for Wireline Service Operations and Subsurface Tracer Studies › Article 4 - Requirements for Personal Safety › Form - FORMS (12VAC5-481)

Current through Register Vol. 40, No. 24, July 15, 2024
Applications for a New Radioactive Material
						License
Academic,
						Research and Development, and Other Licenses of Limited Scope, Revision 4
						(6/2018)
Broad
						Scope, Revision 3 (1/2016)
Fixed
						Gauge Devices, Revision 4 (6/2018)
Industrial
						Radiography, Revision 4 (6/2018)
Irradiators
						- Part XII, Revision 2 (6/2018)
Medical
						Use, Revision 4 (1/2022)
Portable
						Gauges, Revision 3 (6/2018)
Radiopharmacy,
						Revision 2 (6/2018)
Sealed
						Sources, Revision 4 (6/2018)
Self-Shielded
						Irradiators, Revision 4 (6/2018)
Material
						in Well Logging, Tracer, and Field Flood Study, Revision 3
						(1/2016)
XRF
						Devices, Revision 3 (6/2018)
Manufacturing
						and Distribution, Revision 3 (6/2018)
Applications for Renewal of a Radioactive Material
						License
Academic,
						Research and Development and Other Licenses of Limited Scope, Revision 4
						(6/2018)
Broad
						Scope, Revision 3 (1/2016)
Fixed
						Gauge Devices, Revision 4 (6/2018)
Industrial
						Radiography, Revision 4 (6/2018)
Irradiators
						- Part XII, Revision 1 (6/2018)
Medical
						Use, Revision 4 (1/2022)
Portable
						Gauges, Revision 5 (6/2018)
Radiopharmacy,
						Revision 2 (6/2018)
Sealed
						Sources, Revision 4 (6/2018)
Self-Shielded
						Irradiators, Revision 4 (6/2018)
Material
						in Well Logging, Tracer, and Field Flood Study, Revision 3
						(1/2016)
XRF
						Devices, Revision 5 (6/2018)
Manufacturing
						and Distribution, Revision 3 (6/2018)
Training, Experience, and Preceptor Attestations
A
						- Training Preceptor for Radiation Safety Officer and Assistant Radiation
						Safety Officer Revision 1 (1/2022)
B
						- Authorized User Written Directive Not Required Revision
						1(1/2022)
C
						- Authorized User Unsealed Radioactive Material Requiring Written Directive
						Revision 3 (1/2022)
D
						- Authorized User-Manual Brachytherapy Revision 2 (1/2022)
E
						- Authorized User High Dose Remote Afterloader-Teletherapy-Gamma Knife Revision
						1 (1/2022)
F
						- Authorized Medical Physicist or Ophthalmological Physicist Revision 1
						(1/2022)
G
						- Authorized Nuclear Pharmacist Revision1 (1/2022)
Other Forms
Certificate
						of Disposition of Materials, Revision 0 (7/2016)
Certificate
						- Use of Depleted Uranium under General License, Revision 0
						(7/2016)
Cumulative
						Occupational Exposure History, Revision 1 (1/2015)
Fingerprint
						Record, Federal Bureau of Investigation, FD-258, (rev. 9/2013)
Notice
						to Employees, RH-F-12 (1/2011)
Occupational
						Exposure Record per Monitoring Period, Revision 1 (1/2015)
Registration
						Certificate - In Vitro Testing with Radioactive Material under General License,
						Revision 0 (7/2016)
Reciprocity
						Privileges Checklist, Revision 0 (7/2016)
Application
						for Reciprocal Recognition of Out-of-State Radioactive Materials License,
						Revision 0 (2/2021)
Reciprocity
						Notification, Revision 0 ( 2/2021)
Statutory Authority: §
													32.1-229
						  of the Code of Virginia.