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Applications and Forms - Radiation Control Program

Table of Contents

Notice to Employees

Notice to Employees
Document Number Title
RC 203-1 Notice to Employees (PDF, 10KB)
RC 232-1 Notice to Employees (Dentists Only) (PDF, 9KB)
RC 233-2 Notice to Employees (Vets Only) (PDF, 64KB)

Licensing Reciprocity

Licensing Reciprocity Forms
Document Number Title
RC 252-3 Notice of Intent to Work in Texas Under Reciprocity (PDF, 306KB)
Please review the “Sensitive Information” notice on the form
Fillable form version of the RC 252-3 (PDF, 320KB)
RC 252-5RAM Reciprocity Application (PDF,158KB)

X-Ray Machines

X-Ray Machines Applications and Forms
Document Number Title
 RC 17-R  Termination Form
 RC 42-I  Industrial Radiation Safety Officer (RSO) Form
 RC 42-IR  Industrial Radiography Radiation Safety Officer (RSO) Form
 RC 42-R  Radiation Safety Officer (RSO) Form
 RC 204  Radiation Machine Source Unit Fee Schedule
 RC 226-01  Business Information Form - Registration
 RC 226-02  Radiation Machine Application - New and Renewal
 RC 226-03  Radiation Machine Application - Amendment
 RC 226-04  Industrial Radiation Application - New, Reciprocity, and Renewal
 RC 226-05  Industrial Radiation Machine Application - Amendment
 RC 226-06  Radiation Machine Services Application - New, Renewal, and Amendment
 RC 226-08  Mobile Services
 RC 226-09 Coronary Calcium Screening
 RC 226-10  Osteoporosis Screening
 RC 226-11  CT Lung Screening
 RC 229-01 Additional Information for Accelerator Registration 
 RC 229-02 Electronic Brachytherapy Registration 
 RC 229-03  Superficial Radiation Therapy (SRT) Registration 

Equipment Performance Evaluation

Please contact Trae Windham via email or telephone at (737) 218-7084, about any other inspection forms.

Equipment Performance Evaluation Forms
Document Number Title
EPEDent-1 Equipment Performance Evaluation, Dental Radiographic Unit (PDF, 776KB)
EPERad-1 Equipment Performance Evaluation, Radiographic Unit (PDF, 92KB)
EPEVet-1 Veterinary Equipment Performance Evaluation (PDF, 72KB)

Industrial Radiographer Certification

Industrial Radiographer Applications and Forms
Document Number Title
2020 Exam Schedule 2020 Industrial Radiography Examination Schedule (PDF, 345KB)
RC IR-1 Industrial Radiographer Replacement ID Card Application (PDF, 29KB)
Instructions for Industrial Radiographer Replacement ID Card Application (PDF, 46KB)
RC IR-2 Industrial Radiographer Second Certification ID Card Procedures (PDF, 27KB)
RC 255-1 Request for Disability Accommodation for IR Exam (PDF, 73KB)
RC 255-3 Application for Industrial Radiographer Exam (PDF, 369KB)
RC 255-C Accepted Radiation Safety Training Courses (PDF, 66KB)
RC 255-E Trainee Qualification Form (PDF, 27KB)
RC 255-OS Radiographer Qualification - OJT (Years) (PDF, 35KB)
RC 255-R Radiographer Qualification - OJT (Hours) (PDF, 36KB)
RC 255-RC Radiographer Reciprocity Qualification (PDF, 73KB)
RC 255-T Trainer Qualification (PDF, 65KB)

Laser Registration

Laser Registration Applications and Forms
Document Number Title
 BRC 301-3  Written Notice for Laser Light Show in Texas
 RC 17-L  Termination Form
 RC 42-L  Laser Safety Officer (LSO) Form
 RC 204  Radiation Machine Source Unit Fee Schedule
 RC 226-01  Business Information Form - Registration
 RC 301-02  Laser Application - New & Renewal
 RC 301-03 Laser Application - Amendment
 RC 301-04  Laser Service Application - New, Renewal, & Amendment


Radioactive Materials


Radioactive Materials Applications and Forms
Document NumberTitle
CI-40General License Acknowledgement Self-Evaluation Form (PDF, 1.49MB)
RC 251-2General License Acknowledgement of Devices Containing Radioactive Material (PDF, 1,541KB)
RC 252-1Business Information Form - License (PDF, 256KB)
RC 252-2Radioactive Material License (PDF, 195KB)
RC 252-4Certificate of Disposition (PDF, 206KB)
313A(RSO)Radiation Safety Officer (and Associate Radiation Safety Officer)
313A(AUD)Authorized Users for (1)Uptake, Dilution, and Excretion Studies (2)Imaging and Localization Studies (3)Sealed Sources for Diagnosis
313A(AUT)Use of Unsealed Radioactive Material for which a Written Directive is Required (Including I-131)
313A(AMP)Authorized Medical Physicist or Ophthalmic Physicist
313A(ANP)Authorized Nuclear Pharmacist
313A(AUS)Manual Brachytherapy, Ophthalmic Use of Strontium-90, Remote Afterloaders, Teletherapy Units, or Gamma Stereotactic Radiosurgery Units
RC 257-1
Application for Low Level Radioactive Waste Shipper Registration  (PDF, 251KB) 
RC 257-2
Application for A Low Level Radioactive Waste Transporter Registration (PDF, 230KB) 

Mammography

Mammography Applications and Forms
Document Number Title
 RC 17-M  Termination Form
 RC 18-M  Transfer/Disposal Form
 RC 42-R  Radiation Safety Officer (RSO) Form
 RC 204  Radiation Machine Source Unit Fee Schedule
 RC 230-01  Mammography Certification Application - New & Renewal
 RC 230-02 Mammography Certification Application - Amendment
 RC 230-03  Interventional Breast Radiography Application - New & Renewal
 RC 230-04  Interventional Breast Radiography Application - Amendment
 RC 230 234 IP  Acceptable Documents for Interpreting Physicians
 RC 230 234 MP  Acceptable Documents for Medical Physicists
 RC 230 234 RT  Acceptable Documents for Radiologic Technologists
 RC 230-LIP Lead Interpreting Physician (LIP) Form
Last updated June 17, 2022