Applications and Forms
Table of Contents
- Notice to Employees
- Licensing Reciprocity
- X-Ray Machines
- Equipment Performance Evaluation
- Industrial Radiographer Certification
- Laser Registration
- Radioactive Materials
- Mammography
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
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 252-5 | RAM Reciprocity Application (PDF,158KB) |
X-Ray Machines
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 | Registration Branch Fee Schedule |
RC 226-1 | Business Information Form - Registration |
RC 226-2 | Radiation Machine Application |
RC 226-3 | Industrial Radiation Machine Application |
RC 226-4 | Radiation Machine Services Application |
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 Rick Croy via email or telephone at (512) 968-4330, about any other inspection 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
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
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 226-1 | Business Information Form - Registration |
RC 301-2 | Laser Application |
RC 301-3 | Laser Services Application |
Radioactive Materials
Mammography
Document Number | Title |
---|---|
RC 17-M | Termination Form |
RC 18-M | Mammography Machine 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-MLIP | Lead Interpreting Physician Form |
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