Table of Contents
Notice to Employees
Licensing Reciprocity
X-Ray Machines
X-Ray Machines Applications and Forms
Document Number |
Title |
LRS-35 |
Additional Information for Accelerator Registration, Includes Shielding Form (PDF, 21KB) |
RC 17-R |
Request for Registration Termination (PDF, 24KB) |
RC 18-R |
Radiation Machine Transfer/Disposal Form (PDF, 16KB) |
RC 42-3 |
Radiation Safety Officer (RSO) Information for Registration (PDF, 301KB) |
RC 42-4 |
Industrial Radiation Safety Officer (RSO) Form (PDF, 558KB) |
RC 42-5 |
Industrial Radiography (IR/NDT) Radiation Safety Officer (RSO) Form (PDF, 401KB) |
RC 204 |
Schedule of Biennial Fees for Registration for Radiation Machines (PDF, 25KB) |
RC 226-1 |
Business Information Form - Registration (PDF, 24KB) |
RC 226-2 |
Registration Application for Users of Radiation Machines in Healing Arts, Veterinary Medicine and Academic Facilities (PDF, 27KB) |
RC 226-3 |
Registration Application for Industrial Radiation Machines (PDF, 32KB) Instructions for RC 226-3 Registration Application (PDF, 508KB) |
RC 226-5 |
Registration Application for Radiation Industrial Services (PDF, 320KB) Instructions for RC 226-5 Registration Application (PDF, 453KB) |
RC 226-8 |
Excerpt from 25 Texas Administrative Code (TAC) Section 289.226(g). Mobile Service Operation (PDF, 41KB) |
RC 226-9 |
Authorization for Self-Referred CT Coronary Calcium Screening (PDF, 48KB) |
RC 226-10 |
Healing Arts Screening Requirements for Osteoporosis (PDF, 18KB) |
RC 226-11 |
Authorization for Self-Referred Low Dosage CT Lung Cancer Screening (PDF, 35KB) |
Equipment Performance Evaluation
Please contact Trae Windham via email or telephone at (737) 218-7084, about any other inspection forms.
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
Radioactive Materials
Radioactive Materials Applications and FormsDocument Number | Title |
---|
CI-40 | General License Acknowledgement Self-Evaluation Form (PDF, 103KB) |
RC 251-2 | General License Acknowledgement of Devices Containing Radioactive Material (PDF, 1,541KB) |
RC 252-1 | Business Information Form - License (PDF, 256KB) |
RC 252-2 | Radioactive Material License (PDF, 195KB) |
RC 252-4 | Certificate of Disposition (PDF, 206KB) |
RC 256-1a | RSO via Board Certification (PDF, 156KB) |
RC 256-1b | RSO via Hours (PDF, 151KB)
|
RC 256-1c
| RSO via AU (PDF, 122KB)
|
RC 256-2a | AMP via Board Certification (PDF, 146KB)
|
RC 256-2b
| AMP via Post Grad Degree (PDF, 156KB)
|
RC 256-3a
| ANP via Board Certification (PDF, 129KB)
|
RC 256-3b
| ANP via Hours (PDF, 138KB)
|
RC 256-4a
| AU for 256ff and hh Uses via Board Certification (PDF, 156KB)
|
RC 256-4b
| AU for 256ff, hh and ddd Uses via Hours (PDF, 168KB)
|
RC 256-5a
| AU for 256kk Uses via Board Certification (PDF, 179KB)
|
RC 256-5b
| AU for 256kk Uses via Hours (PDF, 186KB)
|
RC 256-6a
| AU for 256rr and ddd Uses via Board Certification (PDF, 148KB)
|
RC 256-6b
| AU for 256rr and ddd Uses via Hours (PDF, 179KB) |
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
Please contact Jo Turkette via email about other Mammography forms, or telephone (512) 834-6688.
Mammography Applications and Forms
Document Number |
Title |
RC 17-M |
Termination of Certification of Mammography Systems (PDF, 17KB) |
RC 18-M |
Mammography Machine Transfer/Disposal Form (PDF, 17KB) |
RC 230-1 |
Application for Mammography Certification - New Facility or Renewal (PDF, 137KB) |
RC 230-2 |
Amendment Application for Mammography Certification (PDF, 131KB) |
RC 230-3 |
Application for Interventional Breast Radiography - New Facility or Renewal (PDF, 73KB) |
RC 230-4 |
Amendment Application for Interventional Breast Radiography (PDF, 77KB) |
RC 230-43 |
Lead interpreting Physician (LIP) Form (PDF, 230KB) |
RC 230 234 - 1 |
New Facility Invoice (PDF, 606KB) |
None |
Acceptable Documents for Interpreting Physicians (PDF, 145KB) |
None |
Acceptable Documents for Medical Physicists (PDF, 199KB) |
None |
Acceptable Documents for Radiologic Technologists (PDF, 126KB) |