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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)
Submit by FAX only. Please review the “Sensitive Information” notice on the form
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 226-10  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)
RC 256-1aRSO via Board Certification (PDF, 156KB) 
RC 256-1bRSO via Hours (PDF, 151KB) 
RC 256-1c
RSO via AU (PDF, 122KB) 
RC 256-2aAMP 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

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 December 7, 2021