TITLE 12. HEALTH
REGISTRAR'S NOTICE:
Forms used in administering the following regulation have been filed by the
agency. The forms are not being published; however, online users of this issue
of the Virginia Register of Regulations may click on the name of a form to
access it. The forms are also available from the agency contact or may be
viewed at the Office of the Registrar of Regulations, 900 East Main Street,
11th Floor, Richmond, Virginia 23219.
Title of Regulation: 12VAC5-481. Virginia Radiation
Protection Regulations.
Contact Information: Beth Schilke, Radiation Safety
Specialist, Virginia Department of Health, 109 Governor Street, Room 730,
Richmond, VA 23219, email beth.schilke@vdh.virginia.gov.
FORMS (12VAC5-481)
Applications for a New Radioactive Material License
Academic, Research and Development, and Other Licenses of
Limited Scope, Revision 3 (1/2016)
Academic,
Research and Development, and Other Licenses of Limited Scope, Revision 4
(6/2018)
Broad Scope, Revision 3 (1/2016)
Fixed Gauge Devices, Revision 3 (1/2016)
Industrial Radiography, Revision 3 (1/2016)
Irradiators - Part XII, Revision 1 (1/2016)
Medical Use, Revision 2 (1/2016)
Portable Gauges, Revision 2 (1/2016)
Radiopharmacy, Revision 1 (1/2016)
Sealed Sources, Revision 3 (1/2016)
Self-Shielded Irradiators, 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 3 (6/2018)
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 2 (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 3 (1/2016)
Academic,
Research and Development and Other Licenses of Limited Scope, Revision 4
(6/2018)
Broad Scope, Revision 3 (1/2016)
Fixed Gauge Devices, Revision 3 (1/2016)
Industrial Radiography, Revision 3 (1/2016)
Irradiators - Part XII, Revision 0 (7/2016)
Medical Use, Revision 2 (1/2016)
Portable Gauges, Revision 4 (1/2016)
Radiopharmacy, Revision 1 (1/2016)
Sealed Sources, Revision 3 (1/2016)
Self-Shielded Irradiators, 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 3 (6/2018)
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 4 (1/2016)
XRF
Devices, Revision 5 (6/2018)
Manufacturing
and Distribution, Revision 3 (6/2018)
Training, Experience, and Preceptor Attestations
A: Radiation Safety Officer for Medical Use,
Revision 0 (7/2016)
B: Authorized User - Written Directive Not
Required, Revision 0 (7/2016)
C: Unsealed Radioactive Material Requiring Written
Directive, Revision 2, (6/2014)
D: Authorized User for Manual Brachytherapy
Sources, Revision 0 (7/2016)
E: Authorized User of Remote Afterloader,
Teletherapy, or Gamma Stereotactic Radiosurgery Units, Revision 0 (7/2016)
F: Authorized Medical Physicist, Revision 0
(7/2016)
G: Authorized Nuclear Pharmacist, Revision 0
(7/2016)
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)
VA.R. Doc. No. R18-5560; Filed July 6, 2018, 9:51 a.m.