TITLE 12. HEALTH
REGISTRAR'S NOTICE: Forms used in administering the 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 with a hyperlink 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.
Agency Contact: Asfaw Fenta, Director, Radioactive Materials Program, Virginia Department of Health, 109 Governor Street, Richmond, VA 23219, telephone (804) 864-8168, FAX (804) 864-8155, or email asfaw.fenta@vdh.virginia.gov.
FORMS (12VAC5-481)
Applications for a New Radioactive Material License
Academic, Research and Development, and Other Licenses of Limited Scope, Revision 4 (6/2018)
Broad Scope, 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)
Medical Use, Revision 4 (1/2022)
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 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 4 (6/2018)
Broad Scope, 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)
Medical Use, Revision 4 (1/2022)
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 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 - Auth User Written Directive R1(7/16)
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)
A - Training Preceptor for Radiation Safety Officer and Assistant Radiation Safety Officer Revision 1 (1/2022)
B - Authorized User Written Directive Not Required Revision 1(1/2022)
C - Authorized User Unsealed Radioactive Material Requiring Written Directive Revision 3 (1/2022)
D - Authorized User-Manual Brachytherapy Revision 2 (1/2022)
E - Authorized User High Dose Remote Afterloader-Teletherapy-Gamma Knife Revision 1 (1/2022)
F - Authorized Medical Physicist or Ophthalmological Physicist Revision 1 (1/2022)
G - Authorized Nuclear Pharmacist Revision1 (1/2022)
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. R22-7045; Filed December 08, 2021