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Industrial Radiographer Certification Renewal
Online Licensing FAQs
Radioactive Material License Administrative Renewal
Online Registration FAQs
Radiation Registration Administrative and Mammography Certification Renewal
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PRIVACY STATEMENT: With few exceptions, you have the right to request and be informed about information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. See http://www.dshs.state.tx.us for more information on Privacy Notification. (Reference: Government Code, Section 522.021, 522.023 and 559.004)
All files are offered in PDF format, which can be read by the Adobe Acrobat Reader. Radiation Control is working towards providing forms in Microsoft Word, also. If a form is available in Word, it is posted below.
You will need to download the Adobe Acrobat Reader to access files on this Web site. Some files require you to install the newest version of the Adobe Acrobat Reader.
ALL INDUSTRIAL RADIOGRAPHER FORMS MAY BE FOUND ON THE
INDUSTRIAL RADIOGRAPHY PAGE.
GENERAL FORMS |
TYPE |
TITLE |
PDF FILES |
WORD FILES |
| Registration/License | Notice to Employees Notice to Employees (Dentists only) |
BRC Form 203-1 PDF 10 KB BRC Form 232-1 PDF 92KB/1 pg |
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| Registration | Business Information Form | RC Form 226-1 PDF 24KB | RC Form 226-1 WORD 53KB |
| License | Business Information Form | Form BRC252-1 PDF 94KB | |
| Registration | Schedule of Biennial Fees for Medical for Educational/Healing Arts Certificate of Registration for Radiation Machines and Lasers | BRC 204 PDF 25 KB | |
| Registration | Registration Application for Users of Radiation Machines in Healing Arts, Veterinary Medicine and Academic Facilities | BRC Form 226-2 PDF 27KB | BRC Form 226-2 WORD 93KB |
| Registration | Application for Registration of Industrial Radiation Machines and Services | RC Form 226-3 PDF 24KB | RC Form 226-3 WORD 63KB |
| Registration | Excerpt from 25 Texas Administrative Code (TAC) Section 289.226(w)(4). Screening Information | BRC Form 226-7 PDF 83KB | |
| Registration | Application for Registration of Lasers and Laser Services | BRC Form 301-2 PDF 14KB | BRC Form 301-2 WORD 48KB |
| Registration | Written Notice for Laser Light Show in Texas | LRS Form 14 PDF 8KB | |
| Registration | RSO Information for Registration | BRC From 42-3 PDF 8KB | BRC Form 42-3 WORD 47KB |
| Registration | Registration of Mobile Services Used in the Healing Arts and Veterinary Medicine | BRC Form 226-8 PDF 72KB | BRC From 226-8 WORD 33KB |
| Registration | Termination of a Registraton or Certification | Form LRS-17 PDF 5KB | Form LRS-17 WORD 35KB |
| Registration | Radiation Machine Transfer/Disposal Form | Form LRS-18R PDF 23KB | Form LRS-18R WORD 36KB |
| Registration | Additional Information for Accelerator Registration, Includes Shielding Form | Form LRS-35 PDF 21KB | Form LRS-35 WORD 32KB |
| License | Application for a Radioactive Material License | RC Form 252-2 PDF 32KB | RC Form 252-2 WORD 119KB |
| License (Medical) | License Application for Radioactive Material License -- Medical Uses | RC Form 252-2a PDF 94KB | RC Form 252-2a WORD 94KB |
| License (Medical) | Preceptor Statement for License Application | RC Form 252-2b PDF 22KB | RC Form 252-2b WORD 88KB |
| License | Application for Acknowledgement to Use the General License for In Vitro Clinical or Laboratory Testing | Form BRC251-1 PDF 83KB | |
| License | Application for a General License Acknowledgement of Devices Containing Radioactive Material | RC Form 251-2 PDF 87KB | RC Form 251-2 WORD 85KB |
| X-Ray Inspection | CI-38 Confirmation of Inspection with special instructions and checklist | Form CI-38 PDF 16KB | |
| Reciprocity | Notice of Intent to Work in Texas Under Reciprocity | Form BRC 252-3 PDF 54KB | |
MAMMOGRAPHY FORMS |
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| Mammography | Application for Mammography Certification | Form 230C-1 PDF 55KB | Form 230C-1 WORD 66KB |
| Mammography | Renewal Application for Mammography Certification | Form 230R-1 PDF 54KB | Form 230R-1 WORD 65KB |
| Mammography | Request for Termination of Mammography Certifications | Form 230-1 PDF 19KB | Form 230-1 WORD 59KB |
| Mammography | Radiation Machine Transfer/Disposal Form | Form LRS-18M PDF 5KB | Form LRS-18M WORD 38KB |
Please contact either or about other Mammography forms. Telephone or email 512-834-6688 |
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INSPECTION FORMS |
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| Registrant/Licensee | List of Survey Equipment | Eqlist.pdf 7KB | |
| Registrant/Licensee | Industrial Radiography | Fsir.pdf 20KB | |
| Registrant/Licensee | Industrial Radiography Records Cross Check | Irrcc.pdf 6KB | |
| Registrant/Licensee | Industrial Radiography Training Worksheet | Ir.pdf 7KB | |
| Registrant | Accelerator | Accreg.pdf 32KB | |
| Registrant | Analytical X-Ray Registration | Axreg.pdf 32KB | |
| Registrant | Basic Registration | reg.pdf 29KB | |
| Registrant | Cabinet X-Ray Registration | Cabxreg.pdf 30KB | |
| Registrant | Confirmation of Scheduled X-Ray Inspection | INSPECONF.pdf 39KB | INSPECONF.pdf 52KB |
| Registrant | Industrial Radiography with X-Ray Machines | Ixccabx.pdf 31KB | |
| Registrant | Personnel Monitoring Data Worksheet | pm.pdf 11KB | |
| Registrant | Training Worksheet | trnw.pdf 6KB | |
| Dental | Equipment Performance Evaluation - Dental Unit | EPE Dental PDF 96KB | EPE Dental WORD 76KB |
| Registration | Equipment Performance Evaluation Veterinary Radiographic Unit |
EPE Veterinary PDF 124KB | EPE Veterinary WORD 45KB |
| Registration | Equipment Performance Evaluation (EPE) Radiographic Unit |
EPE Radiographic PDF 124KB | EPE Radiographic WORD 99KB |
| Registration | Equipment Performance Evaluation (EPE) Fluoroscopic Unit |
EPE Fluoroscopic PDF 88KB | EPE Fluoroscopic WORD 45KB |
| Licensee | Basic License | Baslic.pdf 107KB | |
| Licensee | Gauges | Gglic.pdf 107KB | |
| Licensee | General License for In Vitro Uses | Gliv.pdf 24KB | |
| Licensee | General License Acknowledgement for Gauges | Gla.pdf 97KB | |
| Licensee | General License Acknowledgment Self Inspection/Evaluation, CI-40, and Inventory, CI-40w | CI-40 99KB | |
| License | Industrial Radiography with Radioactive Materials | Irlic.pdf 115KB | |
| License | Medical Uses of Radioactive Material | Medlic.pdf 107KB | |
| License | Moisture Density Gauge | Mdg.pdf 104KB | |
| License | Nuclear Medicine Worksheet | Nucmed.pdf 23KB | |
| License | Pool Irradiators | Poollic.pdf 117KB | |
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Texas Department of State Health Services, Radiation Control Program
1100 West 49th Street - Austin, Texas 78756-3189 - (512) 834-6688 or (512) 834-6770
Last Updated September 11, 2007
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