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Catalog view of the forms listed on this page

Form name

  Form Link  

General License Device Inventory Form

  HEA 0113  

Authorized medical physicist’s training and experience and preceptor certification

  HEA 0122  

Authorized nuclear pharmacist’s training and experience and preceptor certification

  HEA 0123  

Authorized User training and experience and preceptor certification for
3701:1-58-32, 3701:1-58-34, and 3701:1-58-53 uses of radioactive materials 

  HEA 0124  

Authorized user training and experience and preceptor attestation for uses
covered under OAC 3701:1-58-43 and 3701:1-58-55

  HEA 0125  

Authorized user’s training and experience and preceptor certification for uses
covered under Ohio rule 3701:1-58-37

  HEA 0126  

Lifetime Occupational Dose History form

  HEA 5101  

Occupational radiation dose record for a specified monitoring period

  HEA 5102  

Application for use of depleted uranium under a general license

  HEA 5115  

Certificate of Disposition of Materials

  HEA 5119  

Ohio Low-Level Radioactive Waste (LLRW) reporting form with instructions

  HEA 5129  

Radioactive Materials License Application

  HEA 5133  

Sealed Source and Device Registration Application

  HEA 5138  

Training and experience and preceptor certification for a
Radiation safety officer for medical uses of radioactive materials

  HEA 5509  

Application for In-Vitro Testing using Radioactive Material

  HEA 5518  

Trade Secret Designation Request

  HEA 5519  

Reciprocity License Application

  HEA 5522