Forms and Applications

Massachusetts Radiation Control Program
Schrafft Center, Suite 1M2A
529 Main Street
Charlestown, MA 02129
Telephone: (617) 242-3035
Fax: (617) 242-3457

General Forms

• Application for Registration of Accelerators / Electron Beam Accelerators / Electrocurtains / Ion Implanters (PDF) | RTF
  [may be submitted by mail]

• Application for Registration of Generally Licensed Devices (PDF) | RTF
  [may be submitted by mail or fax]

• Application for Registration of Services (PDF) | RTF
  [may be submitted by mail or fax]

• Ionizing Radiation Sources - Application for Registration of Industrial X-ray Device (PDF) | RTF
  [may be submitted by mail or fax]

• Other Ionizing Radiation Sources - Application for Registration of Ionizing Radiation Sources (PDF) | RTF
  [may be submitted by mail or fax]

• Medical X-Ray Unit(s) Registration Termination (PDF) | RTF

• Facility Registration & Laser Inventory (PDF) | Word
  [may be submitted by mail or fax]

• Low Level Radioactive Waste - Calendar Year (CY) 2008 Radioactive Waste Survey (PDF) | RTF
  [may be submitted by mail or fax]

• Cumulative Occupational Exposure History (PDF) | RTF
  [may be submitted by mail or fax]

• Occupational Exposure for a Monitoring Period (PDF) | RTF
  [may be submitted by mail or fax]

• Radiologic Technologist Application/Letter (PDF) | RTF
  [Must be submitted by mail with any supporting documents]

• Radiologic Technologist Application (Temporary) (PDF) | RTF
  [Must be submitted by mail with any supporting documents]

• Radiologic Technologist Application supplement: Mammography Training Attestation (PDF) | RTF

• Mammography Facility License Application, including Machine Identification Form (PDF) | RTF

Radioactive Materials Licensing Forms

• Application for Use of Depleted Uranium Under a General License (PDF) | RTF
  [may be submitted by mail]

• Application for In-Vitro Testing Under a General License (PDF) | RTF
  [may be submitted by mail]

• Certificate of Termination, Disposition of Radioactive Material (PDF) | RTF
  [may be submitted by mail]

• Application for Use of Radioactive Material (PDF) | RTF
  [may be submitted by mail]
  (Do not submit without consulting appropriate Regulatory Guide.)

• Application for Use of NARM Portable XRF Device for Lead Paint Use (PDF) | RTF
  [may be submitted by mail]
  (Do not submit without consulting Regulatory Guide 2.0.)

• Application for Reciprocity for a Radioactive Materials License (PDF) | RTF
  [may be submitted by mail]