The table below lists Radiation Control Program forms which are available for download. Some forms may be mailed or faxed. The correct address and fax number are as follows:
This information is provided by the Radiation Control Program within the Department of Public Health.
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
[may be submitted by mail] - Application for Registration of Generally Licensed Devices
[may be submitted by mail or fax] - Application for Registration of Services
[may be submitted by mail or fax] - Ionizing Radiation Sources - Application for Registration of Industrial X-ray Device
[may be submitted by mail or fax] - Other Ionizing Radiation Sources - Application for Registration of Ionizing Radiation Sources
[may be submitted by mail or fax] - Mammography Permittee Application
- Medical X-Ray Unit(s) Registration Termination
- Facility Registration & Laser Inventory
[may be submitted by mail or fax] - Low Level Radioactive Waste - Calendar Year (CY) 2010 Radioactive Waste Survey
[may be submitted by mail or fax] - Cumulative Occupational Exposure History
[may be submitted by mail or fax] - Occupational Exposure for a Monitoring Period
[may be submitted by mail or fax] - Radiologic Technologist Application/Letter
[ Must be submitted by mail with any supporting documents] - Radiologic Technologist Application (Temporary)
[ Must be submitted by mail with any supporting documents] - Radiologic Technologist Application supplement: Mammography Training Attestation
- Mammography Facility License Application, including Machine Identification Form
Radioactive Materials Licensing Forms
- Application for Use of Depleted Uranium Under a General License
[may be submitted by mail] - Application for In-Vitro Testing Under a General License
[may be submitted by mail] - Certificate of Termination, Disposition of Radioactive Material
[may be submitted by mail] - Application for Use of Radioactive Material
[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
[may be submitted by mail]
(Do not submit without consulting Regulatory Guide 2.0.) - Application for Reciprocity for a Radioactive Materials License
file size 1MB
[may be submitted by mail]
This information is provided by the Radiation Control Program within the Department of Public Health.