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Submit a Cumulative Occupational Exposure History Form or Occupational Exposure for a Monitoring Period Form

Each Licensee should complete forms in accordance with instructions provided on the form.

Contacts

Radiation Control Program

Phone

Main number Call Radiation Control Program, Main number at (617) 242-3035
RCP emergency number Call Radiation Control Program, RCP emergency number at (617) 242-3453

Rings through to Massachusetts State Police

Online

Email Email Radiation Control Program at RadiationControl@mass.gov

The Details   of Submit a Cumulative Occupational Exposure History Form or Occupational Exposure for a Monitoring Period Form

What you need   for Submit a Cumulative Occupational Exposure History Form or Occupational Exposure for a Monitoring Period Form

Please submit a record of dose exposure or record of cumulative occupational exposure.

How to submit   Submit a Cumulative Occupational Exposure History Form or Occupational Exposure for a Monitoring Period Form

Mail your completed and signed report to:

Massachusetts Department of Public Health
Radiation Control Program
Schrafft Center, Suite 1M2A
529 Main St.
Charlestown, MA 02129

You can download the Cumulative Occupational Exposure History and Occupational Exposure for a Monitoring Period forms below.

Fax your completed and signed report to (617) 242-3457.

You can download the Cumulative Occupational Exposure History and Occupational Exposure for a Monitoring Period forms below.

Downloads   for Submit a Cumulative Occupational Exposure History Form or Occupational Exposure for a Monitoring Period Form

Open PDF file, 16.56 KB,  Cumulative Occupational Exposure History (English, PDF 16.56 KB)
Open RTF file, 138.09 KB,  Cumulative Occupational Exposure History (English, RTF 138.09 KB)
Open PDF file, 19.19 KB,  Occupational Exposure for a Monitoring Period (English, PDF 19.19 KB)
Open RTF file, 45.66 KB,  Occupational Exposure for a Monitoring Period (English, RTF 45.66 KB)

Contact   for Submit a Cumulative Occupational Exposure History Form or Occupational Exposure for a Monitoring Period Form

Address
Schrafft Center
529 Main St., Suite 1M2A, Charlestown, MA 02129
Directions 
Phone
Main number Call Radiation Control Program, Main number at (617) 242-3035
RCP emergency number Call Radiation Control Program, RCP emergency number at (617) 242-3453

Rings through to Massachusetts State Police

Online
Email Email Radiation Control Program at RadiationControl@mass.gov
Fax
(617) 242-3457

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