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About this Division

Remediation Program

Radioactive Materials Unit Forms

If you would like a copy of a Radioactive Materials form in Word document format, please send an email to comments.hmwmd@state.co.us and list the form(s) you would like.

License Forms and Instructions

OR-RH 12 Application Form for All Other Radioactive Materials Licensing
- OR-RH 11 Instructions for All Other Radioactive Materials Licensing Form
OR-RH 12-3.0 Application for the Use of Radioactive Materials for Industrial Radiographic Operations
- OR-RH 11-3.0 Instructions for the Application for the Use of Radioactive Materials for Industrial Radiographic Operation
R-12 (7C) Application for Medical Use of Radioactive Materials
OR-RH 12-3.N Application for Persons Providing Services for Other Licensees
- OR-RH 11-3.N Instructions for Application for Persons Providing Services for Other Licensees
OR-RH 12-3.P Application for a License Authorizing the Use of Portable Nuclear Gauges
- OR-RH 11-3.P Instructions for Application for a Radioactive Materials License for the Possession and Use of Portable Nuclear Gauges
RCD Form 62 Certification of Small Entity Status for Purposes of Annual Fees
OR-RH-12.PRV Application for a Provisional License Authorizing Temporary Possession of Radioactive Material Pending Disposal
DOT-SP 10656 Shipment Approval Form Shipment approval forms can now be submitted electronically. Blank forms may be downloaded from the Conference of Radiation Control Program Directors (CRCPD) Transportation web page (http://www.crcpd.org/Transportation) and submitted by email to cdphe.hmdSpecialPermit@state.co.us .
Reciprocity Request Form
OR-RH 23 Request for Termination of a Radioactive Materials License
R-27 Certificate In-vitro Testing with Radioactive Materials Under a General License

Radioactive Materials Inspection Form

Compliance Inspection Form Basic form suitable for many non-medical licenses

Public Dose Calculations for Gauge Storage Areas
- How Do I Demonstrate that I can Meet RH 4.14 and 4.15
Certification of Trustworthiness and Reliability Official(s) - Example Form
OR-RH 15 Notice to Employees Form - - legal size
- Standards for Protection Against Radiation; Notices, Instructions and Reports to Workers; Inspections; Employee Protection
OR-RH 16 Cumulative Occupational Exposure History
OR-RH 17 Occupational Exposure Record for a Monitoring Period
National Source Tracking System - NRC Form 748 - exit to NRC
See also Permits, Notifications, Registrations and Certifications for process summaries