Radioactive Material Forms and Documents

All files are 500 KB or less unless otherwise specified.

• Fees for Radioactive Material Licenses(DOC)
  Regulatory Guide 6.20, Revision 5 — Fees for radioactive material licenses

NOTE: Revision 1 should be used for new license applications, license renewals and amendments as applicable.

• Instructions for Recording and Reporting Occupational Radiation Exposure Data(DOC)
  Regulatory Guide 6.7, Revision 1 — Instructions for recording and reporting occupational radiation exposure data

• Monitoring Criteria and Methods to Calculate Occupational Radiation Doses(DOC)
  Regulatory Guide 3.34, Revision 2 — Monitoring criteria and methods to calculate occupational radiation doses

• Procedures for Radioactive Materials Enforcement Actions – May 2000
  (Incorporated by reference in 64E-5.201 (3), F.A.C., October 8, 2000)

• Radiation Dose to the Embryo/Fetus(DOC)
  Regulatory Guide 3.36, Revision 1 — Radiation dose to the embryo/fetus

Forms and Checklists

All files are 500 KB or less unless otherwise specified.

• Form DH 1054, December 2009(DOC) (Incorporated by reference in 64E-5.207, F.A.C.)
  Non-human use radioactive materials license application

• Non-Human Use Application Checklist(DOC) (Use with form 1054)
  Non-human use radioactive materials application checklist

• Portable Gauge Checklist(DOC) (Use with form 1054)
  Portable gauge license application checklist

• Fixed Gauge Checklist(DOC) (Use with form 1054)
  Fixed gauge license application checklist

• Reciprocity License Notification
  Used by out of state licensees seeking reciprocal recognition of their license to be able to use radioactive materials in Florida.

• Model Radioactive Material Inventory Form(DOC)
  Inventory form — Use to document performance of sealed source inventory. Has columns for recording additional descriptive information not required by chapter 64E-5

• Form DH 1322, December 2009(DOC) (Incorporated by reference in 64E-5.207, F.A.C.)
  Human use radioactive materials license application (for medical applicants only)

• HDR Application Checklist(DOC) (Use with HDR Regulatory Guide 1.60 and DH Form 1322)
  Checklist for high dose-rate (HDR) remote afterloading license application

• Renewal Attestation and Instructions
  Radioactive materials license renewal attestation and instructions (Use for both human and non-human licenses)

• Form DH 360(DOC)
  Certificate — In Vitro Testing

• Form DH 361(DOC)
  Certificate — Medical Use Of Radioactive Material Under General License

• Form DH 1059(DOC)
  Certificate — disposition of radioactive materials

• Notice To Employees(DOC)

• Form DH 1622(DOC)
  Occupational exposure record for a monitoring period

• Form DH 1623(DOC)
  Ccumulative occupational exposure history

• Emergency Notification Poster(DOC) — Instructions(DOC)
  Designed to be printed in color on yellow or canary colored paper

• Transfers of Industrial Devices Report — April, 2007
  Report used to document transfers of generally licensed industrial devices

• Bond Risk Factors Calculation Worksheet — March 2014
  (Incorporated by reference in 64E-5.2167, F.A.C., July 1, 2015)

Information Notices

All files are 500 KB or less unless otherwise specified.

Information Notice 2014-1 — Information Notice 2014-1
Revision 12 filing instructions: Changes to Chapter 64E-5, Florida Administrative Code (F.A.C.)

• Information Notice 2013-1
  Establishment and Maintenance of a Positive Safety Culture

• Information Notice 2012-1
  Authorization for aerosols in diagnostic nuclear medicine

• Information Notice 2010-3
  Industrial radiography reporting requirements (Clarification of the 24 hour notification requirement for an event in which the sealed source assembly did not return to the fully shielded position within the exposure device)

• Information Notice 2010-2
  Technetium 99m shortage and the calibration of dose calibrators

• Information Notice 2009-2
  Notice of proposed changes in 64E-5, Florida Administrative Code — Majority of changes are regarding the medical use of radioactive materials

• Information Notice 2009-1
  Varian Medical Systems Varisource high dose-rate remote afterloader events: Source retraction problems

• Information Notice 2008-3
  Voluntary security enhancements for self-contained irradiators containing cesium chloride sources

• Information Notice 2008-1
  Nuclear medicine procedure verification

• Information Notice 2007-6
  Radioactive material license categories and fee revisions

• Information Notice 2007-4
  Renewal attestation

• Information Notice 2007-3
  Opportunity to Dispose of Unused Radioactive Sources

• Information Notice 2007-2
  Additional requirements for licensees who possess or transfer certain generally licensed (GL) devices

• Information Notice 2006-4
  Portable gauge additional security requirements, Effective 01-01-07

• Information Notice 2006-2
  Leak testing frequency for troxler portable gauges

• Information Notice 2005-1
  Medical physicists — Requirements for medical physicists for brachytherapy procedures

• Information Notice 2004-1
  Overnight mail delivery address

• Information Notice 2003-1
  HAZMAT training requirements for radioactive material licensees (Replaces information notice 99-3). Includes new USDOT requirements for security awareness training and security plans (if applicable)

• Information Notice 2002-9
  Am-241/Pu-238 disposal — Provides contact information for licensees who wish to dispose of unwanted or obsolete Am-241 or Pu-238 sources

• Information Notice 2002-8
  Y-90 Zevalin human use radiopharmaceutical therapy — Contains information needed to amend licenses for medical use of Yttrium-90 (Y-90) as a radiopharmaceutical therapy procedure

• Information Notice 2001-6
  Changes to 64E-5, F.A.C.; Revision 5 Filing Instructions

• Information Notice 2001-4
  Changes to 64E-5, F.A.C.; Revision 3 and revision 4 filing instructions

• Information Notice 2001-3(DOC)
  Panama misadministration information

• Information Notice 2001-2(DOC)
  Specific license applications for amendments, renewals, terminations and new licenses

• Information Notice 2000-3(DOC)
  Licensing requirements for the performance of coronary brachytherapy procedures

• Information Notice 2000-2(DOC)
  Changes to chapter 64E-5, F.A.C.; Revision 2 filing instructions

• Information Notice 2000-1(DOC)
  Change of bureau's mailing address and phone number

• Information Notice 99-5(DOC)
  Problems encountered when manually editing treatment data on the nucletron microselectron-HDR (new) model 105.999

• Information Notice 99-4(DOC)
  Unplanned radiation exposures to radiographers resulting from failure to follow proper radiation safety procedures

• Information Notice 99-2(DOC)
  Guidance on the use of a new dose-calculation formalism and revised air-kerma strength standard for Iodine-125 sealed sources

• Information Notice 99-1(DOC)
  Requirements and responsibilities of authorized users in medical facilities

• Information Notice 98-6(DOC)
  Requirements for advance notification for the shipment of low level radioactive waste

• Information Notice 98-5(DOC)
  Changes to chapter 64E-5, Florida Administrative Code; Filing instructions

• Information Notice 98-3(DOC)
  Requirements for possession, transfer and record retention for generally licensed devices

• Information Notice 98-2(DOC)
  Notice of exemption — Carbon 14 Urea breath test to detect presence of H. Pylori bacteria

• Information Notice 98-1(DOC)
  Additional controls for transport of the Amersham model 660 series radiographic exposure devices

• Information Notice 97-3(DOC)
  Failure of high dose rate (HDR) remote afterlloading device source guide tubes, catheters, and applicators

• Information Notice 97-1(DOC)
  To high dose rate (HDR) licensees regarding treatment planning errors

• Information Notice 96-6(DOC)
  Procedures for incident reporting requirements

• Information Notice 96-2(DOC)
  Failure of safety systems on self-shielded irradiators because of inadequate maintenance and training

Model Procedures

All files are 500 KB or less unless otherwise specified.

• ALARA Model Procedures(DOC)
  ALARA — Model procedures for both sealed and unsealed Sources

• MOP Dose — Main Instructions(DOC)
  MOP main intructions — Model procedures for conducting a member-of-public (MOP) dose compliance study (Use for all MOP studies)

• MOP Dose — Appendix A(DOC)
  MOP TEDE — Model procedures for conducting a member-of-public (MOP) dose compliance study — Appendix A (Use for all MOP studies)

• MOP Dose — Appendix B(DOC)
  MOP DDE — Model procedures for conducting a member-of-public (MOP) dose compliance study — Appendix B (Use for all MOP studies)

• MOP Dose — Appendix C(DOC)
  MOP CEDE non-medical facilities — Model procedures for conducting a member-of-public (MOP) dose compliance study — Appendix C (Use for all non-medical MOP studies with potential for internal exposure)

• MOP Dose — Appendix D(DOC)
  MOP CEDE medical facilities — Model procedures for conducting a member-of-public (MOP) dose compliance study — Appendix D (Use for all medical MOP studies with potential for internal exposure)

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