Radiation Control Forms

 
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Environmental Health
Public Health
 
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​Form (Fillable PDF Format)​Regulatory Guide
​Citizenship Attestation Form - All licensees and registrants are required to complete this form and have it on file per Neb. Rev. §§ 4-108 through 4-114.
NRH-1 -  Cumulative Occupational Exposure History3.4, 3.13, 4.0, 4.5
​NRH-2 - Occupational Exposure Record for a Monitoring Period3.4, 3.13, 4.0, 4.1, 4.5
​NRH-3 - Notice to Employees - Standards for Protection Against Radiation; Notices, Instructions and Reports to Workers; Inspections3.4, 3.13
​NRH-3 (SPAN) - Aviso a los empleados  - Estándares para protegerse de la radiaci ó n; Avisos, instrucciones y reportes para los empleados; Inspecciones ​3.4, 3.13
NRH-3D - Notice to Employees - Standards for Protection Against Radiation; Notices, Instructions and Reports to Workers; Inspections (For Dental Facilities Only) ​21
NRH-3D (SPAN) - Aviso a los empleados  - Estándares para protegerse de la radiaci ó n; Avisos, instrucciones y reportes para los empleados; Inspecciones (exclusivamente para establecimientos de servicios dentales) ​21
​NRH-4 - Application for Registration of Radiation Generating Equipment and U.S. Citizenship Attestation Form6.0, 6.2, 6.3, 6.4, OR 21
NRH-4A - Application for Registration of Radiation Generating Equipment and U.S. Citizenship Attestation Form
NRH-4 (INST) - Instructions for NRH-4 - Application for Registration of Radiation Generating Equipment
NRH-5 - Application for Radioactive Material License and  U.S. Citizenship Attestation Form3.2, 3.4, 3.5, 3.6, 3.13, 5.0, 12, OR 19
NRH-7 - Application for Radioactive Material License - Medical and U.S. Citizenship Attestation Form7.0
NRH-7A - Medical Use Training and Experience and Preceptor Attestation (Refer to Regulatory Guide 7.0 Supplement for Attestation for the different types of medical licenses form.)7.0 Supplement
NRH-9 - Application for Registration of Services for Radiation Generating Equipment and U.S. Citizenship Attestation Form2.1
NRH-9 (INST) - Instructions for NRH-9 - Application for Registration of Services for Radiation Sources
​NRH-11 - Certificate-Use of Depleted Uranium Under General License
NRH-17 - Certificate - In Vitro Testing with Radioactive Material Under General License
​NRH-21 - Dental Interim Inspection Form21
​NRH-21A - Equipment List ​21
NRH-21B - Equipment Performance Evaluation Dental Unit ​21
​NRH-60 - Certification of Disposition of Materials3.4, 3.13
​NRH-653, 653A, 653B - Transfers of Industrial Devices Report
Sample of Records Location Card
​(SPAN) Muestra de la tarjeta a publicar para mostrar dónde se encuentran los documentos