radiation symbol Office of Radiological Health


Forms

Form 
(Fillable PDF Format)
Regulatory Guide
 All licensees and registrants are required to complete this form and have it on file per Neb. Rev. §§ 4-108 through 4-114.
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 Cumulative Occupational Exposure History
RG 3.4, RG 3.13,RG 4.0, RG 4.5
Occupational Exposure Record for a Monitoring Period
RG 3.4, RG 3.13,RG 4.0, RG 4.1,RG 4.5
Notice to Employees - Standards for Protection Against Radiation; Notices, Instructions and Reports to Workers; Inspections
RG 3.4, RG 3.13
Aviso a los empleados  - Estándares para protegerse de la radiaci ó n;    Avisos, instrucciones y reportes para los empleados; Inspecciones
RG 3.4, RG 3.13
Notice to Employees - Standards for Protection Against Radiation; Notices, Instructions and Reports to Workers; Inspections (For Dental Facilities Only)
RG 21
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)
RG 21
 
 
Application for Registration of Radiation Generating Equipment and U.S. Citizenship Attestation Form
RG 6.0, 6.2, 6.3, 6.4 OR 21
Application for Registration of Radiation Generating Equipment (Additional Machines)
Instructions for NRH-4 - Application for Registration of Radiation Generating Equipment
Application for Radioactive Material License and  U.S. Citizenship Attestation Form
RG 3.2, 3.4,3.5,3.6,3.13,5.0, 12, OR 19
Application for Radioactive Material License - Medical and U.S. Citizenship Attestation Form
RG 7.0
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.)
RG 7.0 Supplement
Application for Registration of Services for Radiation Generating Equipments and U.S. Citizenship Attestation Form
RG 2.1
Instructions for NRH-9   Application for Registration of Services for Radiation Sources
Certificate-Use of Depleted Uranium Under General License
Certificate - In Vitro Testing with Radioactive Material Under General License
Dental Interim Inspection Form
RG 21
Equipment List
RG 21
Equipment Performance Evaluation Dental Unit
RG 21
Certification of Disposition of Materials
RG 3.4, RG 3.13
Transfers of Industrial Devices Report
Sample of Records Location Card 
(SPAN) Muestra de la tarjeta a publicar para mostrar dónde se encuentran los documentos

If you are planning to submit an application (NRH 4, NRH-5, NRH-5A, NRH-7, NRH-7A, NRH-9 or NRH-21) and desire more information please contact the program at:

For more information, contact:
Nebraska Department of Health and Human Services
Division of Public Health
Office of Radiological Health
P.O. Box 95026
Lincoln, NE 68509-5007        

Radioactive Material Program or Emergency Response Program - Phone: (402) 471-2079
X-ray Program - Phone: (402)471-0563
Toll Free Phone: (800)242-1100 Option #8
Fax:  (402)471-0169
E-mail:  DHHS.RadiationPrograms@nebraska.gov


 Office of Radiological Health Page

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