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Radon
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Radon in Arizona
Why should a home be tested?
Testing Methods
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Crawl Spaces, Piping and Fans
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Forms
Forms
GENERAL AGENCY FORMS
Services Registration Application (ARRA-SRA)
Physicist Support Application
- Physics Support in variety of modalities (does not add to license or registration)
NVLAP Approved Dosimetry Services
Radiation Safety Consultants
- Registered Physics Support
ARRA Complaint Form
Request for Public Documents
- Commercial Use
Request for Public Documents - Non-Commercial Use
NONIONIZING APPLICATIONS
Non-Ionizing Facility Registration (ARRA-NIR)
- Nonionizing Radiation Facility
Non-Ionizing Machine Information (ARRA-NIMI)
- Make and Model name of
each
Bed, Laser, RF, etc.
Medical Director/Prescribing Official Attestation/Application
Prescribing Authority ONLY
Health Professional Training Application/Attestation
Registered Nurses and Physician's Assistants (RN's & PA's)
Medical Director Acknowledgement (Non-Cosmetic)
form for Medical Facilities (Hospitals, Medical Offices, Veterinary Offices, Podiatric, and Dental Offices)
Medical Director Acknowledgement (Chiro)
Medical Director Acknowledgement/liability for Chiropratic Offices
Cosmetic Facility Medical Director Acknowledgement
form for IPL/Laser Hair Removal and Cosmetic Facilities
LSO Acknowledgement Statement
form for Laser Safety Officers
RF Acknowledgment Form
Acknowledgment form for individuals in charge of RadioFrequency Safety
Nonionizing Annual and Registration Fee Schedule
LASER TECHNICIAN FORMS
New Laser Technician Application
Laser Technician Renewal Application
Affidavit of Practice - Cosmetic Laser Tech
Affidavit of Non Practice - Cosmetic Laser Tech
CLT Duplicate Certificate Request Form
New Cosmetic Training School Application and Renewal
- Application for Didactic and Hands-on Training Schools
Supervising Laser Technician (SLT) 24 hr Approval letter
Supervising Prescribing Health Professional 24 hr approval letter (Medical Director)
Supervising Health Professional 24 hr approval letter
MRTBE FORMS
MRTBE application for all
MRTBE-CT-Preceptorship Training Application
PTR Acknowledgment - Scope of Practice for PTR, PTP, PTBD
MRTBE Blank Renewal Form
Mammography Student Form
Radiologist Assistant Application
AccuBoost Positioning Verification form
Affidavit of Practice
Affidavit of non Practice
MRTBE Complaint form
Application for Boards and Commissions
- Application to serve as a MRTBE Board Member
X-RAY APPLICATIONS
X-Ray Facility Application (ARRA-4)
- Application for Registration of X-Ray Facility
X-Ray Annual and Registration Fee Schedule
X-Ray unit (by Tube and intended use)
Industrial Unit Information (ARRA-4I)
- Supplimental for Industrial or Medical specimen unit
Medical Unit Information (ARRA-4X)
- Supplimental for Medical/Dental/Veterinary
Mammography Screening Application (ARRA-13)
- Supplimental Application for Screening Approval
E-Brachytherapy Supplimental Application (ARRA-ET)
- Therapy Supplemental Form
RAM APPLICATIONS
Industrial/Medical Specific Materials License (ARRA-1G)
Legal Structure Cover Application (AZRRA-LSRAM)
for the Radioactive Materials Program
Laboratory-Industrial License Application (ARRA-L)
Small Entity form
Authorized Medical Physicist Preceptor
Authorized Nuclear Pharmacist Preceptor
Authorized User Preceptor(100,200,& 500)
Authorized User Preceptor(300)
Authorized User Preceptor(400 & 600)
Radiation Safety Officer Preceptor (ARRA-2)
Depleted Uranium Application (ARRA-23)
Fixed Gauge Application (ARRA-FG)
Industrial Radiography Application (ARRA-IR)
Medical Application (ARRA-M)
Medical Event Reporting Form (ARRA-ME)
Particle Accelerator Application (ARRA-PA)
Portable Gauge Application (ARRA-1PG)
Reciprocity Application (ARRA-REC)
Radiation Safety Officer (Delegation of Authority)
Registration Certificate Gauging Device with Radioactive Material Under General License (ARRA-17)
* All forms/applications are in Adobe PDF format. Click icon to get Adobe Acrobat Reader.