Get State Of Indiana Radiation Machine Facility Registration Form

Filling out the State Of Indiana Radiation Machine Facility Registration Form online is a crucial step for facilities operating radiation machines. This guide will provide you with step-by-step instructions to ensure a smooth and accurate completion of the form.

Follow the steps to complete the registration form accurately.

1. Click ‘Get Form’ button to access the State Of Indiana Radiation Machine Facility Registration Form and open it in your preferred editor.
2. Begin Part A by providing general facility information. Clearly indicate if the facility is new, updating existing information, or requiring a routine inspection. Complete all fields regarding the facility name, addresses, contact numbers, and the radiation safety officer’s information.
3. In the registration agreement section, ensure a responsible individual, such as an owner or administrator, signs and dates the form to confirm compliance with the necessary regulations.
4. Proceed to Part B, where you will fill out specific facility information regarding personnel radiation exposure monitoring. Include details of the monitoring devices used, the number of individuals monitored, and additional mammography facility staff qualifications if applicable.
5. Move to Part C to provide detailed information about each radiation machine in the facility. For each machine, fill in the necessary information such as machine type, location, manufacturer, and maximum ratings.
6. After completing all sections, review the form for accuracy and completeness. Once verified, you may save, download, print, or share the completed form as needed.

Begin the registration process online and ensure your facility complies with state regulations.