Get Application Form For Non-medical Radioactive Material License - Iema Illinois

This guide provides comprehensive instructions for completing the application form for a non-medical radioactive material license in Illinois. We aim to support users through the steps required to accurately fill out the form online.

Follow the steps to complete your application form online.

1. Click the ‘Get Form’ button to access the application form and open it in your selected editor.
2. Identify the type of application you are submitting by checking one of the options under Item 1: New license, Renewal, or Amendment.
3. Complete Item 2 with your name and mailing address, ensuring all required contact information is accurate.
4. Provide the contact person's information for the application in Item 3. This should include their phone numbers, fax numbers, and email addresses.
5. Fill out Item 4 with the address(es) where the radioactive material will be used, indicating if it will be stored or both used and stored.
6. In Item 5, list all individuals who will use the radioactive material along with their training and experience, ensuring to attach evidence where necessary.
7. Designate a Radiation Safety Officer (RSO) in Item 6 and include their contact details. Attach evidence of their training and experience.
8. Provide details in Item 7 about the radioactive material to be used, including the radionuclide, chemical form, maximum activity, and authorized use.
9. Complete basic information about instrumentation in Item 8 and ensure any necessary documentation is attached.
10. Document your calibration process for survey instruments in Item 9 by selecting the appropriate option.
11. Detail your facilities and equipment in Item 10, attaching any necessary diagrams or letters from property owners.
12. Describe your personnel training program in Item 11 and attach relevant documentation.
13. Explain your procedures for ordering and receiving radioactive material in Item 12 and provide documentation as needed.
14. Select the applicable procedures for safely opening radioactive material packages in Item 13.
15. Complete Items 14 through 22 with required checkboxes and any accompanying procedures or descriptions.
16. Submit the appropriate license fees information in Item 23 and ensure you follow the guidance on payment.
17. Satisfy the financial assurance requirements in Item 24 according to your status as a new applicant or for renewal/amendment.
18. Complete the certification section in Item 25, ensuring all details are accurate and both signatures are present where necessary.
19. Review your completed form for accuracy and completeness, then save the changes. You can download, print, or share the form as required.

Complete your application form online today to ensure swift processing of your license request.