Get Form Dh 1054

Filling out the Form DH 1054 is an essential step for applying for a radioactive materials license. This guide provides clear and comprehensive instructions to help users complete the application efficiently and accurately.

Follow the steps to successfully complete Form DH 1054 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Item 1.a, enter your legal name, mailing address (including ZIP code), Federal Employer Identification Number (FEI #), phone, and fax numbers.
3. In Item 1.b, if applicable, provide the street address where the radioactive materials will be used or stored, along with the ZIP code.
4. Complete Item 2.a by selecting the appropriate license application fee category based on the descriptions available in regulatory guidance documents.
5. In Item 3, specify the type of application—indicate if this is a new license, an amendment to an existing license, or a renewal. Include any required fees in the designated section.
6. For Item 4, list all individuals who may handle radioactive materials, including those supervising these activities.
7. In Items 5.a and 5.b, provide the name and contact information for the Radiation Safety Officer (RSO) and an alternate emergency contact.
8. Move to Item 6 to describe the formal training and work experience in radiation safety for each individual listed. Attach relevant documentation if necessary.
9. In Item 7, detail the radioactive materials being requested, including the isotope, physical or chemical form, and maximum amount or activity that will be possessed at any one time.
10. In Item 8, explain the specific purpose for which each radioactive material will be used, including necessary equipment details.
11. In Item 9, list the radiation detection instruments available, including their sensitivities and intended uses.
12. For Item 10, indicate the calibration method for the instruments listed in the previous item, including frequencies and procedures.
13. Complete Item 11 by indicating applicable personnel monitoring devices and their exchange frequencies.
14. In Item 12, describe the facilities and equipment that will be used for handling radioactive materials and include any security measures in place.
15. For Item 13, attach a radiation protection program, including emergency and general safety procedures.
16. In Item 14, describe the procedures for waste disposal, including mentioned services and protocols.
17. Finally, complete Item 15 by including the signature of the certifying official, their name printed, title, and date.
18. After completing all items accurately, you can save changes, download the form, print it, or share it as needed.

Start filling out your Form DH 1054 online today to ensure a seamless application process.