Get Tx Dshs Brc 252-3 2012-2025

Filling out the TX DSHS BRC 252-3 form online is a crucial step for anyone intending to perform radiation work in Texas. This guide will provide clear instructions to help you navigate each section of the form effectively.

Follow the steps to successfully complete the TX DSHS BRC 252-3 form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Enter the notification information, beginning with the company name and complete mailing address, including city, state, and zip code. Ensure that the registered senior operator's (RSO) phone number and email are correctly provided.
3. Fill in the materials license number and issuing agency/state. Also, include the x-ray registration number along with its corresponding issuing agency/state.
4. Provide the name of the RSO. Indicate whether or not you possess an Agency letter that grants reciprocal recognition of your license or registration by marking 'Yes' or 'No'.
5. List the names and contact information for each person who will use radioactive material (RAM) and/or x-ray devices. Additionally, provide the name and phone number for the Texas hotel or motel where you will be staying.
6. For radiographic personnel, indicate if documented qualifications for each user are on file with the Agency by selecting 'Yes' or 'No'.
7. Complete the dates relevant to the job, including the date you were notified of this job and the duration of work (from start date to end date). Fill in the customer name and the representative in charge of the Texas job site.
8. Provide the location along with detailed directions to the job site, including road/street names, zip code, and any necessary mileage between points.
9. Enter the type of activity and total workdays. Additionally, provide the city of the job site and the corresponding phone number.
10. Fill in the radioactive material and/or x-ray device information, detailing the radionuclide, activity, sealed source model and serial numbers, and source holder or camera manufacturer details. Note the model and serial numbers alongside the date when the next leak test is due.
11. At the end of the form, certify that all provided information is true and complete by signing and dating the document. Print your name and title in the designated area.
12. After reviewing your entries for accuracy, save changes to the document. You may then download, print, or share the form as needed, and ensure it is submitted to the provided email address or fax number.

Complete your TX DSHS BRC 252-3 form online today for efficient processing.