Get Shielding Application ( Pdf ) - Department Of Health And ... - Scdhec

This guide aims to provide clear and supportive instructions for users on how to accurately fill out the Shielding Application for x-ray plan review. Users will learn how to complete each section of the application form to ensure submission is successful.

Follow the steps to complete the Shielding Application

1. Click the ‘Get Form’ button to obtain the Shielding Application form and open it for editing.
2. In the 'Facility Name' field, enter the name of the person or organization planning the x-ray installation.
3. Fill in the 'Registration #' field with the registration number issued by the Department.
4. Provide the 'Location Address' where the x-ray machine will be installed, if it differs from the mailing address.
5. Enter the name and title of the 'Contact person' responsible for this application.
6. Complete the 'Phone' field with a contact number for the responsible person.
7. Fill in the 'Mailing Address' with complete details including street, city, state, and zip code.
8. Provide a 'Fax' number if applicable.
9. Add the 'E-mail' address for communication regarding the application.
10. Indicate the 'Facility Status' by selecting the relevant option, such as new or relocation.
11. Indicate the 'Equipment Status' as new, replacement, or specify another status.
12. Select the type of 'Facility' from the provided options.
13. Enter the 'Expected date of installation' for the x-ray equipment.
14. Specify the 'Equipment Type' to be installed from the available list.
15. Provide the 'Room/Location' where the equipment will be installed.
16. Fill in the manufacturer name, model number, and type of x-ray equipment to be installed.
17. Select 'Yes' or 'No' to indicate whether the equipment is digital by circling the appropriate option.
18. Provide the details for the 'Shielding Vendor,' including their name, address, registration number, phone number, and contact person.
19. Fill in the 'Installation/Sales Vendor' details similarly.
20. Ensure the application is accompanied by the required supporting documents and the $62.50 shielding plan review fee.
21. Review all entered information for accuracy before proceeding.
22. After completing the application, save your changes, then download, print, or share the form as needed.

Complete your Shielding Application online today to ensure a smooth submission process.