Get Certification For Radiation Protection - Office Of Statewide Health ...

Filling out the Certification For Radiation Protection is an essential process for ensuring compliance with health and safety regulations. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete the form

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Fill in the facility information at the top of the form. Include the project and facility numbers, as well as the facility name and OSHPD building number along with the respective building name.
3. Select the type of facility. Check the appropriate box for options such as Acute Psychiatric Hospital, Correctional Treatment Center, General Acute Care Hospital, Licensed Clinic, or Skilled Nursing/Intermediate Care Facility.
4. Enter the facility address details. Provide the street address, any additional address line, city, county, and state (CA). Also, make sure to include the zip code and a contact phone number.
5. Complete the record detail section. Include the record/project name and a detailed description of the project as required.
6. In the declaration section, affirm that the radiation protection for the project adheres to the applicable provisions of Chapter 31C of the California Building Code. Specify your qualifications as a certified radiation physicist, health physicist, or another relevant title.
7. Sign and date the form. Make sure the signature corresponds to the certifying individual mentioned previously.
8. Fill in the certifying individual’s information, including first name, middle initial, last name, organization name, address details, phone numbers, and fax/email if applicable.
9. Add any additional comments if necessary, then review all entries for accuracy before final submission.
10. Once completed, save the changes to your document. You can then download the file, print it for physical submission, or share it as needed.

Begin filling out your Certification For Radiation Protection form online today.