Click on the badge icon above to get the application form (PDF format).

Click on the “First Name” field and start typing.  

Tab through the next fields until done.  (click on selection boxes to check off)  

If you had radiation badges at other facilities, please indicate each facility and approximate dates.  You will have to sign page 2 to give us permission to get your records from those facilities.  We will complete the rest.  

Print this form, sign it and bring it or send it to Radiation Safety  LG035, MC3930.  We are required to have original signatures.