Application for Registration of Radiation Device
Idaho Bureau of Laboratories
Radiation Control Program
For Office Use Only

Registration #:

Date Registered: 

In compliance with the provisions of the Idaho Radiation Control Rules IDAPA 16.02.27, the Department of Health and Welfare requires registration of all X-ray producing machines.  Please notify the Department within ten (10) days of any change in the following information.  This form can be found at on the Lab and X-Ray Certification page.

Note:  Registration does not imply approval or disapproval of installation.  Registration does not indicate compliance with all Idaho regulations as applicable to radiation machines.  Inspection reports should be kept as evidence of compliance.
By submitting this form, you are certifying that the information contained herein is true and correct to the best of your knowledge.
Radiographic Machine Listing
Please complete additional forms for every 10 machines.
Form revised 06/2014
Application type:

Registration number:

Please complete the following information (required):

Type of facility:

Type of practice: