Delaware Health and Social Services
Division of Public Health
Office of Radiation Control

VERIFICATION OF RADIATION MACHINE REGISTRATION 
The Delaware Radiation Control Regulations require current registration of all 
facilities where machine sources of ionizing radiation are operated or stored. 
Radiation machine facilities are subject to on-site inspection on a periodic basis.  
Registration must be renewed prior to the expiration date, in order to maintain 
good standing.  Facilities operating without registration, or operating with an 
expired registration are subject to citation under the Delaware Radiation Control
Regulations. 

Complete the top portion of this form with facility name, complete street address, 
name of owner or operator, and the registration number of the registered facility.  
Please allow three weeks for processing. Incomplete forms will be returned. Fax 
this form with your request on company letterhead to  302-739-3839, or mail to the 
following address: 

Delaware Division of Public Health
Office of Radiation Control
417 Federal Street
Dover, DE 19901

Facility Name:	___________________________________________________________________
 
Facility Street Address, City, State, Zip Code: ___________________________________
		
		___________________________________________________________________
		 
Name of Facility Owner, or Operator:  _____________________________________________
 
State of Delaware Radiation Machine Facility Registration #________________________ 


For office use, only 


Status: 

	___ 	Current 	Expiration Date: _______________________ 

	___	Expired/Terminated 

	___	No record of this facility 

Verified by: ___________________________________________________ 

Date: ________________________________________________________ 		Board Seal 


To download forms or obtain a copy of the regulations, please visit our web site at 
http://www.dhss.delaware.gov/dhss/dph/hsp/orc.html

DELAWARE DIVISION OF PUBLIC HEALTH
OFFICE OF RADIATION CONTROL
417 FEDERAL STREET
DOVER, DELAWARE  19901                         

ORC-R1C 
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