Iema flm001m a form 2026

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The document is an application form for obtaining a medical radioactive material license from the Illinois Emergency Management Agency. It outlines the necessary information and requirements for both new applicants and those seeking to renew or amend their licenses, including details about the applicant, radioactive materials to be used, personnel training, safety procedures, and financial assurance. The form emphasizes compliance with state regulations and includes sections for certification by the applicant.

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Click ‘Get Form’ to open the iema flm001m a form in the editor.
Begin with Item 1, selecting the type of application: New License, Renewal, or Amendment. Ensure you check the appropriate box.
In Item 2, enter your name and mailing address accurately. This is crucial for correspondence regarding your application.
For Item 3, provide contact details for the person responsible for this application. Include phone numbers and email addresses.
Proceed to Item 4 and specify the address where radioactive material will be used. Indicate if temporary job sites are involved.
Complete Items 5a and 5b by listing individuals who will use radioactive materials and providing evidence of their training.
Continue filling out subsequent items as required, ensuring all necessary attachments are included for compliance.

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