Research X-ray Machine Registration Form

Registration of all x-ray units is required by Iowa Department of Public Health. In order to maintain an accurate and up to date inventory of these units, EHS is requiring that owners complete the information below pertaining to their x-ray machine(s).

Departmental Contact Information

Today's Date *

Month

Day

Year

First Name *

Last Name *

Phone Number *

Contact email address *

X-ray Machine Registration Information

Manufacturer *

Model *

Unit Location *

Manufacturer Date

Serial Number:

Unit Usage

Max kV

Max mA

Submission of Form

It is very important that this form be completed and submitted within 30 days of receiving the unit, and for any unit you believe may not be accounted for already by EHS.

X-ray Unit Inventory Information

X-ray units that are already included in the University’s inventory will have a white sticker that reads “EHS XXXX’ or ‘RPO XXXX’, where XXXX represents a four-digit number assigned to that machine by EHS. If you possess an x-ray machine of any type that does not have this label, please complete this form and forward to EHS.

EHS Contact Information

If you are unsure if the unit is registered, or requires registration, please contact Joe Hawk at 319-384-4541 or email joseph-hawk@uiowa.edu

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Research X-ray Machine Registration Form