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Service & Information Form
Service Request & Information Form
Taking a stake in our client's success
About You
Your Name
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First
Last
Company
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Position
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How Can We Reach You?
We would love to chat with you. How can we get in touch?
Preferred Method of Contact
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Email
Phone
Your Email Address
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Email Address
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Phone Number
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Best Time to Call You
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Select A Time
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11:00 pm
11:30 pm
Which Service Are You Searching For?
Select one.
Select One
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Radiation Safety & Environmental Services
Calibration & Repair
Training & Exercise
Parts & Products
Meter/Equipment Management
Needing Full Time Support?
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Radiation Safety & Environmental Services
Parts & Products
Radiation Safety & Environmental Services
Select all that apply.
Radioactive Materials License Application/Amendment
Radiation Safety Program Development
Radiation Safety Program Audit/Assessment
Survey/Sampling
Leak Testing
Technical or Regulatory Compliance Consult
Radioactive Material Disposal/Management
Rad Waste Storage
Rad Waste Characterization
Rad Waste Transportation/Shipping
Other
Do You Have A Written Work Scope?
(Required)
Yes (Requires Upload)
No
Other
If yes, please upload your document.
Other
(Required)
Please describe your request.
File
(Required)
Max. file size: 500 MB.
Notes
(Required)
Please include any details regarding your inquiry.
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Calibration & Repair
Calibration & Repair
Select all that apply.
Portable Nuclear Density Gauge*
Laboratory or Materials Testing Equipment*
Radiation Detection
Gas Detection
Other
Other
Please include any details regarding your inquiry.
Would you like the equipment serviced via one of our mobile platforms?
(Required)
Yes
No
Location for service
(Required)
Please enter full address.
Date
(Required)
MM slash DD slash YYYY
Please enter the date you need service by.
Equipment List
Max. file size: 500 MB.
Please attach your equipment list.
List your Equipment to be Serviced. Please include make, model, detectors (if applicable), quantity & any service or repair information.
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Meter/Equipment Management
Tell Us About Your Current Program & Needs
Equipment List
Max. file size: 500 MB.
Please attach your equipment list.
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Training & Exercise
Training Courses
Select all that apply.
Radiation Safety Officer – (refresher)
Radiation Safety Officer – (40 hr)
Radiation User/Awareness
Radiation Specialist (3 day)
Radiation Specialist (5 day)
Specialized Radiation or Safety Course Development
Customized Company/Team Course Development & Delivery(s)
Other Hazmat/CBRNE/Safety/Regulatory Course
Exercises
Select all that apply.
1 Day REST (Radiation Event Scenario Training) Exercise
2 Day REST (Radiation Event Scenario Training) Exercise
Custom REST (Radiation Event Scenario Training) Exercise
ARC (Advanced Radioactive Contamination) Exercise
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Parts & Products
Products
Select all that apply.
Radiation Detection
Gas Detection
Nuclear Density Gauge (used/new)
Nuclear Gauge Drill Rods/Plates
Leak Test Kits
Dosimetry Badges
Tell Us More - Make, Model, Type, Quantity, and/or Capability
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Needing Full Time Support?
Needing Full Time Support?
Select all that apply.
Radiation Safety Officer
Assistant Radiation Safety Officer
Radiation Technician
Program Manager
Project Manager
Radiation Safety/Compliance Expert
Training Program Manager/SME
Meter/Equipment Maintenance Manager
Support Request
(Required)
Tell us what you need, and our team can provide trained staff to meet your needs.
Do you have a position description?
(Required)
Yes
No
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General
Any Additional Needs or Questions You Have?
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