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Forms Used by the Department of Health Radon Program

Updated February 15, 2013

• Mandatory Radon Measurement Testing Report Forms
• Application Forms for Radon Measurement and Mitigation Certification
• Certified Business's Monthly Reporting Forms
• Radon Certification Training Forms

Report Forms for Mandatory Testing

Facilities testing for radon must submit their radon measurements to the Bureau of Facility Programs, Radon and Indoor Air Quality Section on one of the forms below. The appropriate form depends on the type of building being tested. A facility built and used as a home (single family homes or apartments used as foster homes, ALF's in houses or family day care homes) reports its measurements on Form 1778. Measurements made in commercially built buildings and buildings no longer lived in as homes are reported on Form 1777 (commercial day care centers in converted houses, hospitals or schools).

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DH Form 1778 (23KB)
Radon measurement report form for measurements in residences (single or multi-family - home day care, foster care, developmentally disabled facility, assisted living facility, etc)

DH Form 1777 (23KB)
Radon measurement report form for tests done in commercially built buildings or in buildings built as residences but no longer lived in (schools, day care centers, assisted living facilities, nursing homes, etc).

DH Form 1777 Supplemental page (22KB)
Supplemental page used to report additional tests performed in a building, when there are more tests than will fit on one page.

Radon Business and Individual Certification Application Forms

Use these forms to apply for radon certification and maintain radon individual and business certification. The applications for individual certification, either mitigation or measurement, is made on DH Form 1751. Mitigation and measurement business application is made on DH Form 1749. All applications are subject to the requirements of Florida Administrative Code 64E-5 Part XII, Subpart A and must include the applicable certification fees. A requirement for maintaining business certification is the monitoring of worker exposure to radon. DH Form 1834 can be used to satisfy that requirement.

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DH Form 1751 (24KB)
Application  to become certified as a certified radon measurement and/or mitigation individual.

DH Form 1749 (22KB)
Application to become certified as a Radon measurement and/or mitigation business.

DH Form 1834 (11KB)

Manual Worker Exposure Tracking Form
Electronic Worker Exposure calculation sheet (10 KB XLS WLMSHET.xls)

Report Forms for Certified Businesses

Certified businesses must report their radon measurement and mitigation activity to the Bureau of Facility Programs, Radon and Indoor Air Quality Section. The reports should be received by the office by the 15th of the month following the completion of the measurements or mitigation. The report forms used by businesses are as follows:

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DH Form 1750 (54KB)
Radon measurement report for measurements in residences (houses, apartments, condominiums, etc)

DH Form 1833 (50KB)
Radon measurement report form for tests performed in commercially built buildings (i,.e. offices, stores, etc)

DH Form 1750 or DH 1833 Supplemental page (23KB)
Supplemental page used to report additional tests performed in a building, when there are more tests than will fit on the main page

DH Form 1753 (29KB)
Monthly Radon Mitigation Report Form

DH Form 1753 Supplemental page (29KB)
Supplemental page used to report additional pre and post mitigation tests performed in a building, when there are more tests than will fit on the main page.

Radon Certification Training Forms

Businesses wishing to offer radon training to qualify individuals for Florida radon certification, must have their courses approved by the Radon and indoor Air Quality section. Application to become a certification training course provider is made on DH Form 1813, Apr 90. Once you are approved as a training course provider, you shall use DH Form 1812 to report the attendees to your courses to the Department and qualify them for certification by the department. The report forms are as follows:

All forms in PDF format

DH Form 1813 (7KB)
Application to become a radon measurement or mitigation training provider

DH Form 1812 (15KB)
Training Course Participant Roster