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The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

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Radon Forms

Radon and Indoor Air Program

Report Forms for Mandatory Testing

Facilities testing for radon must submit their radon measurements to the Bureau of Epidemiology, Radon Program on one of the forms below. The appropriate form depends on the type of building being tested.

*Note: This page contains materials in the Portable Document Format (PDF).  The free Adobe Reader may be required to view these files.

DH Form 1777 (23KB)
Radon measurements made in commercially built buildings or in buildings built as residences but no longer lived in as homes are reported on Form 1777 (schools, commercial day care centers in converted houses, assisted living facilities, nursing homes, hospitals, etc).

DH Form 1778 (23KB)
A facility built and used as a home (single or multi-family homes or apartments used as foster homes, ALF's in houses or family day care homes, home day care, foster care, developmentally disabled facility, assisted living facility, etc) reports its measurements on Form 1778.

DH Form 1777 and 1778Supplemental 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

Use these forms to apply for radon certification and maintain radon individual and business certification. All applications are subject to the requirements of Florida Administrative Code 64E-5 Part XII, Subpart A and must include the applicable certification fees. To maintain a business certification, the monitoring of worker exposure to radon must be reported. DH Form 1834, Electronic Worker Exposure spreadsheet can be used to satisfy that requirement.

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

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

DH Form Re-Examination (16KB)
Applicants who were qualified at the specialist level and passed the exam at the technician level, or those who failed may re-take the exam within two years of the radon certification training.

Reporting Forms for Certified Businesses

For radon measurements >= 100 pCi/l, certified businesses are required to contact the radon program at 1-800-543-8279 or 850-245-4288 within 2 business days.  The results of this measurement shall also be provided to the department by certified mail within the same 2 business day period [per 64E-5.1206(12) (c) F.A.C.].

Certified businesses must report their radon measurement and mitigation activity to the Bureau of Environmental Health's Radon Program. The reports shall 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:

DH Form 1750 (54KB)
Radon measurement report for measurements in residences (houses, apartments, condominiums, 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 1833 (50KB)
Radon measurement report form for tests performed in commercially built buildings (i,.e. offices, stores, etc)

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

DH Form 1753 Supplemental page (29 KB)

Supplemental page used to report additional pre and post mitigation tests performed in a building.

Working Level Forms

DH Form 1834 (11KB)
Manual Worker Exposure Tracking Form (The Excel documents below open in a new window.  You may need to download the Excel viewer)
Electronic Worker Exposure (working level month) calculation sheet (10 KB XLS WLMSHET.xls)

Radon Certification Training Providers' Forms

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

DH Form 1812 (15KB)
Training Course Participant Roster

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

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

Reports and forms may be submitted via e-mail to: RadonReports@flhealth.gov

You may contact the radon program by calling us at 850-245-4288 or in Florida at 800-543-8279.