X-Ray Testing Log
Document each X-ray test performed for compliance and quality control.
Date and Time of Test
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Equipment Used (Model/Serial)
*
Name of Person Conducting Test
*
First Name
Last Name
Type of X-Ray Test Performed
*
Please Select
Chest X-Ray
Abdominal X-Ray
Dental X-Ray
Bone X-Ray
Other
Test Result
*
Pass
Fail
Requires Retest
Attach X-Ray Image or Related Document (if available)
Upload a File
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Choose a file
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of
Notes / Observations
Submit Log Entry
Should be Empty: