Text

Revisions to Emergency Plan Implementing Procedures
	ML020720005
Person / Time
Site:	Surry
Issue date:	02/28/2002
From:	Blount R; Virginia Electric & Power Co (VEPCO)
To:	; Document Control Desk, Office of Nuclear Reactor Regulation
References
	02-128
	Download: ML020720005 (54)
	v • d • e

VIRGINIA ELECTRIC AND POWER COMPANY RICHMOND, VIRGINIA 23261 February 28, 2002 United States Nuclear Regulatory Commission Serial No.02-128 Attention: Document Control Desk SS&LIBAG R0 Washington, D. C. 20555-0001 Docket No.

50-280 50-281 License No. DPR-32 DPR-37 Gentlemen:

VIRGINIA ELECTRIC AND POWER COMPANY SURRY POWER STATION UNITS 1 AND 2 REVISIONS TO EMERGENCY PLAN IMPLEMENTING PROCEDURES Pursuant to 10 CFR 50.54(q), enclosed are revisions to two Surry Power Station Emergency Plan Implementing Procedures.

The revisions do not implement actions which decrease the effectiveness of our Emergency Plan. The Emergency Plan and Implementing Procedures continue to meet the standards of 10 CFR 50.47(b). Please update your manual by performing the actions described in the enclosed tabulation of changes.

Very truly yours, Richard H. Blount, Site Vice President Surry Power Station Enclosure Commitments contained in this letter: None.

cc:

U. S. Nuclear Regulatory Commission, Region II (2 copies)

Sam Nunn Atlanta Federal Center 61 Forsyth Street S.W., Suite 23 T85 Atlanta, Georgia 30303-8931 Mr. R. A. Musser NRC Senior Resident Inspector Surry Power Station

Serial No.02-128 Surry EPIP Revisions VIRGINIA ELECTRIC AND POWER COMPANY REVISION TO SURRY POWER STATION EMERGENCY PLAN IMPLEMENTING PROCEDURE Enclosed are revisions to Surry Power Station Emergency Plan Implementing Procedures. Please take the following actions in order to keep your manual updated with the most recent revisions.

REMOVE AND EFFECTIVE INSERT:

EFFECTIVE DESTROY:

DATE:

EPIP-2.01, Rev. 28 09/05/01 EPIP-2.01, Rev. 29 02/21/02 EPIP-5.07, Rev. 10 09/28/00 EPIP-5.07, Rev. 11 02/21/02 Emergency Plan Privacy and Proprietary Material have been removed.

Reference Generic Letter No. 81-27

V IRG!NAYOLI EM ERGNEPP t 1 RO Ce PROCEDU RE A., ^..AA,rn,~tot tn A C*nntroIled Source NUMBER RE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 (With 3 Attachments) 1Af1 1 of 18 PURPOSE To initially notify State and local governments of the declaration of an emergency and to provide status updates related to the event.

ENTRY CONDITIONS Any of the following:

1.

An emergency has been declared.

2.

Entry directed by Station Emergency Manager.

Approvals on File Effective Date

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1.

REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1)

Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class. THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs.

THEN GO TO Step 26.

-LFJ-t ACTION/EXPECTED RESPONSE F-]

RESPONSE NOT OBTAINED 1

INITIATE PROCEDURE:

By:

Date:

Time:

Location:

2 CHECK FIRST REPORT OF EMERGENCY FOR EVENT -

REOUIRED IF procedure previously initiated, THEN continue from step in effect identified during relief/turnover.

NOTE:

The initial notification of any emergency classification must be completed within 15 minutes of declaring the emergency class.

"* Items 4 through 8 on Attachment 2 may be excluded from the first report of any emergency classification, (including termination).

"* Attachment 1, Instructions for Completing Report of Emergency to State and Local Governments, may be referenced as needed.

3 RECORD INFORMATION ON ATTACHMENT 2 (REPORT OF EMERGENCY TO STATE AND LOCAL GOVERNMENTS) 4 CHECK EMERGENCY REMAINS IN EFFECT

-_ 5 IF emergency terminated before message sent, THEN do the following:

a) Record reason event terminated in Item 3.

b) Record "State EOC portion of message not applicable" on bottom of Attachment 2 Page 2.

HAVE SEM/RM APPROVE REPORT (initial at top of Attachment 2)

NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 2 of 18 F-

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1. REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

Update current message to include changed condition(s).

RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

-ElK ACTION/EXPECTED RESPONSE RESPONSE NOT OBTAINED 6

RECORD TIME NOTIFICATION STARTED NOTE:

Multiple items excluded from a message may be read as a single statement, e.g., "Items 4 through 8 excluded from this message."

Outbound calls through the PBX system are made by dialing 8-1-(area code)-###-####.

Using unrestricted PBX telephones, outbound calls may be made by dialing 9-1-(area code)-###-####

(area code not required for outbound calls within local calling area).

No prefix (8-,

9-) is needed when using a direct outside line.

7 SEND REPORT OF EMERGENCY TO STATE AND LOCAL GOVERNMENTS (i.e., Initial or Follow-up Report, as required):

a)

Check Instaphone -

CLEAR OF CONFLICTING MESSAGE TRAFFIC b)

Use Instaphone to contact State and local Emergency Operations Centers (EOCs) c) Perform initial roll-call (check boxes as EOC(s) answer) d)

Read Items I through 9 a) IF Instaphone NOT available, THEN do the following:

1) Call State EOC on DEM ARD (Alternate: (804) 674-2400).

2) Notify State EOC Duty Officer of need to transmit message.

3)

WHEN Instaphone available for message transmittal, THEN GO TO Step 7.b.

b)

IF Instaphone NOT operable, THEN GO TO Step 11.

(STEP 7 CONTINUED ON NEXT PAGE)

NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 3 of 18

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1.

REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1)

Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

ACTION/EXPECTED RESPONSE F-7 SEND REPORT OF EMERGENCY TO STATE AND LOCAL GOVERNMENTS (i.e., Initial or Follow-up Report, as required): (Continued) e) Check each EOC answers acknowledgement roll-call (check associated box as EOC(s) answer) f)

Repeat any items upon request g)

Record date and time transmittal of Items 1 through 9 completed h) Check message reports emergency REMAINS IN EFFECT RESPONSE NOT OBTAINED e) IF any EOC does NOT respond, THEN circle locality name on.

h)

IF State EOC acknowledged

message, THEN GO TO Step 9.

IF State EOC did NOT acknowledge message, THEN do the following:

1) Use DEM ARD phone to contact State EOC (Alternate:

(804) 674-2400 (ask for Duty Officer)).

IF all means of communications with State EOC are inoperable, THEN do the following:

a) Notify SEM/RM.

b)

GO TO Step 9.

2)

Read Items 1 through 9.

3)

GO TO Step 9.

(STEP 7 CONTINUED ON NEXT PAGE)

NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 4 of 18 I-I

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1. REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emer[gency conditions change (e.g.. classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

ACTION/EXPECTED RESPONSE F-]

7 SEND REPORT OF EMERGENCY TO STATE AND LOCAL GOVERNMENTS (i.e., Initial or Follow-up Report, as required): (Continued) i)

Use DEM ARD phone to contact State EOC (Alternate:

(804) 674-2400 (ask for Duty Officer))

j)

Check State EOC acknowledged message RESPONSE NOT OBTAINED i)

IF all means of communications with State EOC are inoperable, THEN do the following:

1) Use Instaphone to transmit Item 10 to local EOCs.

2) Record the following on second page of Attachment 2:

"* "Transmitted Item 10 to local EOCs."

"* Date and time transmitted to each local EOC.

3)

GO TO Step 9.

j)

Read Items 1 through 9.

k) Read Items 10 and 11

1) Consult with State EOC Duty Officer to determine desired update message schedule m) Record following at Item 12:

"* Update message schedule

"* State EOC Duty Officer's name 8

RECORD DATE AND TIME TRANSMITTAL OF ITEMS TO STATE EOC COMPLETE NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 5 of 18 H-I

_Fýd

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1. REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

ACTION/EXPECTED RESPONSE R

ESPONSE NOT OBTAINED 9

VERIFY ALL LOCAL EOCs ANSWERED IF any EOC(s) did NOT answer roll ACKNOWLEDGEMENT ROLL CALL

call, THEN do the following:

a)

Use telephone to call EOC(s) that did not answer.

b) Refer to the table below for order of priority and list of local EOC phone numbers:

Surry (757) 294-5264 James City (757) 566-0112 Isle of Wight (757) 357-2151 (local)

(757) 357-3191 (local)

Williamsburg (757) 220-2331 Newport News (757) 247-2578 York (757) 890-3603 c)

IF State EOC notified, THEN read Items 1 through 9.

IF NO communications with State

EOC, THEN read Items 1 through

10.

d)

Record the following on :

"* Method of contact.

"* Reason Instaphone failed (if known).

"* Date and time of contact.

10 GO TO STEP 12 NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 6 of 18

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1.

REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

-LFJ-E ACTION/EXPECTED RESPONSE RESPONSE NOT OBTAINED NOTE:

Other personnel may assist using other telephones.

11 SEND REPORT OF EMERGENCY TO STATE AND LOCAL GOVERNMENTS USING ALTERNATIVE MEANS:

a) Call State EOC:

1) Use DEM ARD (Alternate:

(804) 674-2400, ask for EOC Duty Officer)

2)

Read entire Attachment 2

3)

Record date/time transmittal to State EOC complete b) Call each local EOC and read Items I through 9:

Surry (757) 294-5264 James City (757) 566-0112 Isle of Wight (757) 357-2151 (local)

(757) 357-3191 (local)

Williamsburg (757) 220-2331 Newport News (757) 247-2578 York (757) 890-3603 c)

Record date/time transmittal Items 1 through 9 complete by making notifications simultaneously of 12 NOTIFY SEM/RM TRANSMITTAL WAS SENT NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 7 of 18 H-I I

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1. REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments -

DUE, THEN RETURN TO Step 3 to prepare rew emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

ACTION/EXPECTED RESPONSE 13 KEEP ATTACHMENT 2 WITH THIS PROCEDURE 14 CHECK IF ITEM 11 ON REPORT OF EMERGENCY TO STATE AND LOCAL GOVERNMENTS INDICATES REPORT OF RADIOLOGICAL CONDITIONS -

REQUIRED GO TO Step 17.

NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE t*

8 of 18 RESPONSE NOT OBTAINED I-

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1. REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

-LFJ-E ACTION/EXPECTED RESPONSE RESPONSE NOT OBTAINED NOTE:

e The initial Report of Radiological Conditions must be transmitted to the State EOC (or State representatives in the LEOF/CEOF) as soon as possible following the release of radioactive material.

e Follow-up reports should be issued approximately every 60 minutes or when there are changes in radiological conditions.

Time should be measured from time of delivery, time facsimile sent, or time verbal transmittal completed.

15 GET REPORT OF RADIOLOGICAL CONDITIONS FOR THE STATE:

a)

Check if either of the following Radiological Status reports available:

"* MIDAS Radiological Status report OR

"* EPIP-4.03, DOSE ASSESSMENT TEAM CONTROLLING PROCEDURE,, Radiological Status b)

Get Radiological Status report from radiological assessment organization c) Check report -

COMPLETE a)

IF NO Radiological Status report available, THEN do the following:

1) Determine from radiological assessment organization when report will be available.

2) Notify SEM/RM about delay.

3)

WHEN Radiological Status report becomes available, THEN continue in this procedure.

c) IF blank items remain on Radiological Status report, THEN return report to radiological assessment organization for completion.

NUMBER PROCEDURE TITLE EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS B

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1. REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1)

Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

ACTION/EXPECTED RESPONSE 1-]

16 SEND REPORT OF RADIOLOGICAL CONDITIONS TO THE STATE:

a) Attach Radiological Status report to Attachment 3 b) Follow Attachment 3 Part I, Instructions for Virginia Power/Surry Emergency Communicator c)

Check Report of Radiological Conditions to the State SENT VIA FACSIMILE MACHINE d)

Allow 5 minutes for State EOC Duty Officer to verify receipt of message e) Check receipt of message VERIFIED BY STATE EOC DUTY OFFICER RESPONSE NOT OBTAINED c)

IF Radiological Status report communicated verbally or delivered, THEN GO TO Step 16.g.

e) IF receipt of message NOT verified, THEN do the following:

1) Call State EOC on DEM ARD (Alternate: (804) 674-2400).

2) Ask State EOC Duty Officer if message received.

3) IF receipt of message verified, THEN GO TO Step 16.f.

IF message NOT received, THEN do the following:

a) Follow Attachment 3 Part I Item 6 instructions.

b) GO TO Step 16.g.

f)

Record Date/Time verified on Part III Item 1 g) h)

Notify SEM/RM transmittal SENT Keep Attachment 3 with this procedure NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 10 of 18 H-I

-- ýSTEP

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1.

REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/-evised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class. THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STAIUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REOUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR JINTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

-LJ-C ACTION/EXPECTED RESPONSE RESPONSE NOT OBTAINED NOTE:

Follow-up reports of emergency conditions must be provided to State and local governments approximately every 60 minutes (from previous message notification start time) or when there are changes in emergency conditions, unless otherwise agreed upon with the State.

17 CHECK ANY OF THE FOLLOWING MESSAGE UPDATE CONDITIONS EXISTS:

Status of any of the following Report of Emergency items CHANGED:

"* Emergency class (including event termination)

"* Offsite Assistance Required

"* Site Evacuation

" Prcgnosis Worsening 18 WHEN Report of Emergency message update conditions satisfied, THEN RETURN TO Step 3.

WHEN Report of Radiological Conditions message update conditions satisfied, THEN RETURN TO Step 15.

IF termination message has been sent, THEN GO TO Step 27.

"* Radioactive Release

"* Protective Action Recommendati on OR

"* Updated Radiological Status report provided by radiological assessment organization OR

"* Follow-up report due IAW schedule established with State EOC Duty Officer RETURN TO APPLICABLE STEP AS INDICATED BELOW:

Report of Radiological Conditions to the State RTR OSe 5 NUMBER PROCEDURE TITLE REVISION EPIP-2.O1 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 11 of 18 I7Li H-Report of Emergency to State and Local Governments RETURN TO Step 3 i

I i

RETURN TO Step 15 I Report of Radiological Conditions to the State

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1.

REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REDUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

-LF-CýT ACTION/EXPECTED RESPONSE FI RESPONSE NOT OBTAINED NOTE:

Data may be obtained from meteorological panel charts (via TSC staff communicating with Control Room when ERFCS not available),

ERFCS (group reviews or EMCOMM, activated by typing EMCOMM and pressing the gray button labeled LAST),

the computer modem or local data logger (described in O-AP-20.03, LOSS OF METEOROLOGICAL MONITORING INSTRUMENTATION).

Both the ERFCS EMCOMM feature and ERFCS Group Review #39, COMERDS-1, Common ERDS Points, contain meteorological information averaged over the previous 15 minutes.

ERFCS Group Review #39 presents averaged ambient temperature in degrees Fahrenheit (OF).

19 CHECK ON-SITE METEOROLOGICAL INFORMATION AVAILABLE IF on-site data NOT available, THEN do the following:

a)

Get regional information from one of the following:

"* Company Weather Center:

(804) 273-3025.

"* National Weather Service (NWS):

(800) 737-8624.

"* Have HP initiate EPIP-4.10, DETERMINATION OF X/Q.

b) Give meteorological information to requestor.

c)

RETURN TO procedure step in effect.

NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE T

12 of 18 H-I

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1.

REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification).

THEN do the following:

1)

Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

- STEP ACTION/EXPECTED RESPONSE 20 GET ON-SITE METEOROLOGICAL INFORMATION AS REQUESTED:

a)

Refer to specified step(s) to acquire requested information:

Temperature Step 21 Wind Speed Step 22 Wind Direction Step 23 Affected Sectors Steps 23 and 24 Stability Class Step 25 I

RESPONSE NOT OBTAINED b) Give meteorological information to requestor c)

RETURN TO procedure step in effect 21 DETERMINE TEMPERATURE:

a)

Get temperature from Main Tower Temperature indicator b)

Use formula below to convert temperature to OF (if needed):

OF = (°C x 1.8) + 32 NOTE:

Primary source of wind speed is the Main Tower Lower -Level indicator.

Alternate sources are (1) Backup Tower, and (2)

Main Tower Upper Level.

22 GET WIND SPEED NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE L

13 of 18 I-l l

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1. REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization.

THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REDUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5-SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

ACTION/EXPECTED RESPONSE

-II RESPONSE NOT OBTAINED NOTE:

An approximate average wind direction for the previous 15 minutes should be determined.

o Primary source of wind direction is the Main Tower Lower Level indicator.

Alternate sources are (1) Backup Tower, and (2)

Main Tower Upper Level.

e Wind direction is always given as the compass point the wind blows from.

Example: Wind direction is from East North East (ENE).

23 GET WIND DIRECTION IN TERMS OF COMPASS POINT WIND BLOWING FROM:

NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 14 of 18 I-DEGREES COMPASS DEGREES COMPASS DEGREES COMPASS POINT POINT POINT 0-11 N

192-214 SSW 350-371 N

12-34 NNE 215-236 SW 372-394 NNE 35-56 NE 237-259 WSW 395-416 NE 57-79 ENE 260-281 W

417-439 ENE 80-101 E

282-304 WNW 440-461 E

102-124 ESE 305-326 NW 461-484 ESE 125-146 SE 327-349 NNW 485-506 SE 147-169 SSE 507-529 SSE 170-191 S

530-540 S

m l

l

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1. REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

-LJ-t ACTION/EXPECTED RESPONSE I-]

RESPONSE NOT OBTAINED NOTE:

Affected sectors are recorded using alphabetic designations.

24 DETERMINE DOWNWIND SECTORS:

COMPASS POINT DOWNWIND SECTORS COMPASS POINT DOWNWIND SECTORS N

H J

K S

R -

A - B NNE J

K -L SSW A-B -C NE K -

L - M SW B

C - D ENE L-M -N WSW C-D -E E

M-N -P W

D-E -F ESE N -

P -

0 WNW E -

F - G SE P R NW F - G - H SSE

- R -A NNW G -

H J

NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 15 of 18 H-

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1. REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the fol lowing:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

Update current message to include changed condition(s).

° RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

ACTION/EXPECTED RESPONSE RESPONSE NOT OBTAINED NOTE:

Main Tower Delta T is the preferred source of stability class.

Sigma Theta (Backup Tower) is the secondary source.

The value closer to "G" should be used if unable to distinguish Delta T or Sigma Theta value.

Numerical ranges presented below for Delta T and Sigma Theta are less than the range of the chart recorder and indicator in the Control Room.

indications are not expected to read outside the ranges found on these tables.

25 DETERMINE STABILITY CLASS:

MAIN TOWER DELTA T BACKUP TOWER SIGMA THETA DELTA T (°C)

STABILITY CLASS SIGMA THETA (0)

STABILITY CLASS

-0.67

=

A

Ž 22.5

=

A

-0.66 to -0.60

=

B 22.4 to 17.5

=

B

-0.59 to -0.53

=

C 17.4 to 12.5

=

C

-0.52 to -0.18

=

D 12.4 to 7.5

=

D

-0.17 to +0.53

=

E 7.4 to 3.8

=

E

+0.54 to +1.41

=

F 3.7 to 2.1

=

F

> +1.41

=

G

< 2.1 G

G NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 16 of 18 I-i

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1.

REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite -assistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1)

Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments -

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STAFUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REDUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR.INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

-LFJTEP ACTION/EXPECTED RESPONSE F-RESPONSE NOT OBTAINED NOTE:

Responsibilities may be transferred to relief within a facility or to another facility, e.g., Control Room to TSC, Control Room to LEOF or CEOF, or TSC to LEOF or CEOF.

26 TRANSFER RESPONSIBILITY FOR STATE/LOCAL NOTIFICATIONS:

a) Notify SEM (or RM if in LEOF/CEOF) b) Tell relief Emergency Communicator about current event status c)

Review most recently completed Attachments 2 and 3 with relief d) Tell relief Emergency Communicator when next notification is due e) Provide this procedure and all attachments or send copies of attachments to relief f)

Have relief/turnover recorded in event log g)

Check -

INTERFACILITY TURNOVER HAS BEEN COMPLETED g)

RETURN TO step in effect prior to relief.

NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 17 of 18 1-l

CONTINUOUS ACTION PAGE FOR EPIP-2.01

1.

REPORT OF EMERGENCY CONDITION CHANGE CRITERIA WHEN emergency conditions change (e.g., classification, event termination, offsite ssistance, site evacuation, worsening prognosis, release of radioactive material, Protective Action Recommendation),

THEN do one of the following:

a.

IF preparation of a new/revised message will prevent timely transmittal of an initial message reporting an emergency class (i.e., within 15 minutes of classification),

THEN do the following:

1) Complete transmittal of current message.

2)

RETURN TO Step 3 to prepare new emergency message.

b.

IF new/revised message can be prepared without delaying timely transmittal of an initial message reporting an emergency class, THEN do one the following:

"* Update current message to include changed condition(s).

"* RETURN TO Step 3 to prepare new emergency message.

2.

REPORT OF EMERGENCY UPDATE CRITERIA WHEN scheduled Report of Emergency to State and Local Governments -

DUE, THEN RETURN TO Step 3 to prepare new emergency message.

NOTE:

Transmittal of a Report of Emergency to State and Local Governments takes precedence over preparing a new radiological status message, responding to requests for meteorological information and turning-over duties to relief.

3.

REPORT OF RADIOLOGICAL STATUS CONDITION CHANGE CRITERIA WHEN updated Radiological Status report provided by radiological assessment organization, THEN RETURN TO Step 15 to prepare new radiological status message.

4.

METEOROLOGICAL INFORMATION REQUEST CRITERIA IF requested to acquire on-site meteorological information, THEN GO TO Step 19.

5.

SHIFT RELIEF OR INTERFACILITY TURNOVER CRITERIA WHEN shift relief or interfacility turnover occurs, THEN GO TO Step 26.

ACTION/EXPECTED RESPONSE 27 TERMINATE PROCEDURE:

"* Give EPIP-2.01, forms and other applicable records to the Control Room STA (TSC Emergency Procedures Coordinator or EOF Services Coordinator)

Completed by:

Date:

Time:

-END-NUMBER PROCEDURE TITLE REVISION EPIP-2.01 NOTIFICATION OF STATE AND LOCAL GOVERNMENTS 29 PAGE 18 of 18 k-]

RESPONSE NOT OBTAINED H-I l

l

-- ýSTEP

Form Field Approval (SEM or RM)

Message #

Notification Start Time Location Roll Call Instructions for Preparing Form:

Leave blank.

(The Station Emergency Manager (SEM) or Recovery Manager (RM) signs/initials this space after message is drafted.)

Record sequential message number on pages 1 and 2.

A single numbering sequence is used for Reports of Emergency to State and Local Governments (Attachment 2) from the initial classification until the Emergency Plan is exited.

The numbering sequence for Reports of Radiological Conditions to the State (Attachment 3) is separate.

Leave blank.

(Enter notification start time when beginning transmittal of the approved message.)

Check off facility from which notification will be made.

Leave blank.

(Check off recipients of the emergency message when they answer the roll call.)

NOTE:

Information to complete Items 1-2 and 4-7 obtained from SEM/RM.

Items 4. 5. 6. 7 and/or 8 are optional for a message reporting initial entry into the Emergency Plan or an emergency class change, including emergency termination and may be checked 'Excluded from this message.'

Inclusion of onsite result in of optional items, e.g.. Item 6. Evacuation personnel.

should be condsidered when it can avoiding an immediate follow-up message.

Emergency Class.

IF message initial or follow-up report, THEN do the following:

a.

Check block for highest applicable emergency class.

b.

Enter time (0001-2400) and date of declaration.

IF initial message is also a termination report, THEN record time of termination in Item 3.

IF message emergency termination report, THEN do the following:

a.

Check Emergency Terminated block.

b.

Complete Items 2, 3 and 9.

NUMBER ATTACHMENT TITLE REVISION EPIP-2.01 INSTRUCTIONS FOR COMPLETING REPORT OF EMERGENCY TO 29 ATTACHMENT STATE AND LOCAL GOVERNMENTS PAGE 1

1 of 7 Item 1

Form Field Instructions for Preparing Form:

Item 2 Release of radioactive material.

The SEM/RM determines whether a release of radioactive material is occurring, has occurred, has occurred and has been terminated, or is projected to occur based on plant indications and/or consultation with the RAD/RAC.

For the purposes of emergency messages, release refers to a radiological release attributable to the emergency event.

Item 3 Remarks / Description of event.

Write Remarks / Description of event in plain language.

Avoid technical jargon, abbreviations and acronyms.

Explain any change in the prognosis of situation (Item 7) reported in the previous message.

IF Item 2 indicated a radiological release is occurring or has

occurred, THEN remarks should be entered placing the release in context, e.g., release is estimated to be confined to the site, release estimated to be within normal plant limits, site boundary dose rates are below offsite protective action levels.

Avoid repeating Remarks / Description of event from the previous message.

The description should describe current conditions at the time the report approved by the SEM/RM.

Item 4 Assistance requested.

[ I Excluded from this message may be checked for the initial report of an emergency class and termination reports only.

This item documents requests that have been made for on-site assistance from off-site organizations such as from fire departments, rescue squads or law enforcement agencies, including local law enforcement, Virginia State Police, Federal Bureau of Investigation, etc.).

This item is NOT for requesting assistance.

A check block for other off-site organizations and space to record a description of the off-site organization is provided, e.g.,

U.S.

Department of Energy.

Continue to record requests for assistance until the request has been canceled or off-site assistance has been released.

For an ambulance, continue to record request for assistance until the ambulance has been released from the hospital.

NUMBER ATTACHMENT TITLE REVISION EPIP-2.01 INSTRUCTIONS FOR COMPLETING REPORT OF EMERGENCY TO 29 ATTACHMENT STATE AND LOCAL GOVERNMENTS PAGE 1

2 of 7

Form Field Instructions for Preparing Form:

Item 5 Emergency Response Actions Underway.

[ ] Excluded from this message may be checked for the initial report of an emergency class and termination reports only.

Check blocks are provided for the following:

[ ] Station monitoring teams dispatched offsite (teams may be dispatched for any emergency classification, but dispatch is generally required at the Site Area Emergency and General Emergency classifications)

[ ] Station emergency personnel called in (unless special circumstances are involved, station emergency personnel are called-in at an Alert or higher emergency class, but may be called-in for a Notification of Unusual Event)

[ ] Other (examples of other emergency response actions include dispatch of damage control teams, relocation of personnel from selected areas, etc.)

Item 6 Evacuation of onsite personnel.

[ I Excluded from this message may be checked for the initial report of an emergency class and termination reports only.

The Remote Assembly Area is selected in accordance with EPIP-5.05, SITE EVACUATION.

An "Other" check block is provided in case personnel are evacuated to different location, e.g., local evacuation assembly center.

Early release of personnel, i.e., non-essential personnel are sent home early, is reported in Item 3.

Remarks / Description of event.

Continue to :-ecord evacuation of onsite personnel until evacuated personnel released from the applicable Remote Assembly Area.

NUMBER ATTACHMENT TITLE REVISION EPIP-2.01 INSTRUCTIONS FOR COMPLETING REPORT OF EMERGENCY TO 29 ATTACHMENT STATE AND LOCAL GOVERNMENTS PAGE 1

3 of 7

Form Field Instructions for Preparing Form:

NOTE:

Changes in the prognosis of situation should be explained in Item 3. Remarks / Description of event.

Item 7 Prognosis of situation.

[ I Excluded from this message may be checked for the initial report of an emergency class and termination reports only.

The "Other" check block can be used to provide an indication of anticipated event termination, e.g., emergency will be terminated when unit reaches cold shutdown at or about 1700 hours0.0197 days 0.472 hours 0.00281 weeks 6.4685e-4 months .

Item 8 Meteorological data.

[ I Excluded from this message may be checked for the initial report of an emergency class and termination reports only.

[ I Not available may be checked when waiting for meteorological information will delay transmission of a message.

Efforts to obtain meteorological data from alternative sources should not delay sending emergency messages.

Check [ I Based on onsite measurements when meteorological information is acquired from onsite instruments.

Onsite measurements may be acquired from any of the following:

"* ERFCS EMCOMM feature (15-minute average) (activated by typing EMCOMM and pressing the gray button labeled LAST)

"* ERFCS Group Review #39, COMERDS-1, Common ERDS Points (15-minute average)

"* Control Room meteorological panel charts (approximate average for previous 15 minutes) (communicate with Control Room staff when ERFCS not available in other facilities)

"a O-AP-20.03, LOSS OF METEOROLOGICAL MONITORING INFORMATION.

[Instructions for Item 8, Meteorological data, continued on following page.]

NUMBER ATTACHMENT TITLE REVISION EPIP-2.01 INSTRUCTIONS FOR COMPLETING REPORT OF EMERGENCY TO 29 ATTACHMENT STATE AND LOCAL GOVERNMENTS PAGE 1

4 of 7

Form Field Item 8

[continued]

Instructions for PreDarinq Form:

Meteorological data.

Multiple indications of wind direction and wind speed are available.

The priority for using these indications is:

1 Main Tower Lower Level 2

Backup Tower 3

Main Tower Upper Level Check [ ] Based on offsite regional data when onsite measurements are NOT available.

Regional wind speed and wind direction data may be obtained from the following in the order indicated:

1 Company Weather Center, (804) 273-3025 2

National Weather Service (NWS),

(800) 737-8624 Use the following table to convert compass point wind blowing from.

DEGREES or or or or or or or or or 350-371 372-394 395-416 417-439 440-461 462-484 485-506 507-529 530-540 0-11 12-34 35-56 57-79 80-101 102-124 125-146 147-169 170-191 192-214 215-236 237-259 260-281 282-304 305-326 327-349 indicated degree reading to COMPASS POINT N

NNE NE ENE E

ESE SE SSE S

SSW SW WSW W

WNW NW NNW (NORTH)

(NORTH NORTHEAST)

(NORTHEAST)

(EAST NORTHEAST)

(EAST)

(EAST SOUTHEAST)

(SOUTHEAST)

(SOUTH SOUTHEAST)

(SOUTH)

(SOUTH S-OUTHWEST)

(SOUTHWEST)

(WEST SOUTHWEST)

(WEST)

(WEST NORTHWEST)

(NORTHWEST)

(NORTH NORTHWEST)

Record wind direction in compass point wind is blowing from.

Record wind speed.

NUMBER ATTACHMENT TITLE REVISION EPIP-2.01 INSTRUCTIONS FOR COMPLETING REPORT OF EMERGENCY TO 29 ATTACHMENT STATE AND LOCAL GOVERNMENTS PAGE 1

5 of 7

Form Field Item 9 Roll Call Message Close-Out Item 10 Item 11 Instructions for Preparing Form:

Emergency Communicator identification.

Enter name of Emergency Communicator.

Leave blank.

(Check off recipients of the emergency message when they answer the roll call.)

Leave blank.

(Check off facility from which notification was made and enter date/time after transmitting Items 1-9.)

Recommended offsite protective actions.

IF Item 1 indicates the emergency class is a Notification of Unusual Event, Alert or Site Area Emergency, THEN check

[ I None.

IF Item 1 indicates the emergency class is a General Emergency, THEN copy recommended offsite protective action from EPIP-1.06, PROTECTIVE ACTION RECOMMENDATION,,

in Item 10.

Report of Radiological Conditions.

IF Item 2 indicates a release of radioactive material has NOT occurred and is NOT projected, THEN check [ ] We will not issue a Report of Radiological Conditions.

IF a Report of Radiological Conditions is required AND all the following conditions are met:

"* LEOF (or CEOF)

- RESPONSIBLE FOR STATE NOTIFICATIONS

"* Department of Emergency Management -

PRESENT

"* Department of Health (Radiological Health Programs) representative -

PRESENT THEN check [ I We will provide the Report of Radiological Conditions to the State representatives in the LEOF (CEOF).

IF a Report of Radiological Conditions is required AND has to be transmitted to the State EOC, THEN check [ I We will transmit a Report of Radiological Conditions to the State EOC.

NUMBER ATTACHMENT TITLE REVISION EPIP-2.01 INSTRUCTIONS FOR COMPLETING REPORT OF EMERGENCY TO 29 ATTACHMENT STATE AND LOCAL GOVERNMENTS PAGE 1

6 of 7

Form Field Instructions for Preparing Form:

Update schedule and name of State EOC Duty Officer.

Leave blank.

(Update schedule and identification of State EOC Duty Officer is determined in consultation with the State EOC Duty Officer after message is transmitted.)

Leave blank.

(Check off facility from which notification was made and enter date/time after transmitting Items 10-12.)

NUMBER ATTACHMENT TITLE REVISION EPIP-2.01 INSTRUCTIONS FOR COMPLETING REPORT OF EMERGENCY TO 29 ATTACHMENT STATE AND LOCAL GOVERNMENTS PAGE 1

7 of 7 Item 12 Message Close-Out

APPROVAL:

(SEN or RM):

MESSAGE # __

TIME NOTIFICATION STARTED:

This is Surry Power Station

[] Control Room

[I TSC

[] LEOF

[I CEOF.

Standby for a roll-call followed by an emergency message.

Use a Report of Emergency form to copy this message.

(Conduct a roll-call and check boxes as each party answers)

[] Surry County

[I James City County

[] State EOC

[] Isle of Wight County

[] Williamsburg

[] Newport News

[] York County The emergency message is as follows: (READ SLOWLY)

Item 1:

Emergency Class:

[] Notification of Unusual Event

[I Site Area Emergency -

Declared at on Ii] Alert

[] General Emergency j

(24-hr time)

(date) 1] Emergency Terminated Item 2:

Release of radioactive material:

[] Has NOT occurred and is NOT projected

[I Has occurred and is now terminated

[I Is presently occurring

[] Is projected to occur Item 3:

Remarks / Description of event:

NOTE:

Items 4 -

8 may be excluded from Initial message reporting any Item 4:

Assistance requested:

[] None M#) Fire Units from W__

) Police Units from

(#) Rescue Units from I]

Other Item 5:

Emergency response actions underway:

[] None LI Station monitoring teams dispitched offsite

[] Station emergency personnel called in

[I Other Item 6:

Evacuation of onsite personnel:

[] No

[] Yes, evacuated to:

I] Primary Remote Assembly Area

[] Secondary Remote Assembly Area

[] Other emergency class (including termination).

[I Excluded from this message

(] Excluded from this message (ATTACHMENT 2 CONTINUED ON NEXT PAGE)

NUMBER ATTACHMENT TITLE EPIP-2.01 REPORT OF EMERGENCY TO ATTACHMENT STATE AND LOCAL GOVERNMENTS 2

MESSAGE # __

Item 7:

Prognosis of situation:

[I Improving

[E Stable

[] Worsening El Other

[E Excluded from this message Item 8:

Meteorological data is:

E] Excluded from this message

[E Based on onsite measurements;

[E Based on offsite regional data; El Wind direction is from the

[E Wind speed is mph El Not available Item 9:

This is (name)

/Emergency Communicator.

Please acknowledge receipt of this message. (Conduct roll-call and check boxes)

[] Surry County

[I James City County El State EOC El Isle of Wight County E] Williamsburg

[] Newport News

[] York County This is Surry Power Station

[I Control Room

[E TSC El LEOF El CEOF out at on (24-hr time)

(date)

NOTE:

The remainder of this report Is not transmitted when the message reports emergency termination.

When transmitted, the following Informatlen is for state use only.

Transmit to State EOC using the DEM ARD.

This is Surry Power Station

[] Control Room

[3 TSC E] LEOF

[I CEOF.

Continuing the emergency message:

Item 10:

Recommended offsite protective 3ctions are:

[I None

[I Standard:

Evacuate 3600 from 0

miles to 5

miles.

[I Expanded:

[3 Evacuate 360* from 0

miles to 5

miles.

[I Evacuate 3600 from 5

miles to miles.

(I Evacuate sectors from miles to miles.

[] Shelter 360° from __

miles to miles.

[E Shelter sectors from miles to miles.

[] Shelter unaffected sectors from miles to miles.

Item 11:

[] We will transmit a Report of Radiological Conditions to the State EOC.

El We will provide the Report of Radiological Conditions to the State representatives in the LEOF (CEOF).

[I We will not issue a Report of Radiological Conditions.

Item 12:

Update schedule: [E 60 minute;

[] Other Name of State EOC Duty Officer:

This is Surry Power Station

[I Control Room

[I TSC

[E LEOF

[] CEOF out at _

on (24-hr time)

(date)

NUMBER ATTACHMENT TITLE REVISION EPIP-2.01 REPORT OF EMERGENCY TO 29 ATTACHMENT STATE AND LOCAL GOVERNMENTS PAGE 2

2 of 2

PART I.

Instructions for Surry Emergency Communicator:

1. Check name of facility:

[ ] Control Room

[ ] TSC

[ ] Local EOF

[ ] Central EOF

2.

Record Message #:

Communicator's name:

Call-back #:

(

)

3.

Check which report is attached and record the report number and run time (as appropriate):

MIDAS Radiological Status computer printout (2 pages)

Report #

Run Time

__Radiological Status attachment from EPIP-4.03 (I page) Report #

4.

Have Station Emergency Manager (SEM)

/ Recovery Manager (RM) approve transmittal:

APPROVED FOR TRANSMITTAL:

(SEM

/ RM initials) DATE:

/

TIME:

5.

IF report can be delivered to both VDES AND VDH staff in EOF, THEN GO TO PART I,

ITEM 6.

IF report will be sent by facsimile, THEN notify State EOC Report of Radiological Conditions will be sent by facsimile (Use DEM ARD or (804) 674-2400) and request receipt confirmation.

6.

Deliver report to both VDEM AND VDH staff in EOF:

a.

Date/Time Message Delivered to VDEM Representative in Local/Central EOF:

/

b.

Date/Time Message Delivered to VDH Representative in Local/Central EOF:

/

c.

Record N/A by Part 11 and Part III below.

IF report will be sent by facsimile, THEN ask facsimile machine operator to transmit this message.

IF transmittal of report by facsimile NOT achieveable.

THEN do the following:

a.

Notify State EOC using DEM ARD or call (804) 674-2400

b.

Identify yourself and your location

c.

Ask EOC Duty Officer to use a Report of Radiological Conditions form to copy message

d.

Read the attached report

e.

Record when message transmittal completed:

Date/Time Message Completed:

/

f.

Record N/A by Part II and Part III below.

PART II.

Instructions for Facsimile Machine Operator:

1. Record Facsimile Operator's name :

Date/Time Sent:

/

2.

Transmit this message to State EOC facsimile machine (804) 674-2419.

IF facsimile transmission NOT successful, THEN RETURN message to Emergency C-ommunicator.

3. Return original report to State and Local Emergency Communicator.

PART III.

Instructions for State EOC Duty Officer:

1. Notify Surry Emergency Communicator report received.

Date/Time Verified:

/

(Use DEM ARD or see PART I, Item 2 above for call-back number).

Receipt Verification

2.

Forward message to EOC Operations Officer for distribution to State Radiological Health Programs ar.d Information & Planning representatives.

NUMBER ATTACHMENT TITLE REVISION EPIP-2.01 29 ATTACHMENT REPORT OF RADIOLOGICAL CONDITIONS TO THE STATE PAGE 3

1 of 1

LEVEL 2 DISTRIBUTION This Documenq*]ll4jA NP4011 And Annotae RA MnWiULlMN EMER(

I~*PAW*i*J fk*I ING PROCEDURE NUMBER PROCEDURE TITLE REVISION EPIP-5.07 ADMINISTRATION OF RADIOPROTECTIVE DRUGS 11 PAGE (With 2 Attachments)

PAGE 1lof 5 PURPOSE To obtain authorization and medical advice concerning administration of radioprotective drugs, and to provide information regarding dose and side effects to individuals who may be asked to take KI.

ENTRY CONDITIONS Any one of the following:

1.

Activation by another EPIP.

2.

Activation by CPIP-6.2, RADIOLOGICAL ASSESSMENT COORDINATOR.

3.

Survey results indicate inhalation dose may have exceeded 25 Rem.

4.

Entry into high airborne activity area where inhalation dose may exceed 25 Rem.

Approvals on File 7Ev_

Effective Date 7

ACTION/EXPECTED RESPONSE RESPONSE NOT OBTAINED 1

INITIATE PROCEDURE:

Initiated By:

Date:

Time:

NOTE:

The Recovery Manager (RM) may authorize administration of KI for Offsite Monitoring Teams and LEOF personnel.

2 OBTAIN AUTHORIZATION FROM SEM/RM:

a)

Review criteria for administering radioprotective drugs from controlling procedure with SEM/RM:

IF authorization GO TO Step 11.

NOT granted, THEN

"* EPIP-4.01, RADIOLOGICAL ASSESSMENT DIRECTOR CONTROLLING PROCEDURE

"* CPIP-6.2, RADIOLOGICAL ASSESSMENT COORDINATOR b) Record name and identification number of personnel selected to receive KI on Attachment 2 c) Record SEM/RM approval on NOTE:

Offsite Monitoring Team members complete Attachment 1 prior to dispatch in accordance with EPIP-4.02, RADIATION PROTECTION SUPERVISOR CONTROLLING PROCEDURE.

3 CHECK RADIOPROTECTIVE DRUG DOSAGE, SIDE EFFECTS AND MEDICAL STATEMENT PREVIOUSLY COMPLETED IF Radioprotective Drug Dosage, Side Effects and Medical Statement NOT completed, THEN GO TO Step 5.

4 GO TO STEP 6 NUMBER PROCEDURE TITLE REVISION EPIP-5.07 ADMINISTRATION OF RADIOPROTECTIVE DRUGS 11 PAGE 2

2of 5 1-I

-LYI-t ACTION/EXPECTED RESPONSE RESPONSE NOT OBTAINED I

5 HAVE INDIVIDUAL(s)

RECEIVING KI READ AND COMPLETE ATTACHMENT 1, RADIOPROTECTIVE DRUG DOSAGE, SIDE EFFECTS AND MEDICAL STATEMENT IF individual does NOT sign, THEN do the following:

a) Do NOT issue KI to individual b) IF other individual(s) selected, THEN continue procedure for processing other individuals.

IF NO other individual requires KI, THEN GO TO Step 11.

NOTE:

Copies of the Emergency Personnel Notification List (EPNL) are maintained by Security, in the TSC, and in the LEOF/CEOF.

6 NOTIFY MEDICAL STAFF:

a)

Use EPNL (Position 291) to get telephone number for medical staff (Use Post-CERC Activation number after emergency response facilities activated) b) Notify medical staff of decision to issue KI and to whom it will be issued IF medical staff can NOT be notified immediately, THEN do the following:

1) Continue this procedure.

2)

Repeat attempts to contact medical staff.

c) Ask if KI should be issued to individual(s) who checked box 2,

3 or 4 of Attachment 1,Section III NUMBER PROCEDURE TITLE REVISION EPIP-5.07 ADMINISTRATION OF RADIOPROTECTIVE DRUGS 11 PAGE 3 of 5 I

ACTION/EXPECTED RESPONSE F-A 7

CHECK EITHER OF THE FOLLOWING CONDITIONS EXISTS:

"* Individual(s) checked Box 1

"* Medical consent given for individual(s) who checked Box 2, 3 or 4 RESPONSE NOT OBTAINED IF Box 5 checked, THEN do the following:

a)

Do NOT consider individual for emergency work.

b)

Do NOT issue KI.

c)

GO TO Step 11.

IF medical consent NOT given, THEN GO TO Step 11.

CAUTION:

Potassium iodide should not be used without prior medical consent.

by people allergic to iodine NOTE:

Potassium Iodine tablets are maintained in the TSC and LEOF Supply Cabinets, and in each offsite monitoring Emergency Kit.

Alternate supplies are available from North Anna Power Station.

Administration of radioprotective drugs is preferably done prior to exposure, although administration within 2 hours2.314815e-5 days 5.555556e-4 hours 3.306878e-6 weeks 7.61e-7 months after exposure is considered acceptable.

8 GIVE RADIOPROTECTIVE DRUGS TO DESIGNATED INDIVIDUAL(s) 9 COMPLETE ATTACHMENT 2, POTASSIUM IODINE ISSUE LOG NUMBER PROCEDURE TITLE REVISION EPIP-5.07 ADMINISTRATION OF RADIOPROTECTIVE DRUGS 11 PAGE 4 of 5 H-l l

-LIKJ-t ACTION/EXPECTED

RESPONSE

K-]

RESPONSE NOT OBTAINED 10 DO FOLLOW-UP ASSESSMENT IAW NORMAL STATION PROCEDURES:

a)

Wait at least 24 hours2.777778e-4 days 0.00667 hours 3.968254e-5 weeks 9.132e-6 months after exposure was received b)

Do follow-up assessment 11 TERMINATE EPIP-5.07:

Give EPIP-5.07, forms, and other applicable records to the Radiological Assessment Director/Radiological Assessment Coordinator o Completed by:

Date:

Time:

-END-NUMBER PROCEDURE TITLE REVISION EPIP-5.07 ADMINISTRATION OF RADIOPROTECTIVE DRUGS 11 PAGE 5 of 5 F-

SECTION I:

DOSAGE AND SIDE EFFECTS CAUTION Potassium Iodide should not be used by people allergic to Iodine.

Keep out of reach of children.

In case of overdose or allergic reaction, contact a physician or public health authority.

DIRECTIONS FOR USE:

ADULTS:

One (1) tablet once a day.

DO NOT take tablet for more than 10 days.

SIDE EFFECTS:

Usually, side effects occur when people take higher doses for longer periods of time.

Do not take more than the recommended dose and do not take dose for longer than the time that is recommended to you.

Side effects are unlikely due to low doses over short periods of time.

Possible side effects are skin rashes, swelling of salivary glands, and "iodism" (metallic taste, burning of mouth and throat, sore teeth and gums, symptoms of head cold, and sometimes stomach upset and diarrhea).

A few people have an allergic reaction with more serious symptoms.

These could be fever and joint pains.

swelling of parts of the face and body, and severe shortness of breath, requiring immediate medical attention.

Taking iodide may rarely cause overactivity of the thyroid gland. underactivity of the thyroid gland, or enlargement of the thyroid gland (goiter).

WHAT TO DO IF SIDE EFFECTS OCCUR:

If side effects are severe or if you have an allergic reaction, stop taking potassium iodide and call a doctor.

SECTION II:

1.

[ I I have read Section 1, *DOSAGE AND SIDE EFFECTS'.

SECTION III:

Note: Items I through 4 below should be answered to the best of your knowledge.

1.

I have no known sensitivity to Iodine, nor do I have a medical condition that would make me reluctant to take Iodine tablets.

2.

1

]

I have a known sensitivity to Iodine.

3.

C ]

I have a medical condition that may negate my being able to take KI tablets. e.g.,

hyperthyroidism. hypothyroidism, etc.

4.

1

]

1 am currently taking thyroid hormone tablets.

5.

1 I

I am a Declared Pregnant Worker under provisions of. or hereby state my intent to declare pregnancy in accordance with, VPAP-2101.

Radiation Protection Program.

NAME:

DATE

(print)

NUMBER ATTACHMENT TITLE REVISION EPIP-5.07 RADIOPROTECTIVE DRUG DOSAGE, 11 ATTACHMENT PAGE SIDE EFFECTS AND MEDICAL STATEMENT 1

1 of 1 (signature)

TIME OF APPROVED TIME OF INITIAL ID NUMBER (SEM/RM)

EXPOSURE KI DOSE ISSUED BY NUMBER ATTACHMENT TITLE REVISION EPIP-5.07 POTASSIUM IODINE ISSUE LOG 11 ATTACHMENT PAGE 2

1 of 1 NAME

ML020720005

Text

RESPONSE

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