ML033240361

Submittal of Emergency Plan Implementing Instructions

ML033240361
Person / Time
Site:	Perry
Issue date:	11/11/2003
From:	Bauguess D FirstEnergy Nuclear Operating Co
To:	Document Control Desk, Office of Nuclear Reactor Regulation
References
-RFPFR
Download: ML033240361 (19)

Text

FENOC Perry Nuclear PowerPlant 10 Center Road FirstEnergy Nuclear Operating Company PO. Box 97 Perry Ohio 44081 November 11, 2003 PY-CEI/NRR-2751 L United States Nuclear Regulatory Commission Document Control Desk Washington, D. C. 20555 Perry Nuclear Power Plant Docket No. 50-440 Submittal of Emergency Plan Implementing Instructions Gentlemen:

Pursuant to 10 CFR 50 Appendix E, enclosed are changes to the Emergency Plan Implementing Instructions (EPIs) for the Perry Nuclear Power Plant. These changes constitute revisions, temporary changes, or reissued pages. Please follow the updating instructions per the attached Controlled Document Instruction Sheet and return the signed Acknowledgment of Receipt form.

If you have questions or require additional information, please contact me at (440) 280-5589.

Very truly yours, Dav ss, Supervisor Emergency Planning Unit DLB:byr Enclosure cc: NRR Project Manager NRC Resident Inspector NRC Region Ill, Incident Response Center w/attachments A"OL(S

FIRSTENERGY CORPORATION PERRY NUCLEAR POWER PLANT UNIT I & 2 ACKNOWLEDGMENT OF RECEIPT Title Emeraencv Plan ImDlementing Instructions EPI-B81 Rev. 9 Control No. 60 Letter No./Date PY-CEI/NRR-2751 L / November 11. 2003 Signature Date Title Return to:

Perry Nuclear Power Plant Attn: B.Y. Richardson, A240 P. 0. Box 97 Perry, Ohio 44081

FIRSTENERGY CORPORATION Perry Nuclear Power Plant Controlled Document Instruction Sheet Manual: Emergency Plan Implementing Instructions EPI-B8/ Rev. 9 Control Numbers 60 Revision Number Remove and Replace 9 Reissue Entire Document

EPI-B8 Page: i Rev.: 9 PERRY OPERATIONS MANUAL PNPP

,- no9= MA im-1 Emergency Plan Implementing Instruction

.. Cr(dT TITLE:* PROTECTIVE ACTIONS AND GUIDES REVISION: 9 EFFECTIVE DATE: 1-11 -Z33 PREPARED: Lou Sosler 6-3-03

/ Date

EPI-B8 Page:' ii Rev.: 9 .

PROTECTIVE ACTIONS AND GUIDES

... I Tabl of Conten.

Table of Contents Section Title Page St'.;4to '"' '" g ' *POSE 1

2.0 REFERENCES

1 3.0 DEFINITIONS 2 4.0 RESPONSIBILITIES 3 5.0 ACTIONS 5 5.1 Protective Action Logic .5.

5.2 Potassium Iodide (KI) Distribution to Onsite Emergency Response Organization (ERO) Personnel 7 5.3 Potassium Iodide (KI) to RMT Members 9 ATTACHMENTS Attachment.1 - PAR Decision.Flow Chart 11 Attachment 2 Mile EPZ Sectors Versus Subareas. Map 12 Attachment 3 - Potassiuma Iodide -(KI)- Tiacking Form 13 SCOPE OF REVISION:

Periodic Review - Required Rev. 9 - 1. Incorporated Attachments 2..and 3 into Attachment 1.

2. Added Definitions of SUBAREA 1, Lake and General Emergency Default PARs.

3. Added Note to explain that an'area included in a PAR will n(Lot be deleted during subsequent PAR's.

4. Added directions for'PAR beyond 10 miles to Attachment 1.

5. Minor format.-and editorial changes were made to reflect the reduction of attachment-pages. -

V . ; ..;:., :

EPI-B8 Page: 1 Rev.: 9 PROTECTiVE-ACTIONS-AND GUIDES 1.0 PURPOSE This instruction provides guidelines for the formulation-of protective actions for the plume exposure pathway to be recommended to State of Ohio and local county Emergency Management Agencies in the event of an emergency involving the possibility of an abnormal reeaise of radioactive material~s) at the Perry Plant.

Development of ingestion pathway protective action recommendations will be the responsibility of the State of Ohio and Federal response agencies.

The Perry Plant will assist in the collection and analysis of environmental samples using <EPI-BIO>. ,

. -, . - ,. -, *r' i -

2.0 REFERENCES

2.1 Source

References:

, , )  :

1. 10CFR20, Standards 'for rco21i.. Against Radiation

2. EPA-400-R-92, Manual of Protective Action Guides and Protective Actions for Nuclear Incidents (May 1992) I

3. U.S. Nuclear Regulatory Commission Response Technical Manual (RTM) - 92 (October 1992)

4. Emergency - Plan

~.5. ~for~ PNPPPocket

~ ~--. . c-t Nosk N-s . 50-440, 50 4 0 50-41, 1-.

5. EPI-B7a: Automated Offsite Po e Calculations

6. EPI-B7b: Manual Offsite Dos'e Calculations

7. Patient Package Insert for THY.O-BLOCKTM, Wallace Laboratories (10/79) 2.2 Use

References:

1. EPI-B10: Emergency Radiological Environmental Monitoring Program

2. EPI-B3: Radiological Surveys for Emergencies

3. EPI-Bi: Emergency Notification System

4. EPI-Al: Emergency Action Levels

5. EPI-A2: Emergency Actions Based On Event Classification

6. EPI-All: Activation of the Backup Emergency Operations Facility

EPI-B8 Page: 2 Rev.: 9

7. Supplement 3 to NUREG-0654/FEMA-REP-l-(Revision 1): Criteria for Protective Action Recommendatior-ijfor severe Accidenits '

9. PAP-0114: Radiation Protection Program

9. - Commitments addressed in this doqument:

H00022 'P00005 P00029 PO0046 H00024 P00011 :P00037 3.0 DEFINITIONS 3.1 Protective Actions Those emergency measures taken before or after an uncontrolled release of radioactive material has occurred to prevent or.minimize radiological exposure to persons that wouldikely be exposed, if the actions were not taken.

3.2 Protective Action Guides (PAGs)

Projected radiological doses to6indiviuails in the general population that warrant Protective Actions following a release of radioactive material. Protective Actions would,be,warranted provided the reduction in individual dose is not offset by excessive risks to individual safety in taking the Protective Action. The.Protective Action Guide (PAG) does not include the dose that has unavoidably occurred prior to the assessment.

3.3 Deep Dose Equivalent (DDE)

The dose equivalent measured at a tissue depth of 1 cm (1000 mg/cm2 ).

DDE is-the external component of TEDE.

3.4 Committed Dose Equivalent (CDE)

The dose equivalent to organs or tissues of reference that will be received from an intake of radioactive material by an- individual during the 50 year period following the uptake.

3.5 Committed Effective Dose Equivalent (CEDE)

Thd's'um of the products of the weigh~ing factors applicable to each of the body organs or tissues and the CDE to these organs or tissues.. CEDE is the internal dose component of TEDE.

3.6 Total Effective Dose Equivalent (TEDE)

Sum dose of DDE (external dose) and CEDE (internal dose).

EPI-B8 Page: 3 Rev.: 9 3.7 Derived-Air Concentration (DAC)

The concentration of a given radionuclide in air which, if.breathed by the reference man for a wo'king-year of 2,000 hours0 days <br />0 hours <br />0 weeks <br />0 months <br /> under conditions of light work (inhalation rate of 1.2 cubic meters of air per hour),,results in an intake of one Annual-Ltit'on Intake (ALI) per PAP-0114.

3.8 Radiation Emergency Assista iceCenter/Training Site (REAC/TS)

REAC/TS is operated by the Medical Sciences Division of the Oak Ridge Institute for Science and Education for the U.S. Department of Energy (DOE). REAC/TS provides 24-hour direct or consultative assistance with medical and health physics problems associated with radiation accidents in local, national, and international incidents.

3.9 Subarea 1 Subarea 1 is defined as the areawivthin two miles from the Perry Nuclear Power Plant'which inciud'es&'two miles of Lake Erie.

3.10 "Lake" Evacuation Subarea If an affected area evacuation includes "Lake", it means that Lake Erie should be evacuated out -to 106mtiles.

3.11 General Emergency DefaultP Ais General Emergency Default ProtdCtive Action Recommendations (PARs) are based on the potentia -for1 rMAj' trelease of radioactive material from the Perry plant per the guidance set forth in Supplement 3 to

<NUREG-0654/FEMA-REP-l>. The intent of these PARs is to providea means of promptly implementing a minimum evacuati"on--for t-fie-enerai public within 5 miles downwind of the Perry Plant until a detailed assessment can be performed. Implicit in' these'PARs is that assessment actions will continue to determine what additiouial Protective actions are required to ensure the health and safety of the general public',

4.0 RESPONSIBILITIES 4.1 Emergency Coordinator

1. Approve plume exposure pathway protective action recommendations (PARs) for-the general public. ' '

2. Notify the State of Ohio, local counties, and NuclearRegulatory Commission (NRC) of changes in PARs for the general public developed by the Perry Plant.

3. Approve the use of Potassium Iodide (KI) by Radiation Monitoring Team (RMT) personnel.

EPI-B8 Page: 4 Rev.: 9 4.2 TSC Operations Manager

1. Assume the responsibilities of the Emergency Coordinator prior to the Emergency Operations Facility (EOF) being'operationa-l.^

2. Approve the usage of Potassium Iodide (KI)fohralJl ohsite Emergency Response Organization (ERO) personnel. <OPOOll>

4.3 Shift Manager

1. Assume the responsibilities of the TSCOperations Manager prior to the Technical Support Center '(TSC) being operational.

4.4 'EOF Offsite' Radiation Advisor 1.- Supervise the development of ptume'exposure pathway PAR for the general-public. '

2. Review PAR developed for tie' general public and recommend approval.

3. Recommend approval for the use of KI-fok RMT personnel.

4.5 TSC Radiation Protection Coordinator >:<POOO6'

-'1. Assume the responsibilities of- the EOF Offsite Radiation Advisor.

- -prior to-the EOF being operationi.'

2. Recommend approval for the use of KI for all onsite ERO personnel.

4.6 Shift Engineer

1. Review PARs developed for the general public prior to the TSC being operational.

2. Assist in estimating the duration'of a release 'and the prognosis for the restoration or failure of plant equipment/structures which may result in a release beiuig terminated or (re)initiated.

4.7 TSC/EOF Dose Assessor(s)  ;

1. Develop plume exposure pathway PARs'fo'r the general public per this instruction.

4.8' Shift:LeaAd Chemistry Technician

1. Assume responsibility for developing PARs_,for the general public prior to th-6 TSC being operatiopal.

4.9 TSC Operations Advisor/EOF Plant Operations Advisor

1. Assist in estimating the duration of a release and the prognosis for the restoration or failure of plant equipment/structures which may result in the release being terminated or (re)initiating.

EPI-B8 Page: 5 Rev.: 9 5.0 ACTIONS 5.1 Protective Action Logic -

5.1.1 Shift Lead Chemistry 'hchznician/Dose Assessor:

1. Use the PAR Declsion Flow Chart (Attachment 1), to determine the appropriate PAR.

If a PAR based on an actual or projected dose can not be determined within 10 minutes of the declaration of the General Emergency, use-the default PAR.developed per Attachment 1. A PAR upgrade shall'be made as part of a subsequent offsite, notifiscation.per. <EPI-Bl> based on projed'E~dor actual dose, when available, if warranted.

-- If the releas~ehas ot been terminated and an estimate on

-releaseduration-i'

' not immediately available from the Shift Engineer (SEl/TSC Operations Advisor/EOF Plant Operations Advisor, a 6 hour6.944444e-5 days <br />0.00167 hours <br />9.920635e-6 weeks <br />2.283e-6 months <br /> default release duration shall be, usd , -,

2. Submit the PARPaaoipg with supporting data, for review and subsequent approvalto the SE/TSC Radiation. Protection Coordinator (RPC)/EOF Offsite Radiation Advisor (ORA).

--- 'If the SE is not stationed (prior to transferring PAR responsibilities to the TSC), forward .the.PAR directly to the Shift Manager for approval.

3. Assist, when directed, in completing appropriate.,portions of the Initial Notification (PNPP No. 7794) and Follow-Up Notification (PNPP No. 7795).

4. Monitor potential upgrades or changes in the PAR based on degrading plant conditions or changes in wind direction or other meteorological conditions, and if warranted, recommend required PAR changes to the SE/TSC RKt/EOF'ORA'in accordance with logic contained in Attachment.l.

NOTE: Once 'a subarea is included in a PAR, it shall not be removed for subsequent. PAR's1.bas; onhangehanies in conditions. '.

5. Turnover PAR development duties from the Control Room to the TSC, and subsequently to the EOF, when directed.

5.1.2 Shift Engineer (SE)/TSC.Rkdiation Protection Coordinator (RPC)/ EOF Offsite Radiation Advisor (ORA):

1. Review PARs developed for the general public and recommend their approval based the PAR Decision Flowchart (Attachment 1).

EPI-B8 Page: 6 Rev.: 9

2. Ensure that changes in PARs, including their effect on existing subarea protective -actions' .re adeguately reflected in a

-timely manner on oftsite otificatiornsconducted per <EPI-Bi>.

If the release has-notbeeri'tetminated`and an estimate on release duration is not immediately available from the Shift Engineer (SE-)/TSC-Oeerat4.ons-Advisor/EOF Plant Operations Advisor, a C tou+/--~defauit release duration shall be used.

- 3.Provide clarification when required to facility staff on the factors considered in developing the PAR. '

4. Periodically review the PAR based on degrading plant conditions or changes in wind diretctionor' other meteorological conditions to ensure that required protective actions 'are being considered in.Acc6rdance with the PAR logic'outlined in Attachment 1

<P00029> '

NOTE: Once a subarea is included'in a PAR, it shall not be b

removed for Subse, t PARsbased on changes in conditions. -

5.-' Assist in completing appropriate poftions'of the Initial Notification (PNPP No. 7794) and Follow-Up Notification (PNPP No. 7795).

6. Ensure the coordinated-turnover of PAR development and review duties from the Control Room.to the TSC, and subsequently to the EOF. -.

5.1.3 Emergency Coordinator:

-1.' Determine if the -appropriate method was used to determine the PAR using :the PAR Decision Flow Chart (Attachment 1).

2. Approve PARs for the general public developed utilizing Attachment 1 and ensure that the State of Ohio, local counties, and the NRC are notified per <EPI-Bl>.

-- If a PAR based on an actual or projected dose can not be determined within 10 minutes of the declaration of the General Emergency, use the default PAR developed per

- -Attachment 1. ;--

3. Ensure that PAR is- periodically evaluated based on degrading plant conditions or changes in wind direction or other

-meteorological conditions using Attachment 1. <P00029>

NOTE: Once a subarea- is included in a PAR, it shall not be removed for'subsequent PAR's based on changes in conditions.., -

EPI-B8 Page: 7 Rev.: 9

'4`rtimely and qoodinated turnover qf. PAR approval

'ditesfrom e. tjroL to the T,,SC,,and -subsequently to the EOF, when the non-delegatable Emergency Coordinator responsibilities ant transferred per ,<EPI-A2>.

5.2 P6tassjum ro'dide"(XI) Di)stribution to Onsite Emergency Response Organization (ERO) iPersoin <H00022,OO 00024>

r -R NOTE: Recommending the use of KI by the general public is the responsibi~ity of the local County officials. The Perry Plant is nohrt .rspouigb :frrencommending the-use of KI for the general publiC -

5.2.1 TSC Radiation Piotec t -oCQ9rdinator:

1. Direct that the, f'o lowiq~g-information be recorded on a Potassium Iodide (KI) Tracking Form (PNPP No. 9177,

-Attachment 3) for each Control Room, TSC, Operations Support Center (OSC) and; EOF qttaff-memberwho has expeeded or may exceed an ,irbrorne. 4000 Deiived Air aonentrationo.

-Concentration (DACs) AND can not be relocated, dismissed, or have work activities altered to avoid receiving a dose of 1.0 Rem CDE to the ad tgthyroid (CDE child thyroid x 2):

a. Full name,

b. Social Securitv yNo.,

c. Employee's Section/Unit, and

d. Estimated date/time of exposure..

NOTE: KI is 90Z, effective if administered within 1 hour1.157407e-5 days <br />2.777778e-4 hours <br />1.653439e-6 weeks <br />3.805e-7 months <br /> after iMhalation or ingestion, and 50% effective if administered within 4 hours4.62963e-5 days <br />0.00111 hours <br />6.613757e-6 weeks <br />1.522e-6 months <br /> after inhalation or ingestioa, ,

2. Review completed form(s) and forward to TSC Operations Manager for approval.

5.2.2 TSC Operations Manager:

1.' Discuss with TSC Radiation Protection Coordinator whether sufficient As Low As Reasonably Achievable (ALARA) precautions have been taken in aieu of KI.

NOTE: Activation of the Back-up EOF per <EPI-All> should be initiated in lieu of issuing KI to EOF staff. KI should only be issued to EOF staff when necessary to allow for movement of personnel from the EOF, if needed, once deactivated.

EPI-B8 Page: 8 Rev.: 9

2. Once a need for KI is determined, approve the distribution of KI by signing t-he KI tbraci gfForm-(s) -;

3. Contact the Ohio Emergency Managernent'Agency (OEMA), using the-telephone number listed in the Emergency Response Telephone Directory, to obtain guidance from the Radiation Emergency Assistance Center/Training Site' CREAC/TS" on further issuance of KI to those individuals who were already issued the drug.

NOTE: A dosage of one tablet per day for ten days should be followed unless instructed otherwise after consulting with REAC/TS.

4. Order additional quantities of KI through the ODH, as required, using the telephone tiunQxer listed in the Emergency Response Telephone Directory.-

NOTE: Sufficient -K-is available onsite for three shifts per day for't~in days (except' for the EOF which only has limited quantities of KI for evacuation purposes). <PO00 1>'

5.2.3 Shift Manager/OSC Health Physics Supervisor/TSC Radiation Protection Coordinator/EOF Offsite Radiation Advisor:

1. Brief facility staff to be is'su'ued'iI on the possible side effects using the manufacturer's patient package insert located on the back of the WI Tracking Forms, and ensure that each

-:individual has no known allergi'es t6 iodide.

NOTE: Ingestion of1-K1, even as a precautionary measure, is a voluntary act and, therefore,. at the discretion of

-each individual.

2. Instruct each employee receiving KI to initial the KI Tracking Form.

3. Distribute one KI tablet (130 mg.) to'each authorized individual, and record the date/time issued on the KI Tracking Form.

NOTE: ' I is-stored in the E-Plan-equipment/supply cabinets in the Control Room, TSC Display Room, OSC Conference Room, and in the EOF Decontamination Room.

4. Do not dismiss staff members issued KI( until guidance on further KI usage can be obIained from REAC/TS.

P EPI-B8 Page: 9 Rev.: 9 5.3 Potassi'um Todide Kt), to PRNT.N ers.<HQ0022, H00024>--

5.3.1 TSC7;EOF Dose Assesso 1.' dentify to a QF. -ffsite Radiation Advisor the need to

,consicer .issuinF to.o R4MT members who have exceeded or may

-. e=xceed a dos-e of.9l Rem CDE to the adult thyroid (CDE - child I'f the EONS xs.not.operational, this concern shall be brought to6the attention of the TSC Radiation Protection Coordinator.

2. Once issuance of SKI has.,`been approved, ensure that RMT members are briefed on the possible side effects using the manufacturer's patient package insert located on the back of the KI Tracking.Form,,apd ensure that each individual has no -

known all ie ' iodide..

NOTE: Ihgestibon of-.KI, even as a precautionary measure, is a voluntary act and,'therefore,. at the discretion of ea ch indi idual) - -

3. Document RMT members concurrence to taking KI by having each individual initial on. the KI Tracking Form.,

a. If team is cqrrently- n the field, obtain a verbal concurrence furoi ea~ch RMT member and-document response in RMT Log. Direct RMT members to initial KI Tracking Form upon their return to the Perry Plant site.

4. Direct authorized RMT member(s) to take one KI tablet each (130 mg.).

NOTE: Orfe bottle of Ki ('14 tablets) each is stored in RMT Sampling Kit.

5. Record the date/time issued block on the KI Tracking Form, when notified by RMT member that he/she has ingested KI tablet.

6. Do not'dismiss RMT members issued KI until guidance on further KI usage'can be obtained from REAC/T$ by contacting the OEMA, using the'telephone. number listed in the Emergency Response Telephbne Directory.

5.3.2 EOF Offsite Radiation Advisor':

1.' Evaluate the need for KI and, if deemed necessary, direct that the following information be completed on a Potassium Iodide Tracking Form (PNPP No. 9177, Attachment 3) for each RMT member:

a. Full Name,

EPI-B8 Page: 10 Rev.: 9

b. Social Security No,.r  :

c. Employee's Section/Unit, and id. Estimated date/time of exposure.

NOTE: Per <EPI-B3>, movement of the RMTs shobuld be limited to monitoring the plume boundaries if an exposure of 1 Rem TEDE or 10 Rem CDE (adult thyroid) would be exceeded in traversing the plume.

2. Review the KI Tracking Form to ensure that above information on each individual is recorded; then forward tracking form to Emergency Coordinator for approval..

-- : If the EOF-is not-yet operational, the TSC Operations Manager will be responsible for apprqving issuance of KI.

3. Notify the TSC/EOF Dose Assessor(s) when approval is obtained for issuing KI.

4.. 'Contact the OEMA, using the telephone number listed in the Emergency Response Telephone Directory, to obtain guidance from

-REAC/TSon further issuance of KI to those individuals who were already-issued the drug.

5.3.3 BOF Emergency-Coordinator:

.1.. Discuss with EOF Offsite Radiation Advisor whether sufficient

-ALARA precautions have been. taken in lieu of KI and that adequate justification exists for issuance of KI.

2. Once the need for KI is determined, approve'the issuance of KI to RMT members by signing the completed KI Tracking Form(s).

EPI-B8 Rev.: 9 Attachment 1 Page: 11 PAR DECISION FLOWCHART A GeneDE oo Declared?

DEFAULT PAR71M9

/ Wi>,lNote:10Dmterwinddirection IsApreferred.

/ re Projected yes or~~ \ ~ <-~ ~ . ~~~vcae MlsDwwn Act2uaE TATDE or No,2&3

\ Available7? / . f

/ ~~~~~~DEFAULT PAR

- . - - i. ~~~~~~Evacuates 5 Miles Downwind es i  ;; Wind Direction AFECTED, SUBAREAS

- - t c . 1a~~~1 20 -to 2130 EVACUATE I & Lake*

/ \ .- ~~~~2140 to 2810° EVACUATE 1, 2 & Lake*

/ \ to 110

~~~~~~~~2820 EVACUATE 1, 2 & 3 120 to 330 EVACUATE I &3 Are TEDE Doses 340 to 1010 EVACUATE 1, 3 & Lake*

/ 2~>,1.00 E+00R .-

/ 1.00or,E\00 RNo No

• Lake Evacuation is out to 10 Miles Child Thyroid Doses k 5.00E+00 R

\ ~ate or Beyond .5

\ - ~Miles?/

'PAR BASED ON ACTUAL OR PROJECTED DOSE l Evacuates 10 Miles Downwind Wind Direction AFFECTED SUBAREA(S)

Yes 1020 to 2130 EVACUATE 1 & Lake

- o 2140 r_ , to.. 25R8 > EVAC JATE 1 2 L 4 LakA

• [mplernet PAR baseon _. -- _.

Ar4oketed Ioses 2590 to 2810 EVACUATE 1, 2,4, 5 & Lake 2820 to 3030 EVACUATE 1, 2, 3, 4 & 5 3040 to 3260 EVACUATE 1, 2. 3,4, 5 & 6 3270 to 3480 EVACUATE 1,2, 3,5, & 6 If TEDE Doses 2 1.00 E+00 R or 349 0 to 110 EVACUATE 1, 2, 3, 5, 6 & 7 Child Thyroid Doses 2 5.OOE+00 R 120 to 330 EVACUATE1, 3,6 & 7 are projected beyond 10 Miles, coordinate with State and county 340 to 560 EVACUATE1, 3, 6, 7 & Lake officials to determine an appropriate 570 to 1010 EVACUATE1,3,7&Lake Protective Action Recommendation.

EPI-B8 Rev.: 9 Attachment 2 Page: 12 I 10-Mile Emergency Planning Zone and, Evacuation Routes IZZJI1O-Mile Emergency Planning Zone (EPZ)

I.i:.:1Outide of 10-Mile EPZ l Hiff,,

in Evacuation Routes - Soundare I .s L'.

A,

( ( (

EPI-B8 Rev.: 9 Attachment 3 Sheet 1 of 2 Page: 13. , ' I S. . 'I

. t POTASSIUM IODIDE (KI) TRACKING FORM :: :

PNPP No. 9177 Rev. 2/26/02 EPI.B8 Recommended dose: 1 tablet/day 130 mg This form shall be completed by the Shift Manager for Control Room staff, Radiation Protection Coordinator for TSC staff (and RMTs priorto EOF activation), .OSC Health Physics Sup rvisor for OSC staff and Security personnel and Offsite Radiation Advisor for EOF staff and RMTs.- ___

EST DATE/IME INITIALS OF KI ISSUED TO: SOCIAL ' EMPLOYEE'S KI ISSUED AT EMPLOYEE

'(FUILL, NAlME) , , SECURITY No. 'SECTION/UNIT O EXPOSURE DATE TM RCVN_

DATE ., IM DATE TIME R K.

______________i________________________ , A I _____-,____

.,lAdAe a-.~>-;,

-  ; ' 'I' ', It.

o,0';'a:;.i ~. _ . - ; - - -- - . ' - _.  ; .' _ __ _ _ __ _ _ __ _ _

ij:,.

" : .'. i '., ,, =-'.-6, A S~~~~~~

~~- .;.,,pffj~,no

. ,,if l

1. :m': " i"  : 1 : "I

", k:. -

- "t,

" ,, I 1i L'. . ! .-..I Use Approved: .#

(per EPI-B8, Sect. 5.2)

1. Use of KI approved for only tthlose indivi uals listed ab~ove. CQmpleteaseparete trecking fprm to approve and document further Kl usage.

! 'I ,11 ' .

I - . - ".. , .  ; ~,

• Employee's initials indicate that he/she has read the information from the manufacturer's package insert located on the back of this form and understands that taking KI is voluntary. The employee also acknowledges that to the best of his/her knowledge he/she has no allergies to iodide.

R.R MEDI CA C

.D DISTRIBUTION. WHITE- FACILITYRECORDS CANARY- DISPENSARY (CORPORATE MEDICAL DIRECTOR)

EPI-B38 Rev.: 9 Attachment 3 Sheet 2 of 2 Page: 14 - LAST I POTASSIUM IODINE (KI) TRACKING FORM (PNPP No. 9177) ptient pdcale Insert For HOW POTASSIUM IODIDE WORKS Cdan forms of iodineelp your thyoid gland work righL Most ple get the iodine they need from foods, ike iodized salt or The thyroid can "store' or hold only a certain amount of THYRO-BwCKe Iodine.

TABLEI3 In a radiation eme ioctive Iodine may be released In the air. This iatenal be breathed or swallowed. It may POASUM IODIDE W USP) enter the thyrLd ghnd ma it he damage wouldprb-vanmad :KI)c- o wfyChildren are most lily to ye If ou take potasium iodide, it will fill up your thyroid gland.

This reduces the chance that harmful radioactive iodine will TAKE POTASSIUM IODIDE ONLY WHEN PUBLIC HEALTH enter the thyroid gland.

OFFICIALS TELL YOU. IN A RADIATION EMERGENCY, RADIOACTIVE IODINE COULD BE RELEASED NTO THE WHO SHOULD NOT TAKE POTASSIUM IODIDE AIR. POIASSIUM IODIDE (A FORM OF IODINE) CAN HELP The only people who should not take potassium iodide are peo-PROTECT YOLL ple who know they are allergic to iodide. You may take potassi-urn Iodide even ifyou are taking medicies for a thyroid problem YOU AAW THIS MEDICINE, TAKE IT ONE for exanmple, a thyroid hormone or antithyroit drug). Pregnant TIME EVERY 24 HOURS. DO NOT TAKE IT MORE OFTEN. and nursing women and babies and children may alIo take this drug.

MORE WILL NOT HELP YOU AND MAY INCREASE THE RSK OF SIDE EFPECIS. DO Nor TAXI TI DRUG F YOU KNOW HOW AND WHEN TO TAKE POTASSIUM IODIDE YOU ARE ALLERGIC TO IODIDED jSEE SIDE EFFECTS BELOW.) Polassium Iodide should be taken as soon as pos berp c

health ofisa tdl you. You sould take on e dosc vay 24 =ou More will not help you because the thyroid cma "hold" only limited amounts of iodine. Larger doses will increase the risk of side effects. You will probably be told not to take the drug for more than 10 days.

INDICATIONS THYROID BLOCKING IN A RADIATION EMERGENCY SIDE EFFECTS ONLY. Usually, side effects of potassium iodide happen when people take higher doses for a long time. You should be careful not to DIRECTIONS FOR USE take more than the recommended doseor take it for longer than Use only as directed by State or local public health authorities you are told. Side effects are unlikely because of the low dose in the event of a radiation emergency. and the short time you will be taking the drug.

DOSE Possible side effects include skin rashes, swelling of the salivary ublets: ADULTS AND CHILDREN 1YEAR OF glands. and 'iodism" (metallic taste. burning mouth and throat, AGE OR OLDER: One (11tablet once sore teeth and gums, symptoms of a head cold, and sometimes a dn, Crush for small childrn. stwnach upset and diarrhea).

BABIES UNDER I YEAR OF AGE: A few people have an alergic reaction with more serious symni One-half (%)tablet once a day. Crush first. ptoms.-These could be fever and joint painsm or swelling of parts of the face and body and at times severe shortness of breat re-like for 10 da unless directed otherwise by State or local pub. quiring immaediate medical attention.

lie health =uthorites. bking iodide may raely cause overactivity of the thyroid glarc underactivity of the thyroid gland, or enlargement of the thyroid Store at 0

controlled room temperature between i and 30PC (59Y gland (goiter).

to W6 F). Keep container tightly dosed and protect from light.

WARNING WHAT TO DO IF SIDE EFFECT OCCUR If the side effects are severe or Ifyou have an allergic reaction, Pbumium cde shoid no: be uWsf bpople allergicto Wcdd Keep stop taking potassium iodide. Then. if possible, call a doctor or out of reach of children. In case of overdose or allergic reaction, public health authority for instructions.

contact a physician or the public health authority.

DESCRIPTION HOW SUPPLIED Each THYRO-BLOCKt TABLET contains 130 mg of potassium THYRO.BLOCK' TABLETS 1pbtassium Iodide Miblets. USPI iodide. Other ingredients: magnesium stearate, mncrocrystaline bottles of 14 tablets INDC 0037.o 072n20. Each white, round, cellulose, silica gel, sodium thiosulfate. scored tablet contains 130 mg potassium iodide.

WALLACE LABORATORIES DIvision of CARTER-WALLACE, INC.

Cranbury. New Jersey 08512 IN 0472-0l Rev 2185