ML040160055

Various Checklists for the Monticello Initial Examination - September 2003

ML040160055
Person / Time
Site:	Monticello
Issue date:	09/23/2003
From:	Allex G Nuclear Management Co
To:	NRC/RGN-III
References
50-263/03-301, ES-201, ES-201-1 50-263/03-301
Download: ML040160055 (28)

Text

VARIOUS CHECKLISTS FOR THE MONTICELLO INITIAL EXAMINATION - SEP 2003

ES-201 Examination Preparation Checklist Form ES-201-1 (R8,Sl)

Target Date*

Task Description i Reference Facility: MONTICELLO

-\\

Chief Examiner's Initials Date of Examination: 9/23 - 26/2003

-7

-7 15.. Proctoring/written exam administration guidelines reviewed with facrli-ty licensee and authorization granted to give written exams (if applicable) (C.3.k)

16. Approved scenarios, job performance measures, and questions distributed to NRC examiners (C.3.i)

-120 I 2. NRC examiners and facility contact assigned (C.l.d; C.2.e)

-120

-1 20

4. Corporate notification letter sent (C.2.d) lm

3. Facility contact briefed on security & other requirements (C.2.c) v

\\

Y '

[-go]

[5. Reference material due (C.l.e; C.3.c)l dIA

~~

-75

6. Integrated examination outline(s) due (C.l.e & f; C.3.d)

/

-70

7. Examjnation outline s reviewed by NRC and feedback provided to facility licensee (d4.h; C.3.e)

-45

8. Proposed examinations, supporting documentation, and reference materials due (C.l.e, f, g & h; C.3.d)

-30

9. Preliminary license applications due (C.?.I; C.2.g; ES-202) r&

-1 4

10. Final license a lications due and assignment sheet prepared (C.1.I; c.2.g; E!?202)

-1 4

-1 4

11. Examination ap roved by NRC supervisor for facility licensee

12. Examinations reviewed with facility licensee (C.l.j; C.2.f & h; C.3.g) review (C.2.h; c3.f)

-7

13. Written examinations and o erating tests approved by NRC supervisor (c.2.i; c.3.1)

V

-7

14. Final applications reviewed; assignment sheet updated; waiver letters sent (C.2.g, ES-204)

V -

I

h d cc) d 0

cc) d-

+

ai-I I.

I T

cv 0

il

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ES-403 Written Examination Grading Form ES-403-1 A-~

'W Quality Checklist

/' ;

c-I t

-+

4.

Grading for all borderline cases (80% +/- 2%) reviewed in detail

+

J C L $4

5.

All other failing examinations checked to ensure that grades are justified I t

3.

Performance on missed questions checked for training deficiencies and wording problems; evaluate validity of questions missed by half or more of the applicants 1

L df Printed Name / Signature Date

a. Grader

/c d-03 I. Facility Reviewer(*)

NRC Chief Examiner (*)

CO /a /*3

1. NRC Supervisor (*)

/+&3

• )

The facility reviewer's signature is not applicable for examinations graded by the NRC; two independent NRC reviews are required.

5 of 5 NUREG-1021, Revision 8, Supplement I

MONTICELLO -- - 2003 From Pre-Validation Material Submittal d

d d

d Form ES-301-6, 'Competencies Checklist" d

Form ES-301-3, "Operating Test Quality Checklist" Form ES-301-4, "Simulator Scenario Quality Checklist" Form ES-301-5, "Transient and Event Checklist" Form ES-401-7, "Written Examination Quality Checklist" RO & SRO

I ES-301 ODeratina Test Qualitv Checklist Form ES-301-3 Facility:

Date of Exhination:

Operatii

1. GENERAL CRITERIA

a.

The operating test conforms with the previously approved outline; changes are consistent with sampling requirements (e.g., 10 CFR 55.45, operational importance, safety function distibution).

There is no day-today repetition between this and other operating tests to be administered during this examination.

The operating test shall not duplicate items from the applicants' audit test(s)(see Section D.1.a).

Overlap with the written examination and between operating test categories is within acceptable limits.

b.

C.

d.

e.

It appears that the operating test will differentiate between competent and less-than-competent applicants at the designated license level.

1

2. WLK-THROUGH (CATEGORY A 8 B) CRITERIA

a.

Each JPM includes the following, as applicable:

. initial conditions 9 initiating cues

+ references and tools, including associated procedures 3 reasonable and validated time limits (average time allowed for completion) and specific

. specific performance criteria that include:

designation if deemed to be time critical by the facility licensee

- detailed expected actions with exact criteria and nomenclature

- system response and other examiner cues

- statements describing important observations to be made by the applicant

- criteria for successful completion of the task

- identification of critical steps and their associated performance standards

- restrictions on the sequence of steps, if applicable

b.

The prescripted questions in Categoly A are predominantly open reference and meet the criteria in Attachment 1 of ES-301.

Repetition from operating tests used during the previous licensing examination is within acceptable 1,imits (30% for the walk-through) and do not compromise test integrity.

C.

d.

At least 20 percent of the JPMs on each test are new or significantly modified.

3. SIMULATOR (CATEGORY C) CRITERIA

a.

The associated simulator operating tests (scenario sets) have been reviewed in accordance with Form ES-301-4 and a copy is attached.

Printed Name I Signature

a. Author Test Number:

Initials Date

b. Facility Reviewer(')

NOTE:

The facility signature is not applicable for NRC-developed tests.

1. Independent NRC reviewer initial items in Column "c;" chief examiner concurrence required.

23 of 26 NUREG-1021, Revision 8, Supplement 1

/LJ---J I

I

ES-301 Simulator Scenario Quality Checklist Form ES-3014 I'

Facilitv:

MONTICELLO Date of Exam:

9/15/03 Scenario Numbers:

1 / 2 / 3 Owratina Test No. 03-01 QUALITATIVE ATTRIBUTES en it is to be initiated

3.

IO.

The scenarios have been validated. Any open simulator performance deficiencies have been evaluated to ensure that functional fidelity is maintained while running the planned scenarios.

Every operator will be evaluated using at least one new or significantly modified scenario. All other scenarios have been altered i

11.

All individual operator competencies can be evaluated, as verified using Form ES-301-6 (submit the form along with the simulator scenarios).

NUREG-1021, Revision,& Supplement 1 24 of 26 n

ES-301 Simulator Scenario Quality Checklist Form ES-301-4 ime compression techniques are used, the scenario summary clearly so indicates, Operators ve sufficient time to carry out expected activities without undue time constraints. Cues are 4

11, All individual operator competencies can be evaluated, as verified using Form ES-301-6 (submit the form along with the simulator scenarios).

NUREG-1021, Revision 8, Supplement 1 24 of 26

tl Reactivity Normal Instrument /

Component Mainr ES-301 Transient and Event Checklist Form ES-301-5

~

1 2

2 5

3 1

1 1

5 6, 5,6, 5, 6, 4,6, 1

1 4

294, 394, 3,4, 2, 3, 9

9 a

a 1

7, a 7, a 7,g 7

OPERATING TEST NO.:

03-01 I

I I

I activitv Applicant Evolution Minimum Scenario Number I Number M 1

1 1 12 12 15 RO As RO Re&,.....,

NIA NIA N/A N/A Instrument /

2 2, 5 3, 5, 4, 6, 2, - 3, Normal 0

Component Major 8

7, 8 7, 8 7, 9 7

1 Reactivity Normal Instrument /

SRO-U SRO-I NIA N/A NIA N/A NIA N/A NIA N/A NIA N/A NIA NIA 0

1 2

As Component Major SRO N/A N/A N/A N/A 1

1 2

2 5

3 1

1 1

Reactivity 0

Normal 1

- 4, 3,4, 2, 3, Instructions: (1)

(2)

(3)

Author:

NRC Reviewer:

Enter the operating test number and Form ES-D-1 event numbers for each evolution type Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.4.d) but must be significant per Section C.2.a of Appendix D.

Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicants competence count toward the minimum requirement.

NUREG-1 021, Revision 8, Supplement 1

ES-30 I Competencies Checklist Form ES-30 1-6 Competencies Understand Plant Notes:

(I) Includes Technical Specification compliance for an RO.

(2) Optional for an SRO-U.

(3) Only applicable to SROs.

Instructions:

Circle the applicant's license type and enter one or more event numbers that will allow the examinek to evaluate every applicable competency for every applicant.

Author:

NRC Reviewer:

NUREG-I 021, Revision 8, Supplement 1 26 of 26 I

I

Written Examination Form ES-401-7 ES-401 Quality Checklist c

Facility: M~yl$;

c e Date of Exam:. 9 / I </o 3 Exam Level: RO/@

Item Description a

1.

2.

3.

Questions and answers technically accurate and applicable to facility

a. NRC WAS referenced for all questions

b. Facility learning objectives referenced as available ROlSRO overlap is no more than 75 percent. and SRO auestions are aDDroPriate per Section D.2:d of E M 0 1 Question selection and duplication from the last two NRC licensing exams appears consistent with a systematic sampling process

4.

I

5.

Question duplication from the license screeninglaudit exam was controlled as the audit exam was completed before the license exam was started; or the examinations were developed independently; or the licensee certifies that there is no duplication; or other (explain) percent from the bank at least 10 percent new, and the rest modified); enter the actual question distribution at right the exam (including 10 new questions) are ind' ted below (check the item tha!applies)-and appears appropriate:

~-

- ?

the audit exam was systematically and Idomly developed; or

6.

Bank use meets limits (no more than 75 Bank Modified New 3

9 88 4

7.

Between 50 and 60 percent of the questions on Memory CIA

%2 written at the comprehension/analysis level; enter the actual question distribution at right

8.

9.

Referenceslhandouts provided do not give away answers Question content conforms with specific WA statements in the previously approved examination outline and is appropriate for the Tier to which they are assigned; deviations are justified Question psychometric quality and format meet ES, Appendix B, guidelines The exam contains 100, one-point, multiple choice items; the total is correct and

10.

11.

agrees with value on cover sheet

~

I 1

1 Printed Name I Signature Initial

~.. -p C#

-P Date

a. Author Note:

The facility reviewer's initiaMsignature are not applicable for NRC-developed examinations.

1. Independent NRC reviewer initial items in Column "c:" chief examiner concurrence required, NUREG-1021, Revision 8, Supplement 1 42 of 46

.~........,.

ES-401 Written Examination-

~

Form ES-401-7 Quality Checklist icensing exams

5.

Question duplication from the license screening/audit exam was controlled as indi ted below (check the item thakapplies) and appears appropriate:

the audit exam was completed before the license exam was started; or the examinations were developed independently; or

-the licensee certifies that there is no duplication; or other (explain) percent from the bank at least I O percent new, and the rest modified); enter the actual question distribution at right the exam (including 10 new questions) are written at the comprehensionlanalysis level; enter the actual question distribution at right Referencedhandouts provided do not give away answers Question content conforms with specific WA statements in the previously approved examination outline and is appropriate for the Tier to which they are assigned; deviations are justified Question psychometric qualii and format meet ES, Appendix B, guidelines vi;"

he audit exam.3s systematically and randomly developed; or

6.

Bank use meets limits (no more than 75 Bank Modified New 5 7 88 72 5 -

7.

Between 50 and 60 percent of the questions on Memory CIA

8.

9.

IO.

1 1.

The exam contains 100, one-point, multiple choice items; the total is correct and agrees with value on cover sheet mi; Printed Name I Signature Date

a. Author

b. Facility Reviewer (*)

c. NRC Chief Examiner Note:

• The facility reviewer's initialslsignature are not applicable for NRCdeveloped examinations.

1. Independent NRC reviewer initial items in Column "c;" chief examiner concurrence required.

NUREG-1021, Revision 8, Supplement 1 42 of 46

MONTICELLO - 2003 a

From Post-Validation Material Submittal d

d d

d Form ES-301-6, "Competencies Checklist" d

Form ES-301-3, "Operating Test Quality Checklist" Form ES-301-4, "Simulator Scenario Quality Checklist" Form ES-301-5, "Transient and Event Checklist" Form ES-401-7, "Written Examination Quality Checklist" RO & SRO

ES-301 ODeratina Test Quality Checklist Form ES-301-3 Date of Examination: q / Z ~ / o j Operatin Facility: Ho~#,~,,t2~

1. GENERAL CRITERIA

a.

The operating test conforms with the previously approved outline; changes are consistent with sampling requirements (e.g., 10 CFR 55.45, operational importance, safety function distribution).

There is no day-today repetition between this and other operating tests to be administered during this examination.

The operating test shall not duplicate items from the applicants' audit test(s)(see Section D.1.a).

Overlap with the written examination and between operating test categories is within acceptable limits.

b.

C.

d.

e.

It appears that the operating test will differentiate between competent and less-than-competent applicants at the designated license level.

' ' 2. WAkTHROUGH (CATEGORY A 8 B) CdTERlA

a.

Each JPM includes the fpllowing, as applicable:

• initial conditions

. initiating cues

. references and tools, including associated procedures

. reasonable and validated time limits (average time allowed for completion) and specific

. specific performance criteria that include:

designation if deemed to be time critical by the facility licensee

- detailed expected actions with exact criteria and nomenclature

- system response and other examiner cues

- statements describing important observations to be made by the applicant

- criteria for successful completion of the task

- identification of critical steps and their associated performance standards

- restrictions on the sequence of steps, if applicable

b.

The prescripted questions in Categoly A are predominantly open reference and meet the criteria in Attachment 1 of ES-301.

Repetition from operating tests used during the previous licensing examination is within acceptable limits (30% for the walk-through) and do not compromise test integrity.

At least 20 percent of the JPMs on each test are new or significantly modified.

C.

d.

3. SIMULATOR (CATEGORY C) CRITERIA

a.

The associated simulator operating tests (scenario sets) have been reviewed in accordance with Form ES-301-4 and a copy is attached.

Printed Name I Signature

a. Author

b. Facility Reviewerr)

c. NRC Chief Examiner (#)

d. NRC Supervisor Test NumberXE Initials Date 55/03 NOTE:

The facility signature is not applicable for NRCdeveloped tests.

1. Independent NRC reviewer initial items in Column "c;" chief examiner concurrence required.

23 of 26 NUREG-1021, Revision 8, Supplement 1

ES-301 Simulator Scenario Quality Checklist Form ES-301-4

/

..e-the point in the scenario when it is to be initiated the malfunction(s) that are entered to initiate the event the symptomskues that will be visible to the crew the expected operator actions (by shift position) the event termination point (if applicable)

) is incorporated into the scenario without IO.

Every operator will be evaluated using at least one new or significantly modified scenario. All other scenarios have been altered in accordance with Section D.4 of ES-301.

J NUREG-1021, Revision 8, Supplement 1 24 of 26

'W 11 TARGET QUANTITATIVE ATTRIBUTES (PER SCENARIO; SEE SECTION D.4.D)

1.

Total malfunctions (5-8)

2.

Malfunctions after EOP entry (1-2)

3.

Abnormal events (2-4) pP

4.

Major Transients (1-2)

5.

6.

7.

Critical tasks (2-3)

EOPs enteredlrequiring substantive actions (1-2)

EOP contingencies requiring substantive actions (0-2)

ES-301 Simulator Scenario Quality Checklist Form ES-301-4 ActualAttributes I -"f-I - 11 6 1 I 1 1 I 5 x 1 1 1 1 I 1 1 I 1 1 I 3 1 I

3.

Each event description consists of the point in the scenario when it is to be initiated the malfunction(s) that are entered to initiate the event the symptomdcues that will be visible to the crew the expected operator actions (by shift position) the event termination point (ii applicable)

7.

If time compression techniques are used, the scenario summary clearly so indicates, Operators

9.

The scenarios have been validated. Any open simulator performance deficiencies have been evaluated to ensure that functional fidelity is maintained while running the planned scenarios.

10.

Every operator will be evaluated using at least one new or significantly modified scenario. All other scenarios have been altered in accordance with Section 0.4 of ES-301.

NUREG-1021, Revision 8, Supplement 1 24 of 26

'W Reactivity Normal Instrument I Component Maior ES-301 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO.:

03-01 1

2 2

5 1

0 NIA N/A NIA N/A 2

2, 5 3, 6, 3

2, 3, a

I 7, a 7, a 7

7 As RO Reactivity Normal Instrument I SRO-U NIA NIA NIA N/A 0

1 NIA NIA NIA N/A 2

NIA NIA NIA N/A SRO-I I

Component Major As SRO 1

NfA NfA NIA NIA Instructions:

(1)

(2)

(3)

Author:

NRC Reviewer:

Enter the operating test number and Form ES-D-1 event numbers for each evolution type Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.4.d) but must be significant per Section C.2.a of Appendix D.

Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count toward the minimum requirement.

NUREG-1021, Revision 8, Supplement 1

Competencies Checklist Form ES-301-6 ES-301

'd i30?

OATC Ch 5 I

II B p l i c a n t f f l I

m 2

A~pI&3#3 RO RO-I/SRO-U R SRO-RO-U RO RO-I RO-U Competencies SCENARI 0 Understand and Interpret Diagnose Events Comply With and Operate Control

&,I/ 57, Communicate and Comply With and dlr d& Nlq Pin N h Ntl Use Tech. Specs. (3)

Notes:

(I) Includes Technical Specification compliance for an RO.

(2) Optional for an SRO-U.

(3) Only applicable to SROs.

Instructions:

Circle the applicant's license type and enter one or more event numbers that will allow the examiners to evaluate every applicable competency for every applicant.

Author:

NRC Reviewer:

NUREG-I021, Revision 8, Supplement 1 26 of 26 i:::

r

c

-u "3

It:::....

L L

c -_

i/

'W Written Examination Form ES-401-7 ES-401 Quality Checklist Facility: M&q

// b Date of Exam: 7/!22h3 Exam Leve-RC 1 I Initial Item Description a

b*

I.

2.

Questions and answers technically accurate and applicable to facility

a. NRC WAS referenced for all questions

b. Facility learning objectives referenced as available than 75 percent, and SRO questions are appropriate icensing exams

5.

Question duplication from the license screening/audit exam was controlled as indicated below (check the item that applies) and appears appropriate:

d h e audit exam was systematically and randomly developed; or the audit exam was completed before the license exam was started; or the examinations were developed independently; or the licensee certifies that there is no duplication; or other (explain) percent from the bank at least 10 percent new, and the rest modified); enter the actual question distribution at right the exam (including 10 new questions) are written at the comprehensionIanalysis level; enter the actual question distribution at right Referenceslhandouts provided do not give away answers

6.

Bank use meets limits (no more than 75 Bank Modified New 4

9 87

7.

Between 50 and 60 percent of the questions on Memory CIA vo Go

8.

9.

Question content conforms with specific WA statements in the previously approved examination outline and is appropriate for the Tier to which they are assigned; deviations are justified Question psychometric quality and format meet ES, Appendix B, guidelines I O.

11.

The exam contains 100, one-point, multiple choice items; the total is correct and agrees with value on cover sheet Printed Name I Signature Date

3. Author

3. Facility Reviewer p)

2. NRC Chief Examiner (#)

1. NRC Regional Supervisor Vote:

• The facility reviewer's initialslsignature are not applicable for NRC-developed examinations.

1. Independent NRC reviewer initial items in Column "c;" chief examiner concurrence required.

NUREG-1021, Revision 8, Supplement 1 42 of 46 7

9 3

P 7

7 7

9 7

7 7

b.. :

ES-401 Written Examination Form ES-401-7 Quality Checklist 0

Facility:

/cloyt - f ; C c Z / i ~

Date of Exam: Y h - 2 h.3 Exam Level:. R e

5.

Question duplication from the license screening/audit exam was controlled as indicated below (check the item that applies)-and-appears appropriate:

&e audit exam was systematically and randomly developed; or the audit exam was completed before the license exam was started; or the examinations were developed independently; or the licensee certifies that there is no duplication; or other (explain)

I I

I k

6.

Bank use meets limits (no more than 75 Printed Name / Signature Date

a. Author

b. Facility Reviewer (*)

c. NRC Chief Examiner (#)

d. NRC Regional Supervisor Note:

The facility reviewer's initialskignature are not applicable for NRC-developed examinations.

1. Independent NRC reviewer initial items in Column "c;" chief examiner concurrence required.

NUREG-1021, Revision 8, Supplement 1 42 of 46 I'

I t

Monticello Nuclear Generatinu Plant Operated by Nuclear Management Company, LLC October 29,2003 L-MT-03-078 I O CFR 55.40 Mr. Pete Peterson NRC Chief Examiner USNRC, Region Ill 801 Warrenville Road Lisle, IL 60532-4351 MONTICELLO NUCLEAR GENERATING PLANT DOCKET 50-263 LICENSE NO. DPR-22 OPERATOR LICENSE POST-EXAMINATION DOCUMENTATION - EXAMINATION SECURITY AGREEMENT Reference 1 :

NUREG-I 021, Operator Licensing Examination Standards for Power Reactors, Revision 8, Supplement I Reference 2:

NMC letter to NRC, Operator License Post-Examination Documentation, dated October 3, 2003 Pursuant to the requirements of Reference 1, Section ES-501, Initial Post-Examination Activities, and as committed to in Reference 2 Nuclear Management Company, LLC (NMC) is providing the NRC with a completed ES-201-3 form, Examination Security Agree men t.

If you have any questions, please contact Gerard Lashinski, General Supervisor, Operations Training (763-295-1 531 ) or John Fields, Senior Regulatory Affairs Engineer (763-295-1 663).

Thomas J. Palmisano Site Vice President, Monticello Nuclear Generating Plant Nuclear Management Company, LLC CC:

Regional Administrator, USNRC, Region 111, w/o Roger D. Lanksbury, USNRC, Region Ill, w/o 2807 West County Road 75 0 Monticello, Minnesota 55362-9637 Telephone: 763.295.51 51 0 Fax: 763.295.1454

Attachment I NUCLEAR MANAGEMENT COMPANY, LLC MONTICELLO NUCLEAR GENERATING PLANT DOCKET 50-263 FORM ES-201-3, EXAMINATION SECURITY AGREEMENT 5 pages follow 1-1

t -

~ f l ) ~ p 203 iLa Nkc EXA-Examination Security Agreement Form ES-201-3 ES-201

1.

Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week@) of 9hdG-3 as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by ihe NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore,'l am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2.

Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of ?/40.3. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE (I)

DATE SIGNATURE (2) DATENOTE NOTES:

NUREG-1021, Revision 8, Supplement 1 24 of 24

ES-201 Examination Security Agreement Form ES-201-3

1.

Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of f!!5!0) as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore,I am aware of the physical security measures and requirements (as documented in the facility licensees procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations andlor an enforcement examination security may have been compromised.

2.

Post-Examination action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that 1,

To the best of my knowledge, 1 did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of 9/%%/,3. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or pr6vide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) DATENOTE NOTES:

NUREG-1021, Revision 8, Supplement 1 24 of 24

\\

ES-201 Examination Security Agreement Form ES-201-3

1.

Pre-Examination I acknowledge that 1 have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 9kk3 date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2.

Post-Examination To the best of my know1 dg, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week@) of 97P78.3. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

as of the PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SlGNATURE (2) DATENOTE NOTES:

NUREG-1021, Revision 8, Supplement I 24 of 24

• - L J NLC Is~&.&\\

lyNCr, ZDO?>

Form ES-201-3 ES-201 Examination Security Agreement

?.

Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of y/kd2 J as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as,documented in the facility licensees procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2.

Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of $!?/03

. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

1 1

PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (I)

DATE SIGNATURE (2) DATENOTE NOTES:

24 of 24

I I

I I

ES-201 Examination Security Agreement Form ES-201-3 I

1.

Pre-Examination I

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations schedbled for the week(s) of '-?h</$.l as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRCFurthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations andlor an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2.

Post-Examination I

To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of *;/?/0'4

. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

I PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) DATENOTE NUREG-1021, Revision 8, Supplement 1 24 of 24