ML13083A103

NRC Form 361N - Non-Power Reactor (NPR) Event Notification Worksheet

ML13083A103
Person / Time
Issue date:	10/31/2019
From:	NRC/OCIO/GEMSD/IMSB
To:
References
OMB 3150-0238
Download: ML13083A103 (2)

Text

Page of NRC FORM 361N U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-0238 EXPIRES: 10/31/2022 (10-2019) OPERATIONS CENTER Estimated burden per response to comply with this voluntary collection request: 30 minutes. The information provided will be used for evaluation of licensee event description, facility status and for input to the public website.

Send comments regarding burden estimate to the Information Services Branch (T-6 A10M), U.S. Nuclear Regulatory NON-POWER REACTOR (NPR) Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-0238), Office of Management and Budget, EVENT NOTIFICATION Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information WORKSHEET collection.

EN #

NRC OPERATIONS TELEPHONE NUMBERS: PRIMARY - 301-816-5100 or 800-532-3469, BACKUPS - [1st ] 301-951-0550 or 800-449-3694,

[2nd] 301-415-0550 and [3rd] 301-415-0553. Licensees who maintain their own ETS are provided these telephone numbers.

FAX - 301-816-5151, EMAIL - hoo.hoc@nrc.gov Notification Time Facility or Organization Name of Caller Call Back #

Event Time & Zone Event Date Power/Mode Before Power/Mode After Reactor Type Max Power Max Pulse Pulse Inserted During Event?

EVENT CLASSIFICATIONS REPORTABLE CONDITION (Varies by facility TS)

GENERAL EMERGENCY GEN/AAEC TS Deviation ADEV Accident Mitigation AIND SITE AREA EMERGENCY SIT/AAEC TS Required S/D ASHU Offsite Medical AMED ALERT ALE/AAEC RPS Actuation (scram) ARPS Loss Comm/Asmt/Response ACOM UNUSUAL EVENT UNU/AAEC Offsite Notification APRE Invalid Specified System Actuation AINV SAFEGUARDS EVENT (73 App G) Degraded Condition ADEG SUSPICIOUS ACTIVITY MATERIAL/EXPOSURE Unanalyzed Condition AUNA SECURITY EVENT INFORMATION ONLY NNF Specified System Actuation AESF OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)

OTHER UNSPECIFIED REQMT. (see last column) Safe S/D Capability AINA NONR Control of Rad Release AINC NONR Description (Include: System affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continue on Page 2)

WILL NOTIFICATIONS YES NO BE Anything Unusual or not understood? Yes (Explain above) No HQ NPR STAFF Did all systems function as required? Yes No (Explain above)

STATE(s)

LOCAL Mode of operation until corrected (if applicable)

OTHER GOV AGENCIES Estimate for restart date:

MEDIA/PRESS RELEASE Additional Information continued on next page? Yes No NRC FORM 361N (10-2019) Continued on next page

Page of NRC FORM 361N U.S. NUCLEAR REGULATORY COMMISSION (10-2019)

NON-POWER REACTOR (NPR) OPERATIONS CENTER EVENT NOTIFICATION WORKSHEET (Continued) EN #

RADIOLOGICAL / CHEMICAL RELEASES: CHECK OR FILL IN APPLICABLE ITEMS (specific details/explanations should be covered in event description)

Liquid Release Gaseous Release Unplanned Release Planned Release Ongoing Terminated Monitored Unmonitored Offsite Release T.S. Exceeded RM Alarms Areas Evacuated Personnel Exposed or Contaminated Offsite Protection Actions Recommended *State release path in description Release Rate (Ci/sec)  % T.S. Limit HOO Guide Total Activity (Ci)  % T.S. Limit HOO Guide Noble Gas 0.1 Ci/sec 1000 Ci Iodine 10 Ci/sec 0.01 Ci Particulate 1 Ci/sec 1 mCi Liquid (excluding tritium and dissolved 10 Ci/min 0.1 Ci noble gas)

Liquid (tritium) 0.2 Ci/min 5 Ci TOTAL ACTIVITY List of Safety Related Equipment not Operational Event Description (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continued from Page 1)

NRC FORM 361N (10-2019)