ML13319A846
ML13319A846 | |
Person / Time | |
---|---|
Site: | Clinton |
Issue date: | 08/19/2013 |
From: | David Reeser NRC/RGN-III/DRS/OLB |
To: | AmerGen Energy Co |
Shared Package | |
ML11354a433 | List: |
References | |
Download: ML13319A846 (21) | |
Text
2013 CLINTON POWER STATION INITIAL LICENSE EXAMINATION ADMINISTRATIVE FILES
- To: Dave Reeser, NRC Chief Examiner From: Tony Jennings, Clinton Power Station ILT 12-1 NRC Exam Author Date: 9/9/13
Subject:
ILT 12-1 NRC Exam Post Exam Submittal Package Enclosed you will find the ILT 12-1 NRC Exam Submittal Package for the ILT 12-1 NRC Exam administered from 8/19/13-8/30/13.
Package contents are as follows:
o Tab 1 - Memo to Reeser regarding questions asked by the candidates during the written exam.
o Tab 2- ES-403-1 Written Exam Grading Quality Checklist o Tab 3- TQ-AA-151-Fll Exam Comment Sheet o Tab 4- TQ-AA-224-F200 Post Examination Test Item Analysis forms for the RO and SRO written exams o Tab 5- Written Exam Seating Chart o Tab 6- ES-401-7 and ES-401-8 forms I examinee answer sheets o Tab 7- ILT 12-1 NRC SRO Written Exam Answer Key o Tab 8- ILT 12-1 NRC RO Written Exam Answer Key This package does not contain the completed ES-201-3 "Examination Security
- Agreement" forms. The completed forms will be mailed when all personnel have signed off the security agreement.
As previously discussed, please hold the contents of the written exam from public disclosure for a period of two years.
Sincerely, Tony Jennings
MEMORANDUM
- To:
From:
Date:
Subject:
Dave Reeser, NRC Chief Examiner Tony Jennings, Clinton Power Station ILT 12-1 NRC Exam Author 09/09/2013 ILT 12-1 NRC WRITTEN EXAMINATION ADMINISTRATION During the administration of the ILT 12-1 NRC Written Examination, the following questions were asked by the candidates and the associated facility response.
Question Question Question Facility Response Number ID R0-8 896299 What is suppression pool level? You have sufficient information to answer the question as written.
R0-22 896313 What is the trend of the parameter No trend information is necessary shown in the stem? to answer the question.
R0-45 896336 What is the status of SLC Pump You have sufficient information to
'B'? answer the question as written.
What is the trend in SLC tank level?
R0-64 896355 Question stem states A 1 in the Clarified that the stem should read first sentence and 1A in the A1 in both sentences. Provided
- R0-17 R0-34 896308 896325 second sentence.
Can I assume the Main Steam Line Plugs are installed?
being referred to in choice D?
info to all candidates.
Only assume conditions supported by the question stem.
Which RPV level instruments are You have sufficient information to answer the question as written.
R0-37 896328 At what point in the LPRM You have sufficient information to upscale to downscale oscillation answer the question as written.
was the LPRM bypassed?
R0-65 896356 Is there flow in the 'B' VC train? You have sufficient information to answer the question as written.
SR0-15 896381 Do we have a dedicated operator You have sufficient information to stationed? answer the question as written.
For R0-17, I discussed the question posed by the candidate with the Chief Examiner and provided the response listed above based on that discussion.
The remainder of the questions did not require NRC Chief Examiner notification and did not require any pen and ink changes made to the master examination .
- Letter number 1 08/31/11 U.S. Nuclear Regulatory Commission- Region Ill ATTN : Operator Licensing Branch 2443 Warrenville Road - Suite 210 Lisle, IL 60532-4352 Clinton Power Station, Unit 1 Facility Operating License No. NPF-62 NRC Docket No. 50-461
Subject:
Written Exam 2013-301 Challenges
- It is not our intent to challenge any questions pertaining to the 2013-301 written exam, administered on 08/29/13.
Dan Snook Operations Training Manager Clinton Power Station
ES-403 Written Examination Grading Form ES-403-1
- Facility: Clinton Quality Checklist Date of Exam: 08/29/2013 Exam Level: RO [81 SRO [81 Initials Item Description a b c
- 1. Clean answer sheets copied before grading
- 2. Answer key changes and question deletions justified and documented
- 3. Applicants' scores checked for addition errors (reviewers spot check >25% of examinations)
- 4. Grading for all borderline cases (80% +/- 2% overall and 70 or 80, as applicable,+/- 4% on the SRO-only) reviewed in detail
- 5. All other failing examinations checked to ensure that grades are justified
- 6. Performance on missed questions checked for training deficiencies and wording problems; evaluate validity of questions missed by half or more of the applicants Printed Name I Signature Date
- a. Author
- b. Facility Reviewer(*)
- c. NRC Chief Examiner(*)
- d. NRC Supervisor(*)
8/29/13
(*) The facility reviewer's signature is not applicable for examinations graded by the NRC; two independent NRC reviews are required .
- ES-403, Page 5 of 5
/
- TQ-'-151-F11 Revision 0 Page 1 of 2 Exam Comment Sheet Date: 8129113 Submitted By: ...:..T~.J=e=n:..:..:n.:.:....:in~gs=--------- IZI RO IZI SRO Sheet 1 of g_
Exam Section(s): 1Z1 Written I 1Z1 Walk-Through I 1Z1 Simulator Scenario Test Item (Question/JPM/Scenario, etc.) Concern or Problem Recommended Resolution Reference Remarks R0-8 Candidate wanted to None N/A Facility response was that know the value of the candidate had suppression pool level in sufficient information to the question stem. answer the question as I
written.
I R0-22 Candidate wanted to None NA Facility response was that know the trend of the the candidate had parameter indicated in sufficient information the question stem. necessary to answer the question without trend information.
R0-45 Candidate wanted to None N/A Facility response was that know the status of SLC the candidate had Pump 'B' and the trend in sufficient information to SLC Tank Level. answer the question as written.
R0-64 Candidate pointed out Agreed - clarified question to NA Corrected typographical that the equipment was the examinees. Corrected error in the exam bank.
identified as 'A1' in the typographical error in the exam first sentence of the stem, bank.
and as '1A' in the second sentence of the stem.
R0-17 Candidate wanted to None N/A After consulting with the know if he could assume CE, told the candidate to that the MSL Plugs were assume only those installed. conditions supported by the question stem.
SRRS: 30.100; Retain this document until all regulatory actions associated with the exam are complete, at which time it may be discarded.
/"
R0-34
- Candidate wanted to None
- NA TQ-AA-151-F11 Revision 0 Paae 2 of 2 Facility response was that know which RPV Level the candidate had Instruments were being sufficient information to referred to in choice D. answer the question as written.
R0-37 Candidate wanted to None NIA Facility response was that know at what point in the the candidate had LPRM upscale to sufficient information to downscale oscillation answer the question as was the LPRM bypassed. written.
R0-65 Candidate wanted to None NA Facility response was that know if there was flow in the candidate had the 'B' VC train. sufficient information to answer the question as written.
SR0-15 Candidate wanted to None NA Facility response was that know If we had a the candidate had dedicated operator sufficient information to stationed. answer the question as written .
. L__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ * * - - L_______.------~-------
~
~--~-----~~ '------------------------
Additional comments: No comments were provided by the students concerning the Walk-Through or Simulator Scenarios.
Exam Analyzer comments:....;N..;;.o=n...:.;e=---------------------------------------
Final Resolution: As described above.
Reviewed byC.-J!f:k"'*-./l£¥3~
Facili
- g.be)):> Approved by: \:::::.o~A<.- * - A / 1 I/H -. --,
SRRS: 30.100; Retain this document until all regulatory actions associated with the exam are complete, at which time it may be discarded.
TQ-AA-224-F200
=M, Exelon Generation Revision 3 Page 1 of 4 Post Examination Test Item Analysis Individual Exam Analysis Lesson Plan I Course: ILT 12-1 Examination No./
Title:
- 1. Check the results of the examination.
a) D Small class (~6) and some questions were missed by three (3) or more students. Analysis required for these questions.
b) ~ Large class (>6) and some questions were missed by more than 30% of the class. Analysis required for these questions.
c) D Analysis of questions requested by individual.
d) D None of the above apply and no further analysis is necessary.
- 2. If an analysis is to be performed, list the question number(s) on the question analysis worksheet and review each using the following guidelines. Record the results on the worksheet.
a) Review each question to ensure it is worded clearly and is not ambiguous. Ensure that it is properly constructed. Refer to JA-AA-222-0020, Test Item Design and Approval Job Aid".
b) Review each question to ensure that it ties properly to the learning objectives' condition, performance, and standard .
c) Review each question to ensure that it is technically accurate.
d) Review each question to ensure that adequate material was presented to allow for achievement of the associated learning objective.
- 3. Determine if action is required for problem questions (e.g. delete from examination bank; revise question, revise lesson plan, etc.). When action is required, ensure an assignment is initiated for documentation and tracking purposes.
Comments: Reviewed each of the questions listed on page 2 with the ILT 12-1 examinees. All candidates agreed that the questions were technically correct as written and did not require any changes. Discussed correct answers with the candidates to remediate knowledge weaknesses.
/
Completed Byy.;j~UJ rV\~
"' j Date: .'11 ~ \\3 Assignment Tr~cking NuMb(<s): rJ PJV' Answer Key Change I Examination Re-grade I Authorized by: Group Lead I Date
- Retention Requirement per SRRS ID 30.125 Training Documentation Required for Accreditation 2 Yrs
TQ-AA-224-F200 Revision 3 Page 2 of 4 QUESTION ANALYSIS WORKSHEET Vision KIA Construction Objective Technically LP Content Change Question Number ObjiD Category OK? Based? Accurate? Acceptable? Needed?
(Y- N) (Y- N) (Y- N) (Y- N) (Y- N)
LP85804.2.4. 600000AKI.02 y y CL-ILT -887857 A y y N 25 CL-ILT-812587 LP87552.0l. 295025EA2.03 y y y y N 02 CL-ILT-812589A 241000.03 295005/2.1.19 y y y y N CL-ILT-887713A 08400601.0 295003/2.4.9 y y y y N 1.04 CL-ILT -889265 300201.01 215004 I 2.1.25 y y y y N CL-ILT-812632A 245008.11 245000K5.07 y y y y N CL-ILT -812636A 259002.03 259001A3.04 y y y y N CL-ILT-812640 2.1.45 08400901.04 y y y y N CL-ILT-812646A 2.3.7 LP85803.2.3.7 y y y y N
- Retention Requirement per SRRS 10 30.125 Training Documentation Required for Accreditation 2 Yrs
TQ-AA-224-F200 Revision 3 Page 3 of 4 Cumulative Post Examination Test Item Analysis Program I Course:
Examination No./
Title:
- 1. Perform this analysis on all accredited initial program examinations that lead to a final comprehensive exam(s) for the duration of the course, or a period determined by the CRC, when any of the below apply:
a) 0 Program/Course contains> 3 examinations b) D Program/Course spans> 6 weeks c) D Required as a result of CRC decision
- 2. Exam results data shall be analyzed following each exam administered using the cumulative data to identify potential weak areas that are crosscutting over the span of the program. Action(s) to address identified weak areas should be taken throughout the duration of the program. The method for completing this analysis is as follows:
a) Record analysis data on the Cumulative Examination Analysis Worksheet(s) or electronic equivalent as follows:
- i. Record Examination number.
ii. Review each question missed by individual students to determine what key knowledge area I objective and system I lesson plan was tested or needed to be known. (use individual
- cumulative analysis worksheet) iii. For each identified question, record the key knowledge area I objective and system I lesson plan on the analysis worksheet(s).
iv. Review the results for potential weak areas (key knowledge area I objective and system I lesson plan) for each individual student for all examinations for the program to date.
- v. Provide identified weak area determinations to each student, and initiate improvement plans for high miss areas.
Analysis Results (Improvement plans required?):
Completed By: Date:
Improvement Plan Reviewed by: I
~--------------------------------------~G-r~ou~JpLeadiDrue
- Retention Requirement per SRRS ID 3D.125 Training Documentation Required for Accreditation 2 Yrs
TQ-AA-224-F200 Revision 3 Page 4 of 4 INDIVIDUAL CUMULATIVE EXAMINATION ANALYSIS WORKSHEET Training Program: Student I ID:
Exam Question System I Lesson Plan Key Knowledge Area I Objective Number Number
- Retention Requirement per SRRS 10 30.125 Training Documentation Required for Accreditation 2 Yrs
TQ-AA-224-F200 Revision 3 Page 1 of 4 Post Examination Test Item Analysis Individual Exam Analysis Lesson Plan I Course: ILT 12-1 Examination No.I
Title:
- 1. Check the results of the examination.
a) D Small class (::;6) and some questions were missed by three (3) or more students. Analysis required for these questions.
b) ~ Large class (>6) and some questions were missed by more than 30% of the class. Analysis required for these questions.
c) D Analysis of questions requested by individual.
d) D None of the above apply and no further analysis is necessary.
- 2. If an analysis is to be performed, list the question number(s) on the question analysis worksheet and review each using the following guidelines. Record the results on the worksheet.
a) Review each question to ensure it is worded clearly and is not ambiguous. Ensure that it is properly constructed. Refer to JA-AA-222-0020, Test Item Design and Approval Job Aid".
b) Review each question to ensure that it ties properly to the learning objectives' condition, performance, and standard .
c) Review each question to ensure that it is technically accurate.
d) Review each question to ensure that adequate material was presented to allow for achievement of the associated learning objective.
- 3. Determine if action is required for problem questions (e.g. delete from examination bank; revise question, revise lesson plan, etc.). When action is required, ensure an assignment is initiated for documentation and tracking purposes.
Comments: Reviewed each of the questions listed on page 2 with the ILT 12-1 examinees. All candidates agreed that the questions were technically correct as written and did not require any changes. Discussed correct answers with the candidates to remediate knowledge weaknesses.
Completed By: )
Answer Key Change I Examination Re-grade I Authorized by: Group Lead I Date
- Retention Requirement per SRRS ID 30.125 Training Documentation Required for Accreditation 2 Yrs
TQ-AA-224-F200 Revision 3 Page 2 of 4 QUESTION ANALYSIS WORKSHEET Vision KIA Construction Objective Technically LP Content Change Question Number ObjiD Category OK? Based? Accurate? Acceptable? Needed?
(Y- N) (Y- N) (Y- N) (Y- N) (Y- N)
CL-ILT-896508 223001.14 2950 IOAA2.02 y y y y N CL-ILT-812665 239001.14 239001A2.03 y y y y N CL-ILT-887295A LP85804.2.4. 2.4.46 y y y y 46 N
- Retention Requirement per SRRS 10 30.125 Training Documentation Required for Accreditation 2 Yrs
TQ-AA-224-F200 Revision 3 Page 3 of 4 Cumulative Post Examination Test Item Analysis Program I Course:
Examination No./
Title:
- 1. Perform this analysis on all accredited initial program examinations that lead to a final comprehensive exam(s) for the duration of the course, or a period determined by the CRC, when any of the below apply:
a) D Program/Course contains > 3 examinations b) D Program/Course spans> 6 weeks c) D Required as a result of CRC decision
- 2. Exam results data shall be analyzed following each exam administered using the cumulative data to identify potential weak areas that are crosscutting over the span of the program. Action(s) to address identified weak areas should be taken throughout the duration of the program. The method for completing this analysis is as follows:
a) Record analysis data on the Cumulative Examination Analysis Worksheet(s) or electronic equivalent as follows:
- i. Record Examination number.
ii. Review each question missed by individual students to determine what key knowledge area I objective and system I lesson plan was tested or needed to be known. (use individual
- cumulative analysis worksheet) iii. For each identified question, record the key knowledge area I objective and system I lesson plan on the analysis worksheet(s).
iv. Review the results for potential weak areas (key knowledge area I objective and system I lesson plan) for each individual student for all examinations for the program to date.
- v. Provide identified weak area determinations to each student, and initiate improvement plans for high miss areas.
Analysis Results (Improvement plans required?):
Completed By: IDate:
Improvement Plan Reviewed by: I Group Lead I Date
- Retention Requirement per SRRS ID 30.125 Training Documentation Required for Accreditation 2 Yrs
TQ-AA-224-F200 Revision 3 Page 4 of 4 INDIVIDUAL CUMULATIVE EXAMINATION ANALYSIS WORKSHEET Training Program: Student I ID:
Exam Question System I Lesson Plan Key Knowledge Area I Objective Number Number
- Retention Requirement per SRRS 10 30.125 Training Documentation Required for Accreditation 2 Yrs
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 'l$h.,-) )39)17 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 (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). 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 knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of X.\ 1~ It i. 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 I RESPONSIBILITY SIGNATURE (1) DATE DATE NOTE
~-l~l r?#k 6.
7.
'Ywr:t. ~o ~Gr
-~;
- 10. <1I7Uot:;;;:.
5@ ' ~ ?f'i~P At' .. 167.-
- 11. /<.0 . . ' .. .
~ ;: cOf, ~~(.0 *~
ES-201, Page 27 of 28 f:>rH:":"*r~,,,.
R .:: \.# t:1 I vtttJ
~cp -~
~b tC, 7 -.2M~
Ula'
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) ofz),.PJ~Sil~Qh3as 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 (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). 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 li~nsee. 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.dr, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of 8L' , 'l . 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 I RESPONSIBILITY DATE DATE NOTE Attfl.o~ ~k.ntt ciQkf9~t.. ~~
JeJf NOldEn.
M.ltU-Jo"'" L.Y. ..
Dav*,). \Ue.\\s, foil
-j.c.-.r.\~ $,.;..\"'~
Reqc.'J'I' ('
.5E'NIC.IZ. 'REAcrck.
$b'&\-Mo114e,.U
~Jt,rO~-\t,r OQ<I" .,.,..,.,.
OPERAToR =_sl_~ _
'f/t*t>
r-',,,n 5-13-13 5-H-iJ.:il~
S~t<..~s-,,.,-;
- 1/f(o
~::;;-
G)-11-1'3
'1-ll*(}
-JH";--
- =
> q i13t-:;.
.-..,L~~Q~~====--~-!H3 _ _
---"--"""""Mn,.L-J......_,~--~-:7-rleacf,.,- CJt>~....._f,r St.llib... tU"~ i:J~~ /". r ,..,_ EZ - , *~ L-~-~~
- ~ ~~~~~">==
4~/L_
~* * -~ nr * - > (~ ~ f:}~~t6 TetUJ;;J -~-erfil.il?I -* 74Y'<<~ /? rfijj_~
.:SEI'ItoL /LMt:'f'o,( o(JUA1i>r£ ~
ES-201, Page 27 of 28
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 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 (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). 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 knowlfdge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of 8 t<zft'l:l . 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 I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE
!:" ---* * * :-:*-:- ... " ' 7 - - I Ac!nU.n. C'.li!u.tqj-(it!#P- (p-1.2-1.3 ~:'v~
-;rA~LJ J!f'=
' I ~ VI f.* l vwee" :;.._-:
~
' , I(- rxy C
- 8. 'ltf£ S)t)FffJL - . '<
L'C(I f*J,:.-),3 '" - ..... ~ " ..r s,ev N~* ,, * -.vo*-*- (.L6L..,.J!nrkv:chc J::t..T '/. (~ --- -
O/'.J IMJi\.<..1-'e-.ko.. ~*I!!>
o ps i'Vt s-*~ h.-r 9 ( tt (c "5 I>' CAS<-' C..< - ... ~
ES-201, Page 27 of 28
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 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 (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback}. 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 know~dye, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s} of 9 1? . 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 I RESPONSIBILITY SIGNATURE (1} DATE SIGNATURE (2} DATE NOTE
- 1. ,Mcr.J.-~1"0"1th <4>1 &11YV0J.v= ~----- f/lh/1; ~ __t/7/1-:>
- 2. ----
- 3. ----
- 4. ----
- 5. ----
- 6. ----
- 7. _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- 8. _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- 9. _ _ _ _ _ _ _ _ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- 10. ----
- 11. ----
- 12. ----
- 13. ----
- 14. ----
- 15. ----
NOTES:
ES-201, Page 27 of 28
- ES-201
- Examination Security Agreement Form ES-201*3
- 1. Pre-Examination I acknowledge that I have acquired speciali2:ed knowledge about the NRC licensing examinations scheduled for the week(s) of 1$) '"' ~ l h2/1 ? 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 (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). 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 knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of Y,\ !'"')I 1 '- 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 I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE
,.W'WA-t" o w u v w
,.. '\: ..... *"~
C....OP!J('dcf=*.y?p.
t.f\(")~ l--...J£;... .A..A
'if"'~~?o/...v(
t.......rJ ~ . .._,...,
~¥~ ............-?: , -----
' - ~~.tr::[//4
...... ,"\ ,,..; ~ ~~
- <<~.::=.--~ ;
":' .:::~~*- ijj[i ~*~";"' _ --
~~
l'Yl~Ac.n~ Si).ALU./t'lCUl ~'T ----
..Se*viMo&. <:no~"fo/t __ - -
( *~U{Y! _1./j,U-r:pn 5{1 fl.
~~ U;f?/to/ ~ ----
~;:>~o
~ fk ES-201 , Page 27 of 28