ML16214A268

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Revision 009 to Emergency Radiological Equipment Maintenance and Inspection RPM 4.8.5., Health Physics Operations Procedure.
ML16214A268
Person / Time
Site: Millstone  Dominion icon.png
Issue date: 07/25/2016
From:
Dominion Nuclear Connecticut
To:
Document Control Desk, Office of Nuclear Reactor Regulation
References
RPM 4.8.5, Rev 009
Download: ML16214A268 (41)
v • d • e


Text

T!PCK02 PASSPORT DOCUMENT To DOCUMENT CONTROL DESK Facility MP Department TRANSMITTAL Address U.S. NUCLEAR REGULATORY COMMISSION DOCUMENT CONTROL DESK (0140)

WASHINGTON, DC 20555-0001 1 From Date/Time CONTROLLED 07/25/16 13:10 DOCUMENTS 1Tr1 Trans No. 000156142 Transmittal Group Id: 1610972 Total Items: 00011 Item Facility Type Sub Document Number I Title Sheet Revision Doc Date Copy # Media Copies MP. PROC HP RPM 4.8.5 009 p 01

  • 0001 EMERGENCY RADIOLOGICAL EQUIPMENT MAINTENANCE INSPECTION ]REF. 6.2!

MP PROC HP RPM 4.8.5-001 008 p 01

  • 0002 EMERGENCY RESPONSE FACILITY READINESS CHECK REPORT MP PROC HP RPM 4.8.5-003 007 p 01
  • 0003 EMERGENCY OPERATIONS FACILITY TEAM 3 MP PROC HP RPM 4.8.5-004 007 p 01
  • 0004 EMERGENCY OPERATIONS FACILITY TEAM 4 MP PROC HP RPM 4.8.5-005 007 p 01
  • 0005 EMERGENCY OPERATIONS FACILITY TEAM 5
  • 0006 MP PROC HP RPM 4.8.5-013A 009 p 01 EMERGENCY OPERATIONS FACILITY SPARE RMT KIT
  • 0008 MP PROC HP RPM 4.8.5-019 005 p 01 OCA CHECKPOINT AND OFF-SITE EMERGENCY RESPONDER DOSIMETRY

TIPCK02 PASSPORT DOCUMENT To  : DOCUMENT CONTROL DESK Facility  : MP Department : TRANSMITTAL Address  : U.S. NUCLEAR REGULATORY COMMISSION DOCUMENT CONTROL DESK (0140)

WASHINGTON, DC 20555-0001 2 From  : CONTROLLED DOCUMENTS Date/Time  : 07/25/16 13:10 Trans No.  : 000156142 Transmittal Group Id: 1610972 Total Items: 00011 Item Facility Type Sub Document Number I Title Sheet Revision Doc Date Copy# Media Copies

  • 0010 MP PROC HP RPM 4.8.5-025 007 p 01 NAP
  • 0011 MP PROC HP RPM 4.8.5-029 000 p 01 BUILDING 532 OVER WATER MONITORING LOCKER Please check the appropriate response and return form to NDS Bldg 475/3 Millstone Power Station or Fax to 860-440-2057.

§ All documents received.

Documents noted above not received (identify those not received) .

I no longer require distribution of these documents.

Date: Signature: ~~~~~~~~~~~~~~~~~~~~~~~~

~~

~*~Dominion Technical Procedure Approval Page of Instructions for completing this form are included in AD-AA-100.

1. Procedure Number 2. Revision 3. Change Type & No. 4.Page 5. Effective Date (If not approval date)

RPM 4.8.5 009 00 & 00 of 07/26/2016

6. Procedure Title 7. Expiration Date Emergency Radiological Equipment Maintenance and Inspection [Ref. 6.2]
8. Type of Request D New Procedure [gJ Revision D Deletion D Vendor Procedure Change: D Minor Revision D OTO - Permanent Revision Required D OTO - No Permanent Revision Required
9. Has a Condition Report (CR) Been Submitted? 0Yes [gj No CR No.:
10. Reason and Description of Change Step 4.4.7 was modified to include notifying EP ifthere are discrepancies during inventory that will take greater than 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> to resolve.
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? D Yes [gJ No
15. Does this procedure require a 50.59 / 72.48 Evaluation (Form No. 730947)? D Yes [gJ No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-D Yes [gJ No designated procedure that requires a 50.59 I 72.48 Screen?

A change or addition to any of the following:

D Purpose D Acceptance Criteria or Tolerances D "Level of Use" D Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s) D Yes [gJ No D The method for meeting a commitment D Reactivity Management

19. A change that adds or deletes a subsection, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, involves a less conservative method for performing a task, or affects equipment qualification?

D Yes [gJ No 20 A change that decreases personnel safety or fire protection effectiveness? D Yes [gJ No

21. A change that modifies, relocates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level II/Ill Inspector is required. For OTOs and MRs, QIC or Level 11/111 Inspector initial here .) D Yes [gJ No
22. A change to CAUTION or WARNING statements? This does not include adding CAUTJON or WARNING statements. D Yes [gJ No
23. A*changeto*a procedure marked "Infrequently Conducted or Complex Test or Evolution"? D Yes [gJ No
24. Requestor/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Brandon L. Graber I Jean B. Olsen 04/01/2016 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place N/A in blocks 35 and 36.
32. Required Approval Authority (Print Name) 34. Date P. Michael Bradley 07/21/2016
35. SRO Approval For Changes (Print Name) 37. Date 38 Site Vice President Approval, If Required (Print Name) 39. Site Vice President Approval, If Required (Signature) 40. Date NOTE: The individual(s) posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Forms is updated .

. Nuclear E-Forms Updated for Site(s)? 42. Nuclear E-Forms Updated Print Name/Signature 43. Date 0 MP 0 NA 0 SU ~ NIA Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EOP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730682(April 2015)

I*

  • MILLSTONE POWER STATION HEALTH PHYSICS OPERATIONS PROCEDURE Emergency Radiologic~(~quipment Maintenance and Inspeft.~~q [Ref. 6.2]

~M-~~s~$

      • 'i \R~~- 009 .

Approval Date: 07/21/16 Effective Date: 07/26/16

  • Level of Use Information
  • Millstone All Units Health Physics Operations Procedure Emergency Radiological Equipment Maintenance and Inspection [Ref. 6.2]

TABLE OF CONTENTS

1. PURPOSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2. PREREQUISITES .............................................. 4
3. PRECAUTIONS ................................................ 4
4. INSTRUCTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4.1 Inventory Package Preparation ............................... 5 4.2 Kit or Locker Inventories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4.3 Equipment Restoration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 4.4 Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
5. REVIEW AND SIGNOFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
  • 6.

7.

REFERENCES ................................................. 9

SUMMARY

OF CHANGES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 ATTACHMENTS AND FORMS RPM 4.8.5-001, "Emergency Response Facility Readiness Check Report" RPM 4.8.5-003, "Emergency Operations Facility, Team 3" RPM 4.8.5-004, "Emergency Operations Facility, Team 4" RPM 4.8.5-005, "Emergency Operations Facility,cTeam 5" RPM 4.8.5-009, "Emergency Operations Facility" RPM 4.8.5-011, "Unit 2 Control Room" RPM 4.8.5-013A, "Emergency Operations Facility Spare RMT Kit" RPM 4.8.5-015, "Unit 2 Personnel Decon Room Emergency Personnel Decon Kit" RPM 4.8.5-016, "SAP" RPM 4.8.5-019, "OCA Checkpoint and Off-Site Emergency Responder Dosimetry"I RPM 4.8.5-020, "Unit 3 Control Room" RPM 4.8.5-021, "Technical Support Center Locker" RPM 4.8.5-022A, "Technical Support Center TSC Kit" RPM4.8.5 Level of Use *sfoF> .. 'THINK Rev. 009 Information .,_, *..-.

1of10

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  • ATTACHMENTS AND FORMS, CONT'D RPM 4.8.5-022B, "OSC Assembly Area Kit and Locker Building 475, 1st floor" RPM 4.8.5-024, "Unit 3 Personnel Decon Room Emergency Personnel Decon Kit" I

RPM 4.8.5-025, "NAP" RPM 4.8.5-027, "Security Station Emergency Dose Rate Equipment" RPM 4.8.5-029, "Building 532, Over Water Monitoring Locker" I

  • Level of Use Information STOP . THINK ACT REVIEW RPM4.8.5 Rev. 009 2of 10

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  • 1. PURPOSE 1.1 Objective This procedure ensures that the emergency radiological monitoring and protection equipment and other specified supplies at the Emergency Response Facilities are available when needed. It also ensures that the equipment is found in appropriate quantities, and is maintained in its proper operating condition, as required by Unit 2 Technical Specification 6.12 and Unit 3 Technical Specification 6.8.4 (b ).

1.2 Discussion This procedure is provided to ensure that:

  • The minimum quantity of equipment is found at the locations specified on the inventory forms. [Ref. 6. 7 and 6.9]
  • Radiological equipment is found to be in satisfactory working condition.
  • Respiratory equipment has been inspected using guidance from RP-AA-163, "Inspection and Inventory of Respiratory I

Protection Equipment."

Inventory seals are placed on kits by the Calibration Laboratory Technicians solely as an indication to them if the kits have been broken open between inventories.

This procedure impacts aspects of the Millstone Emergency Plan. Any changes to this procedure require evaluation under 10CFR50.54(q) to ensure that the effectiveness of the Emergency Plan has not been impacted.

1.3 Frequency This procedure is to be completed in first, second, third, and fourth quarter of each year. The intent is to be as consistent as possible in the time frame of each inspection; avoid scheduling in January of the first quarter and June of the second quarter. This procedure shall also be completed on a post drill and on an as needed basis. [Ref. 6.7 and Ref. 6.8]

  • Level of Use Information STOP THINK :ACT 'REVIEW RPM4.8.5 Rev. 009 3of10

i ' ~ ':!.

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  • 2. PREREQUISITES 2.1 General N/A 2.2 Documents 2.2.1 RP-M-163, "Inspection and Inventory of Respiratory Protection Equipment" 2.3 Responsibilities 2.3.l Supervisor EC&I approves and makes changes to RPM 4.8.5-001through4.8.5-029. I 2.3.2 Emergency Preparedness Specialist approves changes to RPM 4.8.5-001through4.8.5-029. [Ref. 6.7] I 2.4 Definitions 2.4.1 Emergency Response Facility (ERF)- Facilities containing emergency equipment (including radiological monitoring and protection equipment) which are activated in the event of an incident class ALERT or above classification. The station ERFs include:
  • Emergency Operations Facility

.. Control Rooms

  • North Access Point Assembly Area
  • South Access Point Assembly Area 2.4.2 EC&I - Exposure Control and Instrumentation
3. PRECAUTIONS NIA
  • Level of Use Information THINK. ACT
  • l

/ ,'

REVIEW RPM4.8.5 Rev. 009 4of10

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  • 4. INSTRUCTIONS 4.1 Inventory Package Preparation 4.1.1 RECORD the following on RPM 4.8.5-001:
  • Date
  • Reason for Inventory
  • Kits to be Inventoried 4.1.2 For each kit or locker to be inventoried, SELECT and DATE the corresponding form from RPM 4.8.5-003 through 4.8.5-028.

4.2 Kit or Locker Inventories [Ref. 6.8 and 6.10]

4.2.l SELECT a kit or locker and PERFORM inventory as follows:

  • CHECK and RECORD quantity found.

.. Where indicated on form, RECORD instrument serial numbers and calibration due dates.

" IF kit or locker contains potassium iodide tablets, silver zeolite cartridges, or emergency lantern batteries AND items will expire prior to the next quarterly inventory, REPLACE items and RECORD expiration date where indicated on form.

  • REPLACE the following on dates indicated on form:
  • Batteries
  • TLDbadges
  • Finger rings
  • IF kit or locker contains respirators, Refer To RP-AA-163, "Inspection and Inventory of Respiratory Protection Equipment," and ENSURE respiratory equipment tags are correct and RECORD inspection date where indicated on form .
  • Level of Use Information

$TOP THINK REVIEW RPM4.8.5 Rev. 009 5of10

  • " IF kit or locker contains equipment with batteries or sources, ENSURE the following:
  • Calibration due dates are current
  • Battery condition is satisfactory
  • Source response is satisfactory

" . IF any equipment is found missing OR is removed, RECORD the following information on RPM 4.8.5-001:

" Kit and, if applicable, section title

  • Description of deficiency
  • Actions to be taken to correct deficiency 4.3 Equipment Restoration 4.3.1 WHEN all items have been checked, RESTORE equipment as
  • follows:

a.

b.

ENSURE all Ludlum 177 meters are on and plugged in.

ENSURE all equipment other than Ludlum 177 meters are off.

c. PLACE stop watches in "RUN" mode to relieve spring tension.
d. Neatly REPLACE equipment in storage location.

4.3.2 RESTORE any missing or removed equipment within 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />.

[Ref. 6.10]

4.3.3 IF any equipment can not be restored within 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />, NOTIFY Supervisor EC&I.

  • Level of Use Information
  • sTQP THINK .ACT REV.iEW RPM4.8.5 Rev. 009 6of10
  • 4.3.4 IF any missing or removed items are restored prior to sending RPM 4.8.5-001 to Supervisor EC&I, PERFORM the following:
a. RECORD date deficiency was corrected on RPM 4.8.5-001.
b. RECORD date equipment was returned on the applicable kit or locker inventory form.
c. RECORD quantity of equipment returned on applicable kit or locker inventory form.

4.4 Documentation 4.4.1 RECORD any inventory comments on RPM 4.8.5-001.

4.4.2 SIGN and DATE completed kit or locker inventory form.

4.4.3 IF there are more kits or lockers to be inventoried, Go To Section 4.2.

4.4.4 WHEN all kits or lockers have been inventoried, SIGN and DATE RPM 4.8.5-001.

  • Supervisor I EC&I 1-I 4.4.5 4.4.6 COMPILE completed kit or locker inventory form(s) and RPM 4.8.5-001 and SUBMIT package to Supervisor EC&I for review.

REVIEW RPM 4.8.5-001 and inventory forms for inventory deficiencies.

4.4.7 WHEN any missing or removed item is restored, PERFORM the following:

a.. RECORD date deficiency was corrected on RPM 4.8.5-001.

b. RECORD date equipment was returned on the applicable kit or locker inventory form.
c. RECORD quantity of equipment returned on applicable kit or locker inventory form .
  • Level of Use Information STOP .THINK *'. .. ACT* REVIEW RPM4.8.5 Rev. 009 7of10

.. i

  • d. IF missing or removed item will take greater than 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> to resolve, NOTIFY EP of the following:
  • the discrepancy
  • the compensatory actions
  • the date when the item will be restored 4.4.8 REVIEW and SIGN inventory form(s).

4.4.9 REVIEW and SIGN RPM 4.8.5-001.

4.4.10 SEND a copy of RPM 4.8.5 -001 to Station Emergency Preparedness Specialist. [Ref. 6. 7 and 6.8]

4.4.11 SEND inventory forms to HP Calibration Laboratory to be filed.

Calibration 4.4.12 Refer To the following and MAINTAIN original inventory forms Technician and RPM 4.8.5-001 as instructed:

  • RM-AA-101, "Record Creation, Transmittal and Retrieval" I
  • . Health Physics Nuclear Records Retention Schedule (NRRS)
  • Level of Use Information STOP THINK ACT' REVIEW RPM4.8.5 Rev. 009 8of10

I ,.

  • 5. REVIEW AND SIGNOFF 5.1 The review and signoff for this procedure is located on RPM 4.8.5-001 through 4.8.5-029, of this procedure.
6. REFERENCES 6.1 NUREG-0654, FEME-REP-1, Rev. 1, "Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants,"Section II, Part H 6.2 NUREG-0737, "Supplement 1 to NUREG-0737 - Requirements for Emergency Response Capability (Generic Letter No. 82-33)," dated December 17, 1982.

. 6.3 Millstone Nuclear Power Station Emergency Plan, Appendix E, "Emergency Equipment," Rev.17, June 1995.

6.4 EPPCR-94-22, "Emergency Planning and Health Physics Improvements" 6.5 EPPCR-95-05, "Silver Zeolite Cartridges" 6.6 EP-95-023, "Operational Support Center Change," T. J. Dembek dated January 6, 1995.

6.7 NOV VIO 50-245, 336, 423/97-81-02 and CR M3-97-4483 6.8 NU Letter A02567, Combined Inspection No. 50-245; 50-336; 50-423, "MNPS, Unit Nos. 1, 2, & 3 Response to Notice of Violation," dated September 18, 1982, specifies frequencies of inventories, operations checks, change out and replacement schedule for items* having-limited shelf life. It also specifies replacement for instruments taken for calibration and collectively states that finger rings will be provided in the on-site emergency monitoring team kits and at the EOE 6.9 NU Letter, dated 12/27/76. Emergency Plan equipment is on an inventory list.

6.10 NU Letter, dated 12/27/76. Emergency Plan equipment is replaced in a timely manner.

6.11 Unit 2 Technical Specification 6.12 6.12 Unit :j Technical Specification 6.8.4(b)

  • Level of Use Information

$TOP THINK.

<l\dt 'REVfEW RPM4.8.5 Rev. 009 9of10

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  • 6.13 Memo EP-98-127, "Implementation of Millstone Emergency Plan Revision #24," from Mark White to Millstone HP Management Personnel 6.14 USNRCEmergency Preparedness Position (EPPOS 1) on Emergency Plan and Implementing Procedures C~anges 6.15 MP-HP0-99081, "Closure of NR 99006430-01," from A. S. Klotz to H. W. Siegrist, dated May 21, 1999.
7.

SUMMARY

OF CHANGES 7.1 Step 4.4.7 was modified to include Supervisor EC&I notifying BP if there are discrepancies during inventory that will take greater than 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> to resolve. This is corrective action to CA3028309.

7.2 The RMT notebooks (maps are usually inside front cover) have been placed in the lockers (or trucks for 3, 4,& 5) instead of the kits to allow BP personnel to update procedures without breaking the inventory seal.

RPM 4.8.5-003, -004, -005, -016, and 025 were revised to move the RMT notebooks to a separate table. Because the one table was split and divided into two, the word "Kit" was removed from the title on RPM 4.8.5-003, -004, and -005 .

7.3 RPM 4.8.5-001 was updated with new inventory form titles and deleted "Form" from the title.

7.4 RPM 4.8.5-013A was modified to move the Section for "Emergency Operations Facility Spare RMT Locker" to a new form, RPM 4.8.5-029, "Building 532 Over Water Monitoring Locker." This is corrective action to CA3032490.

7.5 RPM 4.8.5-019 was renamed "OCA Checkpoint and Off-Site Emergency Responder Dosimetry as it no longer serves as the Forward Access Point.

7.6 RPM 4.8.5-021 was revised to change the number of battery sets to 3:

there are only 2 portable meters plus a charger. This is corrective action to CA3029047.

7. 7 Updated Section 4.4, "Documentation," section.
  • Level of Use Information STOP.

.,.,i

.REYIEW RPM4.8.5 Rev. 009 10of10

~~

  • .{j/jp*" Dominion"'

Instructions for completing this form are included in AD-AA-100.

1. Procedure Number RPM 4.8.5-001
2. Revision 008
3. Change Type & No.

00 & 00 Technical Procedure Approval l4'*#DIH11f!j!tttA;1;,t4;1t 4.Page of Page of

5. Effective Date (If not approval date) 07/26/2016
6. Procedure Title 7. Expiration Date Emergency Response Facility Readiness Check Report
8. Type of Request D New Procedure [8J Revision D Deletion D Vendor Procedure Change: D Minor Revision D OTO - Permanent Revision Required D OTO - No Permanent Revision Required
9. Has a Condition Report (CR) Been Submitted? 0Yes [8J No CR No.:
10. Reason and Description of Change Updated titles of applicable kits and lockers. Removed "Form" from the title of the form title.
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? D Yes [8J No
15. Does this procedure require a 50.59 / 72.48 Evaluation (Form No. 730947)? D Yes [8J No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-designated procedure that requires a 50.59 I 72.48 Screen?

D Yes [8J No

~liahge *otJrit~n~ eli'ei;
klist* * .*. If "yes" ~o"any o.f ihe f~_llowin*g qµes't!on.s, Cognizant Mariagemeht"'~" .<!PP~oval .tequJreq, Check item 3q . . * . * .

.. ~ :; .; * ';' * * . : *"lf."Non to all'of the.following questions; Cogi:iizant Management "A" approval required. CHe*cr< item 31. .  :

17. A new procedure or procedure deletion? D Yes [8J No afi- change or addition to any of the following:

91::] Purpose D Acceptance Criteria or Tolerances D "Level of Use" D Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s) D Yes [8J No D The method for meeting a commitment D Reactivity Management

19. A change that adds or deletes a subsection, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, involves a less conservative method for performing a task, or affects equipment qualification?

D Yes [8J No 20 A change that decreases personnel safety or fire protection effectiveness? D Yes [8J No

21. A change that modifies, relocates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level II/Ill Inspector is required. For OTOs and MRs, QIC or Level 11/111 Inspector initial here .)

D Yes [8J No

22. A change to CAUTION or WARNING statements? This does not include adding CAUTION or WARNING statements. 0Yes 0 No
23. A change to a procedure marked "Infrequently Conducted or Complex Test or Evolution"? D Yes [8J No
24. Requestor/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Brandon Graber I Jean Olsen 04/01/2016 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place N/A in blocks 35 and 36.
32. Required Approval Authority (Print Name) 34. Date P. Michael Bradley 07/21/2016
35. SRO Approval For Changes (Print Name) 37. Date 38 Site Vice President Approval, If Required (Print Name) 39. Site Vice President Approval, If Required (Signature) 40. Date NOTE: The individual(s) posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Forms is updated.

uclear E-Forms Updated for Site(s)? 42. Nuclear E-Forms Updated Print Name/Signature 43. Date 0 MP 0 NA D SU [8l NIA Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EDP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730682(April 2015)

I .

  • 07/21/16 07/26/16 Approval Date Effective Date Emergency Response Facility Readiness Check Report Date: _ _ _ _ _ Reason for Inventory: O Quarterly O Post Drill O Other: _ _ _ __

Kit Or Locker To Be Inventoried Form v For Kits To Be No. Inventoried All NIA I

Emergency Operations Facility, Team 3 3 Emergency Operations Facility, Team 4 4 Emergency Operations Facility, Team 5 5 Emergency Operations Facility 9 Unit 2 Control Room 11 Emergency Operations Facility Spare RMT Kit 13A Unit 2 Personnel Decon Room Emergency Personnel Decon Kit 15 SAP 16 OCA Checkpoint and Off-Site Emergency Responder Dosimetry Unit 3 Control Room 19 20 I

Technical Support Center 21 Technical Support Center TSC Kit 22A OSC Assembly Area, Building 475, 1st Floor 22B Unit 3 Personnel Decon Room Emergency Personnel Decon Kit 24 NAP 25 Security Station Emergency Dose Rate Equipment 27 Building 532, Over Water Monitoring Locker 29 I

Actions to be Taken to Date Kit I Locker Section Title Description of Deficiency Correct Deficiency Corrected Comments:

Completed B y : - - - - - - - - - - - - - - Date: _ _ _ _ _ _ _ _ __

Reviewed By: Date:

~

RPM 4.8.5-001 Rev. 008 Page 1of1

Instructions for completing this form are included in AD-AA-100.

1. Procedure Number RPM 4.8.5-003
2. Revision 007
3. Change Type & No.

00 & 00 Technical Procedure Approval

  • Ab*AA~100*Attachinerit2 4.Page of

. -. ~

5. Effective Date (If not approval date) 07/26/2016
6. Procedure Title 7. Expiration Date Emergency Operations Facility Team 3
8. Type of Request D New Procedure [g] Revision D Deletion D Vendor Procedure Change: D Minor Revision D OTO - Permanent Revision Required D OTO - No Permanent Revision Required
9. Has a Condition Report (CR) Been Submitted? 0Yes [81 No CR No.:
10. Reason and Description of Change Removed RMT notebook (maps are usually inside front cover) from kit and placed it in RMT 3 Truck to allow EP personnel to update procedures without breaking the inventory seal.
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? D Yes [g] No
15. Does this procedure require a 50.59 / 72.48 Evaluation (Form No. 730947)? D Yes [g] No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-D Yes (g] No designated procedure that requires a 50.59 / 72.48 Screen?

A change or addition to any of the following:

D Purpose D Acceptance Criteria or Tolerances D "Level of Use" D Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s) D Yes [g] No D The method for meeting a commitment D Reactivity Management

19. A change that adds or deletes a subsection, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, involves a less conservative method for performing a task, or affects equipment qualification?

D Yes [g] No 20 A change that decreases personnel safety or fire protection effectiveness? D Yes (g] No

21. A change that modifies, relocates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level 11/111 Inspector is required. For OTOs and MRs, QIC or Level 11/111 Inspector initial here .) D Yes (g] No
22. A change to CAUTION or WARNING statements? This does not include adding CAUTION or WARNING statements. D Yes [g] No
23. A change to a procedure marked "Infrequently Conducted or Complex Test or. Evolution"? D Yes [g] No
24. Requestor/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Bridget Beck I Jean Olsen 10/04/2015 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place N/A in blocks 35 and 36.
32. Required Approval Authority (Print Name) 34. Date P. Michael Bradley 07/21/2016
35. SRO Approval For Changes (Print Name) 37. Date 38 Site Vice President Approval, If Required (Print Name) 39. Site Vice President Approval, If Required (Signature) 40. Date NOTE: The individual(s) posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Forms is updated.

Nuclear E-Fonms Updated for Site(s)? 42. Nuclear E-Fonms Updated Print Name/Signature 43. Date 0 MP 0 NA 0 SU ~ NIA Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EDP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730682(April 2015)

I . ,

07/21/16 07/26/16 Approval Date Effective Date Emergency Operations Facility Team 3 I Date: _ _ _ _ _ _ __

Quantity Returned Item Description Required I As Found Quantify I Date Facility Team 3 Kit Ludlum 2241-2 or equivalent 1 Serial No. Date Due R0-2A or Equivalent 1 Serial No. Date Due ASP-1/HP-270 or Equivalent 1 Serial No. Date Due Portable Air Sampler (12 Volts) 1 Serial No. Date Due Batteries, Spares For Survey Meters and Dosimeter Charger 4 Sets Batteries Replaced (4th quarter)

Dosimeters (Low Range) Date Due 2 Dosimeters (High Range) Date Due 2 Dosimeter Charger - Batteries Replaced (4th quarter) 1 TLD Badges (Replace Semi-annually) Date Due 2 Smears (Pkg of 25) 1 Filters, Particulate (Pkg of 50) 1 Bags, Clear Pla~tic 4x6 12 Bags, Clear Plastic 6x12 6 Duct Tape, roll 1 Silver Zeolite Cartridges 4 Expiration Date:

Calculator (Solar powered) 1 Disposable Gloves (Pairs) 6 Coin Envelopes 12 Rain Gear (Sets) 2 Ballpoint Pens 2 Markers, Felt Tip 2 Screwdriver 1

  • RPM 4.8.5-003 Rev. 007 Page 1of2

i . i .

  • Box of Staples Item Description Quantity Required 1

As Found Returned Quantity Date Stapler 1 Scissors 1 Stopwatch 1 Forceps 1 Keys For Fox Island Wildlife Area 2 Clipboard With Paper 1 Pkg of Potassium Iodide Tablets (Expiration Date: ) 1

---~~~~~~~~~~~~-F-a_c_il-ity~Ti-e_a_m_3~'fr-u-c+k~-~~~r--~~----tt--~~-+-~----t

!MT No. 3 EPP Notebook Map Of Sample Locations I

Inventoried By:

  • Reviewed By:
  • RPM 4.8.5-003 Rev. 007 Page 2of2

Technical Procedure Approval AD-AA-100 - Att~clim~nt 2 . ~

Instructions for completing this form are included in AD-AA-100.

1. Procedure Number 2. Revision 3. Change Type & No. 4.Page 5. Effective Date (If not approval date)

RPM 4.8.5-004 007 00 & 00 of 07/26/2016

6. Procedure Title 7. Expiration Date Emergency Operations Facility Team 4
8. Type of Request D New Procedure ~ Revision D Deletion D Vendor Procedure Change: D Minor Revision D OTO - Permanent Revision Required D OTO - No Permanent Revision Required 9, Has a Condition Report (CR) Been Submitted? 0Yes ~No CR No.:
10. Reason and Description of Change Removed RMT notebook (maps are usually inside front cover) from kit and placed it in RMT 4 Truck to allow EP personnel to update procedures without breaking the inventory seal. *
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? 0Yes~ No
15. Does this procedure require a 50.59 I 72.48 Evaluation (Form No. 730947)? 0Yes~ No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-0Yes~ No designated procedure that requires a 50.59 I 72.48 Screen?

,.Cflailge of Intent Checklist * - If "Yes" to any of the following questions, Cagnizant Management "B" approval.required. Check.item 30. : * * * * ,

~,:-:' :_ . - *

  • If "No" to all of the following questions, Cognizant Management "A" approval required~ Check-item 3i * * ' :" *. *.
17. A new procedure or procedure deletion? 0Yes~ No 1.change or addition to any of the following:

Purpose D Acceptance Criteria or Tolerances D "Level of Use" Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s) 0Yes ~No D The method for meeting a commitment D Reactivity Management

19. A change that adds or deletes a subsection, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, 0Yes~ No involves a less conservative method for performing a task, or affects equipment qualification?

20 A change that decreases personnel safety or fire protection effectiveness? 0Yes~ No

21. A change that modifies, relocates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level II/Ill Inspector is required. For OTOs and MRs, QIC or Level II/Ill Inspector initial here .) 0Yes~ No
22. A change to CAUTION or WARNING statements? This does not include adding CAUTION or WARNING statements. 0Yes ~No
23. A change to a procedure marked "Infrequently Conducted or Complex Test or Evolution"? D Yes~ No-
24. Requestor/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Bridget Beck I Jean Olsen 10/04/2015 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place N/A in blocks 35 and 36.
  • *I
32. Required Approval Authority (Print Name) 33.

P. Michael Bradley

35. SRO Approval For Changes (Print Name) 36.

38 Site Vice President Approval, If Required (Print Name) 39. Site Vice President Approval, If Required (Signature) 40. Date NOTE: The individual(s) posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Forms is updated.

41. uclear E-Forms Updated for Site(s)? 42. Nuclear E-Forms Updated Print Name/Signature 43. Date MP 0 NA 0 SU !XI N/A Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EOP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730682(April 2015)

07/21/16 07/26/16

  • Approval Date Date: _ _ _ _ _ _ __

Emergency Operations Facility Team 4 Effective Date I

Quantity Returned Item Description Required I As Found Quantity I Date Facility Team 4 Kit Ludlum 2241-2 or equivalent 1 Serial No. Date Due R0-2A or Equivalent 1 Serial No. Date Due ASP-1/HP- 270 or Equivalent 1 Serial No. Date Due Portable Air Sampler (12 Volts) 1 Serial No. Date Due Batteries, Spares For Survey Meters and Dosimeter Charger 4 Sets Batteries Replaced (4th quarter)

Dosimeters (Low Range) Date Due 2

  • Dosimeters (High Range) Date Due Dosimeter Charger - Batteries Replaced (4th quarter)

TLD Badges*(Replace Semi-annually) Date Due Stopwatch 2

2 1

1 Forceps 1 Smears (Pkg of 25) 1 Filters, Particulate (Pkg of 50) 1 Bags, Clear Plastic 4x6 .. 12 Bags, Cfoar Plastic 6x12 6 Duct Tape, roll 1 Silver Zeolite Cartridges 4 Expiration Date:

Calculator (Solar powered) 1 Disposable Gloves (Pairs) 6 Coin Envelopes 12 Rain Gear (Sets) 2 Ballpoint Pens 2

  • RPM 4.8.5-004 Rev. 007 Page 1of2
  • Screwdriver Item Description Quantity Required 1

As Found Returned Quantity Date Markers, Felt Tip 2 Stapler 1 Box of Staples 1 Scissors 1 Clipboard With Paper 1 Pkg of Potassium Iodide Tablets (Expiration Date: ) 1

~~~~~~~~~~~~~F-a_c_il_ity~Ti-e-am~4~Tr-u-c+k~-~~~1--~~--t1--~~-+-~--1 RMT No. 4 EPP Notebook Map of Sample Locations I

Inventoried By:

Reviewed By:

  • RPM 4.8.5-004 Rev. 007 Page 2of2

~~

iill',.. Dominion Technical Procedure Approval AD*AA-100. Attachment 2 * - ~

Instructions for completing this form are included in AD-AA-100.

1. Procedure Number 2. Revision 3. Change Type & No. 4.Page 5. Effective Date {If not approval date)

RPM 4.8.5-005 007 00 & 00 of 07/26/2016

6. Procedure Title 7. Expiration Date Emergency Operations Facility Team 5
8. Type of Request D New Procedure [:8l Revision 0 Deletion D Vendor Procedure Change: D Minor Revision 0 OTO - Permanent Revision Required D OTO - No Permanent Revision Required
9. Has a Condition Report (CR) Been Submitted? 0 Yes [:8l No CR No.:
10. Reason and Description of Change Removed RMT notebook (maps are usually inside front cover) from kit and placed it in RMT 5 Truck to allow EP personnel to update procedures without breaking the inventory seal.
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? D Yes [:8l No
15. Does this procedure require a 50.59 / 72.48 Evaluation (Form No. 730947)? 0Yes~ No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-0Yes~No designated procedure that requires a 50.59 I 72.48 Screen?

Change of !nter:it Checklist

  • If "Yes" to any of the. following questions, Cognizant Management "B" approval required. Check item 30 .

.'*: , If "No" to all of the following question's, Cogniza.nt Management "A" approval required. Check item 31.

17. A new procedure or procedure deletion? D Yes [:8l No change or addition to any of the following:

Purpose D Acceptance Criteria or Tolerances D "Level of Use"

  • Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s) 0Yes~ No D The method for meeting a commitment D Reactivity Management
19. A change that adds or deletes a subsection, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, involves a less conservative method for performing a task, or affects equipment qualification?

D Yes~ No 20 A change that decreases personnel safety or fire protection effectiveness? D Yes [:8l No

21. A change that modifies, relocates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level 11/111 Inspector is required. For OTOs and MRs, QIC or Level 11/111 Inspector initial here .) 0Yes~ No
22. A change to CAUTION or WARNING statements? This does not include adding CAUTION or WARNING statements. 0Yes ~No
23. A change to a procedure marked "Infrequently Conducted or Complex Test or Evolution"? D Yes~ No
24. Requestor/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Bridget Beck I Jean Olsen 10/04/2015 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place N/A in blocks 35 and 36.
32. Required Approval Authority (Print Name)

P. Michael Bradley

35. SRO Approval For Changes (Print Name)

N/A 38 Site Vice President Approval, If Required (Print Name)

N/A NOTE: The individual(s) posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Forms is updated.

4 uclear E-Forms Updated for Site(s)? 42. Nuclear E-Forms Updated Print Name/Signature 43. Date MP 0 NA 0 SU ~ N/A Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EOP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730682(April 2015)

I '

07/21/16 07/26/16 Approval Date Effective Date Emergency Operations Facility Team 5 Quantity Returned Item Description Required I As Found Quantity I Date Facility Team 5 Kit Ludlum 2241-2 or equivalent 1 Serial No. Date Due R0-2A or Equivalent 1 Serial No. Date Due ASP-1/HP- 270 or Equivalent 1 Serial No. Date Due Portable Air Sampler (12 Volts) 1 Serial No.  !)ate Due Batteries, Spares For Survey Meters and Dosimeter Charger 4 Sets Batteries Replaced (4th quarter)

Dosimeters (Low Range) Date Due 2 Dosimeters (High Range) Date Due 2 Dosimeter Charger - Batteries Replaced (4th quarter) 1 TLD Badges (Replace Semi-annually) Date Due 2 Smears (Pkg of 25) 1 Filters, Particulate (Pkg of 50) 1 Bags, Clear Plastic 4x6 12

,Bags,_Clear Plastic 6x12 6 Duct Tape, roll 1 Silver Zeolite Cartridges 4 Expiration Date:

Calculator (Solar powered) 1 Disposable Gloves (Pairs) 6 Coin Envelopes 12 Rain Gear (Sets) 2 Ballpoint Pens 2 Screwdriver 1

  • RPM 4.8.5-005 Rev. 007 Page 1of2
  • Stapler Item Description 1

Quantity Required As Found Returned Quantity I

Date Markers, Felt Tip 2 Box of Staples 1 Scissors 1 Stopwatch 1 Forceps 1 Clipboard With Paper 1 Pkg of Potassium Iodide Tablets (Expiration Date: ) 1 t--------------F-a_c_il_ity_Ti_e-am_S_Tr_u_c~k--~-----,1-------11----+-----1 RMT No. 5 EPP Notebook Map of Sample Locations I

Inventoried By: Date: _ _ _ _ _ _ _ __

  • Reviewed By: Date: _ _ _ _ _ _ _ __
  • RPM 4.8.5-005 Rev. 007 Page 2of2

~~

jj#JJ.. Dominion~* Technical Procedure Approval Page of Instructions for completing this form are included in AD-AA-100.

1. Procedure Number 2. Revision 3. Change Type & No. 4.Page 5. Effective Date (If not approval date)

RPM 4.8.5-013A 009 00 & 00 of 07/26/2016

6. Procedure Title 7. Expiration Date Emergency Operations Facility Spare RMT Kit
8. Type of Request 0 New Procedure ~ Revision D Deletion 0 Vendor Procedure Change: 0 Minor Revision D OTO - Permanent Revision Required 0 OTO - No Permanent Revision Required
9. Has a Condition Report (CR) Been Submitted? 0 Yes ~No CR No.: 1026823
10. Reason and Description of Change RPM 4.8.5-013A was modified to move the Section for "Emergency Operations Facility Spare RMT Locker" to a new form, RPM 4.8.5-029, "Building 532 Over Water Monitoring Locker."

a 19 a.

11. CFAM, If Required (Print Name) 12.
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? 0 Yes~ No
15. Does this procedure require a 50.59 / 72.48 Evaluation (Form No. 730947)? 0 Yes~ No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-designated procedure that requires a 50.59 / 72.48 Screen?

D Yes~ No

  • Ct\ange of lnt(!rit Checklist
  • If "Yes" to any of.the following questions, C6gpizarit Ma.nagell}~ht ';l?°'.'.apP.rov~f r~ql!.ire*g, qliecl<'it~nJ.. 3*p. *** ~' ** ....

, *,, . . If ;,~o;' to ~II of the foiloWing questions, CogniZant Management*.A'~ ap'proval reqlifr(!d:*ciiecfdteni 31. * .<* " ., .: : **

17. A new procedure or procedure deletion? 0Yes~ No
18. A change or addition to any of the following:

Ai Purpose D Acceptance Criteria or Tolerances D "Level of Use" 0Yes~ No

~Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s)

D The method for meeting a commitment D Reactivity Management

19. A change that adds or deletes a subsection, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, 0Yes~ No involves a less conservative method for performing a task, or affects equipment qualification?

20 A change that decreases personnel safety or fire protection effectiveness? 0Yes~ No

21. A change that modifies, relocates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level II/Ill Inspector is required. For OTOs and MRs, QIC or Level II/Ill Inspector initial here .) 0Yes~ No
22. A change to CAUTION or WARNING statements? This does not include adding CAUTION or WARNING statements. 0Yes~No
23. A change to a procedure marked "Infrequently Conducted or Complex Test or Evolution"? O Yes~ No
24. Requestor/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Steve Grondahl I Jean Olsen 06/08/16 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place N/A in blocks 35 and 36.

., I ..

D 28. FSRC D

32. Required Approval Authority (Print Name)

. -~

34. Date P. Michael Bradley 07/21/2016
35. SRO Approval For Changes (Print Name) 36. 37. Date 38 Site Vice President Approval, If Required (Print Name) 39. 40. Date NOTE: The individual(s) posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Forms is updated.
41. Nuclear E-Forms Updated for Site(s)? 42. Nuclear E-Forms Updated Print Name/Signature 43. Date MP 0 NA 0 SU ~ N/A Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EDP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730682(April 2015)

07/21/16 07/26/16

  • Approval Date Emergency Operations Facility Spare RMT Kit Effective Date Quantity Returned Item Description Required fAs Found Quantity I Date Emergency Operations Facility Spare RMT Kit Ludlum 2241-2 or equivalent 1 Serial No. Date Due R0-2A or Equivalent 1 Serial No. Date Due ASP- l/HP-270 or Equivalent 1 Serial No. Date Due Portable Air Sampler (12 Volts) 1 Serial No. Date Due Batteries, Spares For Survey Meters and Dosimeter Charger 4 Sets Batteries Replaced (4th quarter)

Dosimeters (Low Range) Date Due 2 Dosimeters (High Range) Date Due 2 Dosimeter Charger - Batteries Replaced (4th quarter) 1 TLD Badges (Replace Semi-annually) Date Due 2 Stopwatch 1 Forceps 1 Smears (Pkg of 25) 1 Filters, Particulate (Pkg of 50) -1 -

Bags, Clear Plastic 4x6 12 Bags, Clear Plastic 6x12 6 Duct Tape, roll 1 Silver Zeolite Cartridges 4 Expiration Date:

Calculator, (Solar Powered) 1 Disposable Gloves (Pairs) 6 Coin Envelopes 12

~* RPM 4.8.5-013A Rev. 009 Page 1of2

  • Rain Gear (Sets)

Item Description Quantity Returned Required As Found Quantity 2

Date Ballpoint Pens 2 Markers, Felt Tip 2 Screwdriver 1 Stapler 1 Box of Staples . 1 Scissors 1 Clipboard With Paper 1 Spare Team EPP Notebook 1 Map of Sample Locations 1 Pkg of Potassium Iodide Tablets (Expiration Date: ) 1 Inventoried By: Date: _ _ _ _ _ _ _ __

Reviewed By: Date: _ _ _ _ _ _ _ __

  • RPM 4.8.5-013A Rev. 009 Page 2of2

Technical Procedure Approval i!'*f;t.91.1earj;m;1 .. t4ne Page of Instructions for completin this form are included in AD-AA-100.

1. Procedure Number 2. Revision 3. Change Type & No. 4.Page 5. Effective Date (If not approval date)

RPM 4.8.5-016 007 00 & 00 of 07/26/2016

6. Procedure Title 7. Expiration Date SAP
8. Type of Request D New Procedure ~ Revision D Deletion D Vendor Procedure Change: D Minor Revision D OTO - Permanent Revision Required D OTO - No Permanent Revision Required
9. Has a Condition Report (CR) Been Submitted? D Yes ~No CR No.: 1026823
10. Reason and Description of Change Removed RMT notebook (maps are usually inside front cover) from kit and placed it in SAP Locker to allow EP personnel to update procedures without breaking the inventory seal.
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? 0Yes~No
15. Does this procedure require a 50.59 I 72.48 Evaluation (Form No. 730947)? 0Yes~ No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-0Yes~ No designated procedure that requires a 50.59 I 72.48 Screen?

.Slfang~ of (nte'1t.c11ecl<lisf...: .,If. ;,¥e§> to 'aiiy of the fciilciWiilg questions, Cognizant Management ..*s** approv~! require~. Check item 30. ". ;

!::~: ~ .~: *. . . . * * *

  • If "No" to* ail of the following 'questions, Cognizant Mam1gerlient "A'; approvai require'd. Check itei:n \31.
17. A new procedure or procedure deletion? 0Yes~ No change or addition to any of the following:

Purpose D Acceptance Criteria or Tolerances D "Level of Use" D Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s) 0Yes~ No D The method for meeting a commitment D Reactivity Management

19. A change that adds or deletes a subsection, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, 0Yes~ No involves a less conservative method for performing a task, or affects equipment qualification?

20 A change that decreases personnel safety or fire protection effectiveness? D Yes~ No

21. A change that modifies, relocates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level 11/111 Inspector is required. For OTOs and MRs, QIC or Level II/Ill Inspector initial here .) 0Yes~ No
22. A change to CAUTION or WARNING statements? This does not include adding CAUTION or WARNING statements. 0Yes~ No
23. A change to a procedure marked "Infrequently Conducted or Complex.Test or Evolution"? D Yes~ No
24. Requestor/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Al Johnson I Jean Olsen 06/30/2016 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place NIA in blocks 35 and 36.
32. Required Approval Authority (Print Name) 34. Date P. Michael Bradley 07/21/2016
35. SRO Approval For Changes (Print Name) 36. 37. Date 38 Site Vice President Approval, If Required (Print Name) 39. 40. Date NOTE: The individual(s) posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Forms is updated.

4 Nuclear E-Forms Updated for Site(s)? 42. Nuclear E-Forms Updated Print Name/Signature 43. Date MP 0 NA 0 SU ~ N/A Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EDP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730682(April 2015)

07/21/16 07/26/16

  • Date:--------

Approval Date SAP Effective Date Quantity Returned Kit Item Description Required As Found Quantity Date Ludlum 2241-2 1 Serial No. Date Due R0-2A or Equivalent 1 Serial No. Date Due Portable Air Sampler (12 Volts) 1 Serial No. Date Due Batteries, Spares For Survey Meters and Dosimeter Charger 3 Sets Batteries Replaced (4th quarter)

Calculator, Extra Battery (N/A Solar) 1 Batteries Replaced (4th quarter)

TLD Badges (Replace Semi-annually) Date Due 4 Finger Rings [Ref.6.8] (Replace Semi-annually) Date Due 8 Dosimeters (Low Range) Date Due 4 Dosimeters (High Range) Date Due 4 Dosimeter Charger - Batteries Replaced (4th quarter) 1 Smears (Pkg of 50) 1 Filters, Particulate (Pkg of 50) 1 Bags, Clear Plastic 4x6 12 Bags, Clear Plastic 6x12 6 Coin Envelopes 12 Silver Zeolite Cartridges 4 Expiration Date:

Rain Gear (Sets) 2 Sets Disposable Gloves (Pairs) 6 Ballpoint Pens 2 Markers, Felt Tip 2 Barrier Tape 1 Tape 1

  • RPM 4.8.5-016 Rev. 007 Page 1of2
  • Stopwatch Kit Item Description Can't Quantity Returned Required As Found Quantity 1

Date Screwdriver 1 Forceps 1 Scissors 1 Stapler 1 Box of Staples 1 Clipboard With Paper and Survey Forms 1 Pkg of Potassium Iodide Tablets (Expiration Date: ) 1 Quantity Returned Locker Item Description Required As Found Quantity Date RM-14 or Equivalent 1 Serial No. Date Due 110 Volt Air Sampler 1 Serial No. Date Due Radiation Area Signs 3 Respirators With Charcoal Filters 5 Date Inspection Due Emergency Lanterns (batteries): Expiration Date: 5 Particulate Filters 50 Extension Cord 1 PCs Complete Sets 6 I

RMT No. 2 EPP Notebook 1 On-Site Field Monitoring Map 1 Source Plaque 1 Quantity Returned Item Description Required As Found Quantity Date ARM or Dose Rate Meter 1 Serial No. Date Due Inventoried By:

Reviewed By:

  • RPM 4.8.5-016 Rev. 007 Page 2of2

~~

,;;,.**Dominion Technical Procedure Approval l!11f;¥;ll*lt#ji@j;J,,t4.tf Page of Instructions for completing this form are included in AD-AA-100.

1. Procedure Number 2. Revision 3. Change Type & No. 4.Page 5. Effective Date (If not approval date)

RPM 4.8.5-019 005 00 & 00 of 07/26/2016

6. Procedure Title 7. Expiration Date OCA Checkpoint and Off-Site Emergency Responder Dosimetry
8. Type of Request D New Procedure ~ Revision D Deletion D Vendor Procedure Change: D Minor Revision D OTO - Permanent Revision Required D OTO - No Permanent Revision Required
9. Has a Condition Report (CR) Been Submitted? 0Yes ~No CR No.:
10. Reason and Description of Change RPM 4.8.5-019 was renamed "OCA Checkpoint and Off-Site Emergency Responder Dosimetry" as it no longer serves as the Forward Access Point.
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? 0Yes~ No
15. Does this procedure require a 50.59 / 72.48 Evaluation (Form No. 730947)? 0Yes~ No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-designated procedure that requires a 50.59 / 72.48 Screen?

D Yes~ No G'."liange of Intent Checklist '. If "Yes" to any of the folioy.rihg questions, Cogniza.nt.Mahagernen~ !'I;!;~ app):9val r¢quireCI: qhecl<Jtem 3Q:. :* ;. . ., *:.* *. 1 *

. . . . fo If "No'; all of the following questions, Cognizant Management ,;A" appfoslal ,fequii'ect Check item.31': "<< ; . :-* .,.

17. A new procedure or procedure deletion? 0Yes~ No 1 A change or addition to any of the following:

Purpose D Acceptance Criteria or Tolerances D "Level of Use"

. D Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s) 0Yes~No D The method for meeting a commitment D Reactivity Management

19. A change that adds or deletes a subsection, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, involves a less conservative method for performing a task, or affects equipment qualification?

D Yes~ No 20 A change that decreases personnel safety or fire protection effectiveness? D Yes~ No

21. A change that modifies, relocates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level 11/111 Inspector is required. For OTOs and MRs, QIC or Level 11/111 Inspector initial here .)

D Yes~ No*

22. A change to CAUTION or WARNING statements? This does not include adding CAUTION or WARNING statements. D Yes~ No
23. A change to-a procedure-marked "Infrequently Conducted or Complex Test or Evolution"? D Yes~ No
24. Requester/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Steve Grondahl I Jean Olsen 06/08/16 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place N/A in blocks 35 and 36.
  • I
32. Required Approval Authority (Print Name)

P. Michael Bradley

35. SRO Approval For Changes (Print Name) 37. Date 38 Site Vice President Approval, If Required (Print Name) 39. Site Vice President Approval, If Required (Signature) 40. Date NOTE: The individual s posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Fonns is updated.

4 Nuclear E-Forms Updated for Site(s)? 42. Nuclear E-Forms Updated Print Name/Signature 43. Date MP 0 NA 0 SU ~ N/A Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EOP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730682(April 2015)

07/26/16 07/21/16 Approval Date Effective Date OCA Checkpoint and Off-Site Emergency Responder Dosimetry I Date: _ _ _ _ _ _ __

Quantity Returned Item Description Required As Found Quantity Date Paper Coveralls 3 Rubber Shoe Covers (Pair) 3 Plastic Booties (Pair) 3 Rubber Gloves (Pair) 3 Surgical Gloves (Pair) 3 TLD Badges (Replace Semi-annually) Date Due 4 Dosimeters (Low Range) Date Due 4 Dosimeter Charger 1 Batteries Replaced (4th quarter)

Batteries, Spare For Charger 1 Batteries Replaced (4th quarter)

Hospital gown 2 Hospital mask 2 Herculite Sheet or Plastic tarp 1 Radiation Area Sign 1 Off-site Emergency Responder TLDs - located at security 24 Guard check point (Replace Semi-annually)

Date Due Duct Tape (Roll) 1 Waste-Bag 1 Inventoried By:

Reviewed By:

  • RPM 4.8.5-019 Rev. 005 Page 1of1 -

~~

.-ti!IJ*" Dominion"' Technical Procedure Approval AD-AA-100 -Attachment 2 ~

Instructions for completing this form are included in AD-AA-100.

1. Procedure Number 2. Revision 3. Change Type & No. 4.Page 5. Effective Date (If not approval date)

RPM 4.8.5-021 009 00 & 00 of 07/26/2016

6. Procedure Title 7. Expiration Date Technical Support Center k>rker ,J
8. Type of Request D New Procedure ~ Revision D Deletion D Vendor Procedure Change: D Minor Revision D OTO - Permanent Revision Required D OTO - No Permanent Revision Required
9. Has a Condition Report (CR) Been Submitted? 0Yes ~No CR No.:
10. Reason and Description of Change RPM 4.8.5-021 was revised to change the number of battery sets to 3: there are only 2 portable meters plus a charger.
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? 0Yes~ No
15. Does this procedure require a 50.59 / 72.48 Evaluation (Form No. 730947)? 0Yes~ No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-designated procedure that requires a 50.59 / 72.48 Screen?

A change or addition to any of the following:

0Yes~No D Purpose D Acceptance Criteria or Tolerances D "Level of Use" D Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s) D Yes~ No D The method for meeting a commitment D Reactivity Management

19. A change that adds or deletes a subsec;:tion, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, 0Yes~ No involves a less conservative method for performing a task, or affects equipment qualification?

20 A change that decreases personnel safety or fire protection effectiveness? D Yes~ No

21. A change that modifies, relocates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level 11/111 Inspector is required. For OTOs and MRs, QIC or Level 11/111 Inspector initial here .) D Yes~ No
22. A change to CAUTION or WARNING statements? This does not include adding CAUTION or WARNING statements. 0Yes~ No 23: A change to a proceduremarked-"lnfrequently Conducted or ComplexTest*orEvolution"? 0Yes~ No
24. Requester/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Bridget Beck I Jean Olsen 04/12/2016 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place N/A in blocks 35 and 36.
    • I
32. Required Approval Authority (Print Name) 34. Date P. Michael Bradley 07/21/2016
35. SRO Approval For Changes (Print Name) 36. 37. Date 38 Site Vice President Approval, If Required (Print Name) 40. Date NOTE: The individual(s) posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Forms is updated.

Nuclear E-Forms Updated for Site(s)? 42. Nuclear E-Forms Updated Print Name/Signature 43. Date MP 0 NA 0 SU ~ N/A Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EOP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730682(April 2015)

07/21/16 07/26/16

  • Approval Date Date: _ _ _ _ _ _ __

Technical Support Center Effective Date Quantity Returned Item Description Required I As Found Quantity I Date Technical Support Center Locker RM-14 or Equivalent

l. Serial No. Date Due 3
2. Serial No. Date Due
3. Serial No. Date Due Teletector or Equivalent 1 Serial No. Date Due R0-2A or Equivalent 1 Serial No. Date Due 110 Volt Air Sampler 1 Serial No. Date Due Batteries, Spares For Survey Meters and Dosimeter Charger 3 Sets I

Batteries Replaced (4th quarter)

Radiation Area Signs 12 Respirators With Charcoal Filters 20 Date Inspection Due Emergency Lanterns (batteries) Expiration Date: 2 Paper Coveralls 20 Survey Forms 1 Set PCs (Sets) 20 Dosimeters (Low Range) Date Due 4 Dosimeters (High Range - SR ) Date Due 20 Dosimeters (Accident) Date Due 3 Dosimeter Charger Batteries Replaced (4th quarter) 1 Source Plaque 2 TLD Badges (Replace Semi-annually) Date Due 20 Finger Rings [Ref.6.8] (Replace Semi-annually) Date Due 20 Smears (Pkg of 50) 1 Stopwatch 1

  • RPM 4.8.5-021 Rev. 009 Page 1of2

I *. I*.

  • Forceps Item Description Quantity Returned Required As Found Quantity 1

Date Screwdriver 1 Particulate Filters (Pkg of 50) 1 Clear Plastic Bags 6x12 5 Silver Zeolite Cartridges 4 Expiration Date:

Calculator, Extra Battery (NIA Solar) 1 Batteries Replaced (4th quarter)

Disposable Gloves (Pairs) 12 Coin Envelopes 5 Rain Gear 4 Sets Ballpoint Pens 12 Markers, Felt Tip 12 Scissors 1 Stapler 1

  • Clipboard with paper On-Site Field Monitoring Map RMT Procedures and Fonns Pkg of Potassium Iodide Tablets (Expiration Date: )

1 1

1 1

Technical Support Center Area Radiation Monitor 1 Serial No. Date Due SCBA 6 Inventoried By:

Reviewed By:

  • RPM 4.8.5-021 Rev. 009 Page 2of2

~~

r1i/IJ.*" Dominion'" Technical Procedure Approval E1*!!r§l1Ie$!ttS;1;.t4;1t Page of Instructions for completing this form are included in AD-AA-100.

1. Procedure Number 2. Revision 3. Change Type & No. 4.Page 5. Effective Date (If not*approval date)

RPM 4.8.5-0. 2. '7 . 007 00 & 00 of 07/26/2016

6. Procedure Title 7. Expiration Date NAP
8. Type of Request D New Procedure ~ Revision D Deletion D Vendor Procedure Change: D Minor Revision D OTO - Permanent Revision Required D OTO - No Permanent Revision Required
9. Has a Condition Report (CR) Been Submitted? 0Yes ~No CR No.: 1026823
10. Reason and Description of Change Removed RMT notebook (maps are usually inside front cover) from kit and placed it in RMT 4 Truck to allow EP personnel to update procedures without breaking the inventory seal.
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? D Yes~ No
15. Does this procedure require a 50.59 / 72.48 Evaluation (Form No. 730947)? 0Yes~ No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-

11111-0Yes~ No designated procedure that requires a 50.59 I 72.48 Screen?

A change or addition to any of the following:

D Purpose D Acceptance Criteria or Tolerances D "Level of Use" D Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s) D Yes~ No D The method for meeting a commitment D Reactivity Management

19. A change that adds or deletes a subsection, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, 0Yes~No involves a less conservative method for performing a task, or affects equipment qualification?

20 A change that decreases personnel safety or fire protection effectiveness? D Yes~ No

21. A change that modifies, relocates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level 11/111 Inspector is required. For OTOs and MRs, QIC or Level 11/111 Inspector initial here .) 0Yes~No
22. A change to CAUTION or WARNING statements? This does not include adding CAUTION or WARNING statements. D Yes~ No
23. A change to a procedure marked "Infrequently Conducted or Complex Test or Evolution"? D Yes [81 No
24. Requestor/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Steve Grondahl I Jean Olsen 06/08/16 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place N/A in blocks 35 and 36.
32. Required Approval Authority (Print Name) 34. Date P. Michael Bradley 07/21/2016
35. SRO Approval For Changes (Print Name) 36. 37. Date 38 Site Vice President Approval, If Required (Print Name) 40. Date NOTE: The individual(s posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Forms is updated.

Nuclear E-Forms Updated for Site(s)? 42. Nuclear E-Forms Updated Print Name/Signature 43. Date 0 MP 0 NA 0 SU ~ N/A Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EDP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730682(Apnl 2015)

07/21/16 07/26/16

  • Approval Date NAP Effective Date Quantity Returned Kit Item Description Required As Found Quantity Date Ludlum 2241-2 1 Serial No. Date Due R0-2A or Equivalent 1 Serial No. Date Due Portable Air Sampler (12 Volts) 1 Serial No. Date Due Batteries, Spares For Survey Meters 3 Sets Batteries Replaced (4th quarter)

Calculator, Extra Battery (NIA Solar) 1 Batteries Replaced (4th quarter)

TLD Badges (Replace Semi-annually) Date Due 4 Finger Rings [Ref.6.8] (Replace Semi-annually) Date Due 8 Dosimeters (Low Range) Date Due 4 Dosimeters (High Range) Date Due 4 Dosimeter Charger - Batteries Replaced (4th quarter) 1 Smears (Pkg of 50) 1 Filters, Particulate (Pkg of 50) 1 Bags, Clear Plastic 4x6 12 Bags, Clear Plastic 6x12 6 Coin Envelopes 12 -

Silver Zeolite Cartridges 4 Expiration Date:

Rain Gear (Sets) 2 Sets Disposable Gloves (Pairs) 6 Ballpoint Pens 2 Markers, Felt Tip 2 Barrier Tape 1 Tape 1

  • RPM 4.8.5-025 Rev. 007 Page 1of2
  • Screwdriver Kit Item Description, Con't Quantity Returned Required As Found Quantity 1

Date Stopwatch 1 Forceps 1 Scissors 1 Stapler 1 Box of Staples 1 Clipboard With Paper And Survey Forms 1 Pkg of Potassium Iodide Tablets (Expiration Date: ) 1 Quantity Returned Locker Item Description Required As Found Quantity Date RM-14 or Equivalent 1 Serial No. Date Due 110 Volt Air Sampler 1 Serial No. Date Due '

Radiation Area Signs 3 Respirators With Charcoal Filters 5 Date Inspection Due Emergency Lanterns (batteries) Expiration Date: 5 Particulate Filters 50 Extension Cord 1 PCs Complete Sets 6 I

RMT No. 2 EPP Notebook 1 On-Site Field Monitoring Map 1 Source Plaque 1 Quantity Returned Item Description Required As Found Quantity Date NAP - ARM or Dose Rate Meter 1 Serial No. Date Due Inventoried By: - - - - - - - - - - - - - - - - - Date: __________

Reviewed By: Date:----------

  • RPM 4.8.5-025 Rev. 007 Page 2of2

,;llJJ"' Dominion'"*

Instructions for completing this form are included in AD-AA-100.

Technical Procedure Approval AD-AA-100 -Attachment 2 ~

1. Procedure Number 2. Revision 3. Change Type & No. 4.Page 5. Effective Date (If not approval date)

RPM 4.8.5-029 000 00 & 00 of 07/26/2016

6. Procedure Title 7. Expiration Date Building 532, Over Water Monitoring Locker
8. Type of Request ~ New Procedure D Revision D Deletion D Vendor Procedure Change: D Minor Revision D OTO - Permanent Revision Required D OTO - No Permanent Revision Required
9. Has a Condition Report (CR) Been Submitted? ~Yes 0No CR No.: 1026823
10. Reason and Description of Change Original issue, created from RPM 4.8.5-013A, Section for "Emergency Operations Facility Spare RMT Locker."
14. Does this change involve a Temporary Modification that affects nuclear safety as documented in CM-AA-TCC-204? 0Yes~ No
15. Does this procedure require a 50.59 / 72.48 Evaluation (Form No. 730947)? 0Yes~ No
16. Is this a "Special Test" procedure, an EPIP or Security procedure, a FCA, a FSG, an EOP, required by RP-AA-274, or is it an ICCE-0Yes~ No designated procedure that requires a 50.59 I 72.48 Screen?

A change or addition to any of the following:

D Purpose D Acceptance Criteria or Tolerances D "Level of Use" D Initial Conditions D Scaling or Setpoints D System/Component As-Left Condition(s) 0Yes~ No D The method for meeting a commitment D Reactivity Management

19. A change that adds or deletes a subsection, deletes a step verification (IV, CV, or PC), adds an alternative method for performing a task, 0Yes~ No involves a less conservative method for performing a task, or affects equipment qualification?

20 A change that decreases personnel safety or fire protection effectiveness? D Yes~ No

21. A change that modifies, relo~ates, deletes, or adds a hold point? (Review by the QIC or certified discipline QC Level II/Ill Inspector is required. For OTOs and MRs, QIC or Level II/Ill Inspector initial here .) D Yes~ No
22. A change to CAUTION or WARNING statements? This does not include adding CAUTION or WARNING statements.* 0Yes~ No
23. A change to a procedure marked "Infrequently Conducted or Complex-Test or*Evolution"? D Yes~ No.
24. Requestor/Writer (Printed Name) 25. Date 26. Reviewed By (Printed Name) 27. Date Steve Grondahl I Jean Olsen 06/08/2016 If FSRC approval is required for a Procedure Change, it is not necessary for SRO to approve the Procedure Change. Place NIA in blocks 35 and 36.
32. Required Approval Authority (Print Name)

P. Michael Bradley

35. SRO Approval For Changes (Print Name) 36. 37. Date 38 Site Vice President Approval, If Required (Print Name) 39. Site Vice President Approval, If R 40. Date NOTE: The individual(s posting a new or revised document to EDMS are responsible for ensuring Nuclear E-Forms is updated.

Nuclear E-Forms Updated for Site(s)? 42. Nuclear E-Forms Updated Print Name/Signature 43. Date 0 MP 0 NA 0 SU ~ N/A Key: FSRC-Facility Safety Review Committee; EPIP-Emergency Plan Implementing Procedures; EOP-Emergency Operating Procedure; OTO-One Time Only; MR-Minor Revision; ICCE-lnfrequently Conducted or Complex Evolutions; FCA-Fire Contingency Action; FSGs-FLEX Support Guideline; SRO-Senior Reactor Operator; QIC-Quality Inspection Coordinator; CFAM-Corporate Functional Area Manager Form No. 730BB2{April 201s)

07/21/16 07/26/16

  • Approval Date Date: _ _ _ _ _ _ __

Effective Date Building 532, Over Water Monitoring Locker Quantity Returned Item Description Required As Found Quantity Date Respirators with Charcoal Cartridges 6 Date Inspection Due:

Complete set of PCs 6 All Weather Suit 2 Flashlight 2 Spare Batteries for Flashlights 2 sets Emergency Lantern (Expiration Date: ) 1 Inventoried By:

Reviewed By:

  • RPM 4.8.5-029 Rev. 000 Page 1of1
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