ML17157C001
| ML17157C001 | |
| Person / Time | |
|---|---|
| Site: | Susquehanna  |
| Issue date: | 09/17/1992 |
| From: | Bettenhausen L NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | Keiser H PENNSYLVANIA POWER & LIGHT CO. |
| References | |
| NUDOCS 9209220031 | |
| Download: ML17157C001 (7) | |
Text
SEP 17 1992 Docket Nos.
50-387 50-388 Mr. Harold W. Keiser Senior Vice President Nuclear Pennsylvania Power
& Light Company 2 North Ninth Street Allentown, Pennsylvania 18101 Gentlemen
SUBJECT:
REVISED NRC FORMS 396 AND 398 Enclosed is a
copy of the revised NRC Form-396 (Enclosure 1),
Certification of Medical Examination By Facility Licensee and revised NRC Form-398 (Enclosure 2),
Personal Qualifications Statement Licensee.
All changes to the NRC Form-396 and the NRC Form-398 are detailed in Enclosure 3.
All applications for licenses are to be submitted on these revised forms as soon as possible but no later than November 1, 1992.
The enclose'd applications are for your use.
Your office can obtain additional copies of these forms by contacting Beverly Martin by telephone on (301) 492-8138 or by writing to her, U.S.
Nuclear Regulatory Commission, Information and Records Management
- Branch, Mail Stop MNBB-7714, Washington, D.C.
20555.
If you have any questions regarding these
- forms, please contact Richard J.
Conte at (215) 337-5210 or Glenn W. Meyer at (215) 337-5211.
Sincerely, Wfe(n~l Sf er ad BV:
Lee H. Bettenhausen, Chief Operations Branch Division of Reactor Safety
Enclosures:
As stated cc w/enclosures:
W. Lowthert, Manager Nuclear Training A; Fitch, Supervisor-Operations Training qppgy2pppgl 920917 PDR ADOCK 0 P
Susquehanna Steam Electric Station cc w/o enclosures:
J.
Kenny, Nuclear Licensing H. Stanley, Superintendent of Plant R. Bryam, Vice President, Nuclear Operations R. Peal, Supervisor, Nuclear Compliance H. Woodeshick, Special Assistant to the President J. Tilton, III, Allegheny Electric Cooperative, Inc.
NRC Resident Inspector Commonwealth of Pennsylvania Public Document Room (w/encl)
Local Public Document Room (w/encl)
Nuclear Safety Information Center (w/encl) bcc w/enclosures:
OL Facility File RI:DRS Curley 09/ig /92 RI:DRS Battanhausan 09//a'/92 Official Record Copy
NRC FORM 396 (8.92) 10 CFR 55.23, 55.25, 55.27, 55.31, 55.33 55.57 U.S. NUCLEAR REGULATORY COMMISSION i
CERTIFICATION OF MEDICALEXAMINATION BY FACILITYLICENSEE NAME QF APPUCANT APPROVED BY OMB: No. 3150.0024 EXPIRES: 1.31.84 EstlMATED BuRDEN PER
RESPONSE
TO COMPLY WITH THts INFORMATION COLLECIlON REQUEST:
15 MINUTES.
FORWARD COMMENTS REGARDING BURDEN ESTlMATE TO THE INFORMATIONAND RECORDS MANAGEMEhr BRANCH (MNBB 7714),
U.S.
NUCLEAR REGULATORYCOMMISSON, WASHINGTON, OC 205554001, ANDTO THE PAPERWORK REDUCTION PROJECT (3150 0024),
OFFICE OF MANAGEMENTAND BUDGET, WASHINGTON, DC 20503, FACIUTY FA(XtflYDOCKET NUMBER A. MEDICALEXAMINATIONCERTIFICATION THIS IS TO CERRFY THATTHE ABOVE NAMEDAPPUCANT FOR AN OPERATOR/SENIOR OPERATOR UCENSE HAS BEEN EXAMINEDBYA PHYSICIAN.
P1L'NTED NAME(olprrysicren)
STATE ANDUCENSE NUMBER EXAMINATIONDATE BASED ON THE RESUI.TS OF THE EXAMINATION,INCLUDINGINFORMATIONFURNISHED BY THE APPUCANT, THE PHYSICNN HAS DETERMINED THATTHE APPUCANT'S PHYgCALCONDfnON AND GENERAL HEALTHARE SUCH THAT THE APPUCANT WOULD NOT BE EXPECTED TO CAUSE OPERATIONAL ERRORS ENDANGERING PUBUC HEALTHAND SAFETY. I CERBFY THAT IN REAQHING THis DETERMINATIQN,THE GUIDANGE QQNTAINEDIN ANsi/ANs 3.4.1 983, oR ANsf/ANs 15.4 1988 (N380) wAs FQLLowED ANDTHATDQQUMENTATIQNIs AYAILABLEFoR REYIEw BY NRC.
IF THE GUIDANCE IN THE APPROPRIATE ANSI/ANS DOCUMENT IS NOT COMPUED WAH, AN ACCEPTABLE ALTERNAllVEMETHOD, WHICH HAS BEEN APPROVED BY NRC, WAS USED.
ON THE BASIS OF THE RECOMMENDATIONOF THE PHYSICIAN, I RECOMMEND THAT THE APPUCANT'S OPERATOR LICENSE BE CONDITIONED AS FOLLOWS:
- 1. NO RESTRICTIONS 2.
CORRECTIVE LENSES BE WORN WHEN PERFORMING LICENSED DUTIES 3,
HEARING AID BE WORN WHEN PERFORMING LICENSED DUTIES 4.
RESTRICTED LICENSE OR EXCEPTION - Provide details below and attach supporting medical evidence for NRC review.
5.
RESTRICTION CHANGE FROM PREVIOUS SUBMITTAL-Provide details below and attach supporting medical evidence for NRC review.
PROPOSED WORDING OF RESTRICTION (B/ock 4 above)
RELATIQNsHip oF RESTRIQTIQN To orsQUAUFYING cQNDiTIQN(Brr'erry indicrde how testriclion willcorrect rne disqueriryirrg concitierr)
REMARKS FOR RESTRICTION CHANGE (Block 5 above)
B. NONMEDICALCERTIFICATION THIS CERTIFIES THATTHE APPUCANT HAS BEEN FOUND TO MEET THE SAF EGUARDS AND FiTNESS FOR OU1Y REQUIREMENTS OF THIS FACItflYFOR UCENSED OPERATORS.
ANY FALSE STATEMENT OR OMISSION IN THIS DOCUMENT, INCLUDING ATTACHMENTS, MAY BE SUBJECT TO CIVILAND CILMINALSANCTIONS. I CERTIFY UNDER PENALTY OF PERIURY THATTHE INFORMATIONIN THIS DOCUMENT ANDATTACHMENTSIS TRUE ANDCORRECT.
PRiNTED NAMEAND TITLE (Senior Management Representative on Site)
~
SIGNATURE DATE In accordance with 10 CFR 55.5, Communications, this form shall be submitted to the NRC as follows: BY MAILADDRESSED TO:
REGIONALADMINISTRATOR.REGION I U.S. NUCLEAR REGUIATORYCOMMISSON 475 ALLENDALEROAD I0NG OF PRUSSIA PA 19406 1415 REGIONAL ADM'NISTRATQR,REGION IV U.S. NUCLEAR REGULATORYCOMMISSON 611 RYAN PLAZA DRIVE, SUITE 400 ARUNGTON, TX 6011.8064 REGIONALADMINISTRATOR,REGION II U.S. NUCLEAR REGULATORYCOMMISSION 101 MARIETTASTREET NW, SufTE 2900 ATLANTA.GA 30323 REGIONALADMINISTRATOR,REGION V U.S. NUCLEAR REGULATORYCOMMISSION 1450 MARIALANE WALNUTCREEK, CA 94596.5368 REGIONALADMINISTRATOR,REGK)N ltl U.S. NUCLEAR REGULATORYCOMMISSION 799 ROOSEVELT ROAD GLEN ELLYN,IL 60137 OPERATOR UCENSING BRANCH DIVISIONOF UCENSEE PERFORMANCE AND QUAUTYEVALUATION U.S. NUCLEAR REGULATORY COMMISSION WASHINGTON, DC 205554XOI PRIVACYACT STATEMENT pursuant To 5 U.s.c. 552a(e)(3), enacted Into Iaw by section 3 of the privacy Act of 1974 (public Law RQURNE UsE(s):
The Information may be disposed to an appropriate Federal, state and 93.579), the following statement is furnished to indMduafs who supply information to the U.s. Nuclear local agency in the event the Information indicates a vioiation or potential violation ot law and in the course of an administrative or judbial proceeding.
In addition, this information may be Regulatory Commission on NRC Form 398, This infonnatbn Is maintained In ~ system of recoids transferred to an appropriate
- Federal, State, or local agency to the extent relevant and designated as NRC-16 and described at 55 Federal Register 33978 (August 20, 1990), or the most necessary for an NRC decabn about you.
recenl Federal Register Publicatbn of lhe Nucleat Regulatory Commasion's Republicalion of Systems WHEIHER DISCLOSURE IS MANDATORYOR VOLUNTARYAND EFFECT ON INDIVIDUALQF of Records Notices that is avrvrable at the NRC Public Document Room. Geirnan Buiidingi Lower NQT pnovIDING INFQRMATIQN: D'sctosure is voluntary.
If the requested inforrnatiotl is not Level, 2120 L Street NW, Washington, D.C.
piovided, howevet, the application fot a facilityoperator's ot senior operator's license may be AUTHQRAYI Section 107 and 161(i) ot the Atomic Energy Act of 1954, as amended (42 U.S.C. 2137 and 2201(i)).
SYSTEM MANAGER(S) AND ADDRESS:
Ch'ief, Operator Ucensing Branch Office ot Nuclear Reactor Regulation PRINCIPAL PURPOSE(S):
Information entered on this fohn is used to determine whether the physical condition and general health of the apphcant are such that they wilt not cause operational errors endangering pubac heahh and safety, The Information may be used by the NRC staff Io determine If Ihe indwidual meets the requirements of 10 CFR 55 lo take an examination or lo be issued an opeiator's license.
NRC FORM 3&6 (6.92)
INSTRUCTIONS FOR COM NG NRC FORM 398, PERSONAL QUALIFICATI ATEMENT-LICENSEE TO REMAINVALID,THIS FORM MUST NOT BE ALTERED TYPE OF APPLICATION a.
NEW-
"X'F YQU ARE A NEW APPUCANT.
COMPLETE EACH CATEGORY OF THE FORM COMPLETELY, FOLLOWING THE INSTRUCTIONS BELOW. THIS IS TO INCLUDEALLEDUCATION, TRAININGAND EXPERIENCE THAT YOU HAVE RECEIVED UP TO THE DATE OF THIS APPLICATION. NOTE: SEE ITEM 12-THERE IS AN EXCEPTION. ALSO, THIS BLOCK IS TO BE MARKED IF PREVIOUS NEW APPLICATIONWAS WITHDRAWN. PLEASE WRITE WITHDREW" NEXT TO NEW.
FOR 4.b THROUGH 4.e, COMPLETE EACH CATEGORY COMPLETELY, BUT INDICATEONLYTHE EDUCATION,TRAINING,ANDEXPERIENCE YOU HAVE RECEIVED SINCE YOUR LAST APPUCATION. NOTE: SEE ITEM 12-THERE IS AN EXCEPTION.
13 14 15 16.
17.
18.
b.
RENEWAL ~ X'F YQU ARE RENEWING CURRENT UCENSE.
c.
UPGRADE-X IF YQU HOLD A RO UCENSE AND ARE NOWAPPLYING TO UPGRADE YOUR LICENSE TO A SRO.
d, MULTI-UNIT- "X'FYQU CURRENTLY HOLD A LICENSE AT YOUR FACILITYAND ARE APPLYING TO AMENDYOUR CURRENT LICENSE TO ADD AN ADDITIONALUNIT.
,.o.
REAPPLICATION - X IF YOU HAVE PREVIOUSLY BEEN DENIED A UCENSE AND ARE REAPPLYING.
f.
WAIVER REQUESTED - X" THE APPLICABLEWAIVER REQUESTED AND JUSTIFY IN COMMENTS SECTION (ITEM 17).
g.
DATE PASSED GENERIC FUNDAMENTALSEXAMINATIONSECTION (GFES) - THIS IS NOT APPLICABLETO RESEARCH REACTORS OR LICENSES UMITEDTQ FUEL HANDLING. ENTER THE MONTHANDYEARTHE GENERIC FUNDAMENTALSEXAMINATIONSECTION QF THE WRITTEN EXAMINATIONWAS PASSED.
IF THE GFES WAS NOT TAKEN,YOU MUST HAVEPASSED AN NRC LICENSING EXAMINATIONQN THE APPLICABLEREACTOR TYPE (PWR OR BWR) AFTER FEBRUARY 1 ~ 1982, WHICH LED TO THE ISSUANCE OF A LICENSE. THIS DOES NOT INCLUDE INSTRUCTOR CERTIFICATION EXAMINATIONSOR REQUALIFICATIONEXAMINATIONS.
EDUCATION - INDICATEBOTH ACADEMICANDVOCATIONAL/TECHNICALPOST HIGH SCHOOL EDUCATION. FOR MAJORAREA(S) OF STUDY, INDICATETHE NUMBER OF YEARS SPENT IN EACH COLLEGE CURRICULUMAND THE HIGHEST DEGREE RECEIVED, USING THE DEGREE CODE PROVIDED.
FQR VOCATIONAL/TECHNICALEDUCATION, INCLUDING PROGRAMS SUCH AS NUCLEAR POWER SCHOOL, MIUTARY TRAINING,AIRCONDITIONING/REFRIGERATION,DIESEL MECHANICSCHOOL, ETC. INDICATETHE NUMBEROF MONTHS IN EACH PROGRAM AND WHETHER A CERTIFICATE OR DEGREE WAS AWARDED. IF ADDITIONALSPACE IS NEEDED, CONTINUE UNDER COMMENTS (ITEM 17).
FACILITYOPERATORTRAININGPROGRAM - CHECKTHEAPPRQPRIATEBOXINITEMS12aAND12b. IF YES ISCHECKEDINBOTHITEMS 12.a AND 12.b, THEN ITEMS 13 (TRAINING), 14 (EXPERIENCE), AND 15 (EXPERIENCE DETAILS) DO NDT HAVETO BE DOCUMENTED, WITHTHE EXCEPTION OF BLOCK 13.3.c. NEW APPUCATIONS MUST STILLINCLUDETHE NUMBEROF SIGNIFICANTCONTROL MANIPULATIONSWHICH AFFECT REACTIVITYOR POWER LEVELUNDER ITEM 13.3,c. NOTE: INPO ACCREDITED MEANSACCREDITATIONBYTHE NATIONALNUCLEAR ACCREDITING BOARD AND THAT THE MINIMUMREQUIREMENTS OF REGULATORY GUIDE 1.8, REV. 2, ARE MET.
TRAINING -
INDICATE THE TRAINING YOU HAVE RECEIVED TO MEET THE GUIDELINES OF ANSI N18.1/ANS 3.1, AS ENDORSED BY REGUIATORY GUIDE 1.8, REV. 2. THE BREAKDOWN OF TRAINING IN THIS CATEGORY PARALLELS THE ANSI/ANS STANDARDS. REFER TO THE STANDARDS IF YOU NEED FURTHER CLARIFICATION. INCLUDE BOTH BEGINNING AND COMPLETION DATES AND THE TOTALNUMBER OF WEEKS SPENT IN EACH TYPE OF TRAINING. THE NUMBER OF WEEKS IS PROVIDED,IN ADDITIONTO BEGINNING AND COMPLETION DATES, TO ACCOUNT FOR INTERMITTENTTRAINING(FOR EXAMPLE.4 WEEKS OF ClASSROOM TRAININGSPREAD OVER A2.MONTHPERIOD).
THEREFORE, THE DATE COLUMNS MAY INDICATE A LARGER TIME SPAN THAN THE ACTUAL NUMBER OF WEEKS SPENT IN FULL-TIME TRAINING. TIME IN TRAINING FOR THE UCENSE APPLIED FOR CANNOT BE DOUBLE COUNTED UNDER EXPERIENCE (ITEM 14).
ALLREQUALIFICATIQNTRAININGTIME IS TO BE ACCOUNTED FOR INTHE REQUALIFICATIONITEM 13.6. PLEASE DO NOT DOUBLE LIST"THE TIME SPENT IN REQUALIFICATIONTRAINING FOR CLASSROOM OR SIMULATORTIME UNDER ITEMS 13.1, 13.2, OR 13.3.
EXPERIENCE - A MINIMUMOF 6 MONTHS AT THE SITE FOR WHICH THE LICENSE IS SOUGHT IS REQUIRED. FOR EACH POSITION HELD, COMPLETE ITEM 15.
00 NQT DOUBLE COUNT TIME.
IF YOU HAD OVERLAPPING DUTIES, THE MONTHS SHOULD REFLECT THE PROPORTIONATE AMOUNTOF TIMEYOUWERE ASSIGNED TO THOSE PARTICULARDUTIES. IN NO CASE SHOULDTHE NUMBEROF MONTHS REPORTED FOR A PARTICULARTIME PERIOD EXCEED THE NUMBER OF MONTHS THATARE IN THATTIME PERIOD.
EXPERIENCE DETAILS - INCLUDEPOSITION TITLE, TIMEPERIOD-FROM/TO, FACILITY,ANDA BRIEF DESCRIPTiON OF DUTIES PERFORMED WHILE SERVING IN THAT POSITION.
IF MORE SPACE IS NEEDED,USE COMMENTS (ITEM 17), OR IF NECESSARY, ATTACH ADDITIONAL INFORMATION.
FOR RENEWALS ONLY - (1) ENTER THE APPROXIMATENUMBEROF HOURS SINCE PREVIOUS RENEWALOR ISSUANCE OF UCENSE IF FIRST RENEWAL. (2) ENTER DATE AND RESULT OF MOST RECENT NRC ADMINISTEREDREQUAUFICATIONEXAMINATION.
COMMENTS - USE THIS SPACE TO INCLUDEANYEXTRAINFORMATIONOR ClARIFICATIONFOR OTHER ITEMS ON THE APPLICATIONFORM.
IF THE SPACE PROVIDED IS NOT SUFFICIENT, YOU MAYATTACH EXTRA INFORMATIONWITH YOUR APPLICATION.
NRC FORM 396, CERTIFICATION OF MEDICALEXAMINATIONBY FACILITYLICENSEE - MUST ACCOMPANYTHIS APPLICATION.
SIGNATURES SIGN AND DATE ITEM 19.a.
OBTAIN YOUR TRAINING COORDINATOR'S SIGNATURE AND THAT OF YOUR SENIOR MANAGEMENTREPRESENTATIVE ON SITE.
DETACH THESE INSTRUCTIONS AND SUBMIT THE. COMPLETED NRC FORMS 398 AND 396 (ORIGINALAND TWO COPIES EACH) TO THE APPROPRIATE REGIONALADMINISTRATOR. (SEE REVERSE SIDE FOR PRIVACYACT STATEMENT AND ADDRESSES)
NRC FoRM 30s IS.82)
PRIVACYACT STATEMENT pursuant to U.s.c. 552a(e)!3), enacted into law by section 3 of tho privacy Act of 1974 rpublic Law 93.579), the foliowing is furnished to individuals who upply information to the U.S. Nuclear Regulatory Commissinn on NRC Form 398.
This information is maintained in a System of Records designated as NRC 16 and described at 55 Federal Register 33978 (August 20, 1990), or the most recent Federal Register publication of the Nuclear Regulatory Commission's 'Republication of Systems of Records Notices" that is available at the NRC Public Document Room, Gelman Building, Lower Level, 2120 L Street NW, Washington, D.C.
1.
AUTHORITY. Section 107 AND 161(i) of the Atomic Energy Act of 1954, as amended (42 U.S.C. 2137 and 2201 (i))
2.
PRINCIPAL PURPOSES.
The information willbe collected and evaluated for determining licensing eligibilityand to generate statistical data and reports on licensing actions.
3.
ROUTINE USES.
Information entered on this form may be used to:
(a) determine if the individual meets the requirements of 10 CFR Part 55 to be issued an operator's license; (b) provide researchers with information for statistical evaluations related to selection, training, and examination of facility operators; (c) piovide facility management with sufficient information to enroll the Ind4iduais in the licensed operator requalification program; (d) provide for examination and testing material and obtain results from contractors.
WHETHER DISCLOSURE IS MANDATORYOR VOLUNTARYAND EFFECT ON INDIVIDUALOF NOT PROVIDING INFORMATION. Disclosure is voluntary. However, if the information requested is not provided, NRC willnot be able to evaluate whether the application meets the requirements of 10 CFR Part 55.
5.
SYSTEMS MANAGER(S) AND ADDRESS.
Chief, Operator Licensing Branch, Office of Nuclear Reactor Regulation, U.S. Nuclear Regulatory Commission, Washington, DC 205554001.
6.
In accordance with 10 CFR 55.5, Communications, this form shall be submitted to the NRC as follows: BY MAILADDRESSED TO REGIONALADMINISTRATOR,REGION IV U. S. NUCLEAR REGULATORY COMMISSION 611 RYAN PLAZA DRIVE, SUITE 400 ARLINGTON,TX 76011 8064 REGIONAL ADMINISTRATOR,REGION V U. S. NUCLEAR REGULATORY COMMISSION 1450 MARIALANE WALNUTCREEK, CA 94596-5368 REGIONALADMINISTRATOR,REGION I REGIONAL ADMINISTRATOR,REGION Il U. S. NUCLEAR REGULATORY COMMISSION U. S. NUCLEAR REGULATORY COMMISSION 475 ALLENDALEROAD
~
101 MARIETTASTREET NW, SUITE 2900 KING OF PRUSSIA, PA 19406-1415
'TLANTA.GA 30323 REGIONALADMINISTRATOR,REGION III U. S. NUCLEARREGULATORYCOMMISSION
'99 ROOSEVELT ROAD GLEN ELLYN, IL 60137 OPERATOR LICENSING BRANCH DIVISION OF LICENSEE PERFORMANCE AND QUALITYEVALUATION U.S. NUCLEAR REGULATORYCOMMISSION WASHINGTON, DC 205550001
NRC FORM 398 16.92) 10 CFR 55.31, 5525 55A7, and 55.57 V.S. NUCLEARREGUlATORYCOMMISSION PERSONAL QUALIFICATIONSTATEMENT-LICENSEE TO REMAINVALID,THIS FORM MUST NOT BE ALTERED
~ APPROVED BY0MB:NO. 31504090 EXPNES: 12.31.94 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS INFORMATION COLLECTION REQUESTI 2.0 HRS. FORWARD COMMENTS REGARDING BURDEN ESTIMATE TO THE INFORMATION AND RECORDS MANAGEMENTBRANCH IMNBB7714), U.S. NUCLEAR REGULATORY COMMISSION, WASHINGTON, DC 205550001, AND TO THE PAPERWORK REDUCTION PROJECT (3150.0090). OFFICE OF MANAGEMENT ANDBUDGET. WASHINGTON,DC 20503 DATE RECEIVE D (To be completed by NRCI 1 ~ APPLICANT'S FULLNAME (Lesl First, (y(iddlej AND ADDRESS (include ZIP Code) '. TYPE OF APPLICATION (C>>ec>> eppgcebie bores)
HOT COLO
- 2. CITlZENSHIP
~. UNITED STATES
- b. OTHER (Specify)
- 5. TYPE OF UCENSE APPLIED FOR
- 3. BIRTH DATE MONTH OAY YEAR
- a. NEW
- b. RENEWAL
- c. UPGRADE
- d. MULTIUNIT(Afl(ENDTO INCLUDEADD/TIONALUN/77
- e. REAPPUCATION 1
~ FIRST 2 ~ SECOND 3 ~ THIRD
- 6. PREVIOUS LICENSE(sj HELD I. WAIVERREQUESTED (Justify on Reverse) 1
~ WRITTEN (Cetegoryl 2 ~ OPERATING (Cetegoryl 3 ~ ELIGIBILITY 4 ~ MEDICAL 5 ~ OTHER
- 9. DATE PASSED GENERIC FUNDA.
MENTALS EXAMINATIONSECTION (IFAPPUCABLEI
- a. OPERATOR
- b. SENIOR OPERATOR
- c. LIMITEDSRO (e.g., Fuel Hend/erl a DOCKET NUMBER 55.
- b. UCENCE NUMBER C.
I N
I I
I (L FACILITYDOCKET NUMBER 50.
, 7. NAMEAND ADDRESS OF APPLICANT'S EMPLOYER (include Z(P Codel
- 10. CURRENT POSITION AT FACILITY
- 8. NAME OF APPLICANT'S FACILITY
'9, ADDITIONALFACILITYDOCKETS (Mutt/unit Licenseesl FACILITYDOCKET NUMBER
- a. PLANT SUPERINTENDENT
- b. ASSISTANT PLANTSUPERINTENDENT
- c. SHIFT SUPERVISOR
- d. STAFF ENGINEER
- e. SHIFT TECHNICALADVISOR/SHIFT ENGINEER INSTRUCTOR
- 0. SENIOR CONTROL ROOM OPERATOR II. CONTROL ROOM OPERATOR I. AUXILIARYUNITOPF R.
ATOR/TRAINEE/TURBINE BUILDING/EQUIPMENT OPERATOR (NON E/CENS.
ED OPERA TOR/
j, OTHER (Specify/
11.
EDUCATION a.
HIGH SCHOOL GRADUATE GED EQUIVALFNCY NO
- o. NUMBER OF YEARS OF COLLEGE
- c. MAJOR AREAIS) OF STUDY ENGINEERING (F(EEDS/
OTHER
- 12. FACILITYOPERATO DEGREE CODES (To be used for HIGHEST DEGREE" obteinedl 0 ~ NONE 1 ~ CERTIFICATE 2 ~ ASSOCIATE 3 ~ BACHELOR s
~ MASTER 5 ~ OOCTORAL R TRAININGPROGRAIVI
- d. VOCATIONAL/TECHNICAL NUMBER Of MONTHS CERTHICA'I RECEIVED
- e. GRADL/ATEOF INPO ACCREDITED OPERATOR TRAININGPROGRAM THATIS BASED UPON A SYSTfMS APPROACH TO TRAINING YES NO
- b. CERTIFIED ON NRC FORM st ~ I SIMuLAFIDIVFACRITY CER fir/cAT/ON IOR IIRCAPPROVED SIMULATIONFAGUTYIS USED IN THf OPERATOR TRAININGPROGRAM YES
- 13. TRAINING (S(NCE lASTAPPL(CAT(ON-SEE(NSTRUCT(DNSI IR M
b.
V Of WEEKS
- 14. EXPERIENCE (DD NOT DOUBLE COUNT-SEE(NSTRUCT(ONSI NAVY o.
u Of WEEKS 1 NUCLEAR POWER PLANTFUNDAMENTALS 2 PLANT SYSTEMS CLASSROOM OBSERVATION 3 OPERATING PRACTICE CONTROL ROOM OPERATIONS ON SHIFT SIMUlATOROPERATING (includes Clessrooml SIMULATORNAMES Klou.
tooR"I 1 ~ RO 2 ~ EOOW/PPWO 3 ~ EWS/PPWS 4 ~ ERS/CRW 5 ~ OTHER (Specify/
COMMERCIALNUCLEAR (including Reseerc/I/Fest Reectorl 10 ~ REACTOR OPERATOR (liCeneedl 11
~ SENIOR OPERATOR (L(censed/
12 ~ SHIFT SUPERVISOR (Licensed/
13 ~ STAFF/SHIFT ENGINEER (licensedl I D UP PROGRAM COMPLETED YES NO 4 SRO INSTRUCTION 5
EXTRA PERSON ON SHIFT IN CONTROL ROOM WF KMFNIMuMI e TIME ON SHIFT ASOVf 20 ~ POWER I IM MI 6REQUALIFICATION 7OTHER (Specify/
C NOMBIROf SIGNeICANT ON'IROL MAN<fuLAIIONS u
IS ~ AVXJEQVIP. OPERATOR (IVonlicensedl 15 ~ PLANTSTAFF 16 ~ OTHER (Specify/
FOSSIL 6 ~ OPERATOR 7 ~ SUPERVISOR 9 ~ PLANTSTAFF
- 9. OTHE(j (SPec(fy/
IRC FORM 39$ (6.92)
Enclosure 3
DESCRIPTION OF CHANGES NRC Form Number Item Number Change 396 398 512 The 10 CFR Part 55 referenced in the upper left hand 'orner was corrected.
.The parapraph in Section A "Medical Examination Certification,"
was changed to include the statement regarding ANSI/ANS 3.4-1983, or ANSI/ANS 15.4-1988(N380) was followed or an acceptable alternative
- method, which has been approved by NRC, was used.
This was "Training."
Item f12 is NOW "Facility Operator Training Program."
413 414 515 416 418 This was "Experience."
Item 413 is NOW nTraining This was "Facility Operator Training Program."
Item 5 14 is NOW "Experience."
.This section was reorganized but not renumbered.
This was "For Renewals Only." Item 415 is NOW "Experience Details."
This was "Experience Details."
Item f16 is NOW "For Renewals Only."
"Attach" should be "attached."