ML17262A992
| ML17262A992 | |
| Person / Time | |
|---|---|
| Site: | Ginna  |
| Issue date: | 09/17/1992 |
| From: | Bettenhausen L NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | Mecredy R ROCHESTER GAS & ELECTRIC CORP. |
| References | |
| NUDOCS 9209220026 | |
| Download: ML17262A992 (8) | |
Text
Docket No. 50-244 SEP 17 tgsg Dr. Robert C. Mecredy Vice President Ginna Nuclear Production Rochester Gas and Electric Corporation 89 East Avenue Rochester, New York 14649 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 enclosed 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.
Enclosures:
As stated Sincerely, 6+<Rinol SZPg)ed 8~~
Lee H. Bettenhausen, Chief Operations Branch Division of Reactor Safety cc w/enclosures:
R. Carroll, Manager Training 920922002b 9209i7 PDR ADOCK 05000244 P
yl p(
~,
/,I 4
R. E. Ginna Nuclear Power Plant cc w/o enclosures:
R. Smith, Senior Vice President, Production and Engineering Central Records (4 copies)
- Director, Power Division State of New York, Department of Law N. Reynolds, Escpxire State of New York, SLO Designee NRC Resident Inspector 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 gb'9//5 /92 RI:DRS B~e enhausen 09/g /92 Official Record Copy
NRC FORM 3S6 (6.92) 10 CFR 55.23, 55.25, 55.27, 55.31, 55.33 55.57 U.S. NUCLEAR REGULATORY COMMISSION CERTIFICATION OF MEDICALEXAMINATION BY FACILITYLICENSEE NAMEOF APPUCANT FACIUlY APPROVEO BY OMB: No. 31504024 EXPIRES: 1.31.94 ESTIMATED BURDEN PER
RESPONSE
TO COMPLY WITH THIS INFORMATIOM COLLECTIOM REOVEST:
15 MlhUTES.
FORWARD COMMENTS REGARDING BURDEN ESTIMATE TO THE INFORMATIONAND RECORDS MANAGEMEhT BRANCH (MNBB 7714),
U.S.
NUCLEAR REGULATORYCOMMISSION, WASHINGTON, DC 205554001
~ ANDTO THE PAPERWORK REDUCTION PROJECT (3150.0024),
OFFICE OF MANAGEMENTAND BUDGET, WASHINGTON, DC 20503, FACIUTYDOCKET NUMBER A. MEDICALEXAMINATIONCERTIFICATION THIS IS TO CERrlFY THATTHE ABOVE NAMEDAPPLICANTFOR AMOPERATOR/SEMOR OPERATOR UCENSE HAS BEEN EXAMINEDBYA PHYSICIAN.
PAINTED NAME(orprryslcian)
STATE AND UCENSE NUMBER EXAMINATIONDATE BASED OM THE RESULTS OF THE EXAMINATION,INCLUDINGWFORMATIONFURNISHED BY THE APPUCANT, THE PHYSICuuf HAS DETERMINED THATTHE APPUCANT'S PHYSCA'ONDinoN AND GENERAL HEALTH AAE SUCH THAT THE APPUCAMT WOULD NOT BE EXPECTED TO CAUSE OPERATIONAL ERRORS ENDANGERING PUBUC HEALTH AND SAFEIY. I CERTIFY THAT IM REACHING THIS DETERMINATION,THE GUIDANCE CONTAINEDIN ANSI/ANS3.4.1983, OR ANSI/ANS 15.4.1988 (N380) WAS FOLlOWED ANDTHATDOCVMENTATIONIS AVAILABLEFOR REVIEW BY NRC.
IF THE GUIDANCE IN THE APPROPRIATE ANSI/ANS DOCUMENT IS NOT COMPUED WITH, AN ACCEPTABLE ALTERNATIVEMETHOD, WHICH HAS BEEN APPROVED BY NRC, WAS USED.
ON THE BASIS OF THE RECOMMENDATIONOF THE PHYSICIAN, I RECOMMEND THAT THE APPLICANT'S OPERATOR LICENSE BE CONDITIONED AS FOLLOWS:
- t. 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)
RELATIDNsHip oF REsTRicTioN To DisoVAUFYINGcoNDITIQN(Bneiiy indicate how restriction wiN correct me disrruarrfyrng condidon)
REMARKS FOR RESTRICTION CHANGE (Biock 5 above)
B. NONMEDICALCERTIFICATION THIS CERTIFIES THATTHE APPUCANT HAS BEEN FOUND TO MEET THE SAFEGVARDS AND FfTNESS FOR DV1YREOVIREMENTS OF THIS FACIUTYFOR UCENSED OPERATORS.
ANY FALSE STATEMEh'r OR OMiSSIOM IM THIS DOCUMENT, INCLVDWG ATTACHMENTS, MAYBE SUBJECT TO CIVILAND CRIMINALSANCTIONS. I CERTIFY UNDER PENALTY OF PERJURY THATTHE INFORMATIONW THIS DOCUMENTANDATrACHMENTSIS TAVEANDCORRECT.
PRIMTED NAMEANDTITLE (Senior Afenegement Represenrerrve on Sire)
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 V.S. NUCLEAR REGVtATORYCOMMISSION 475 ALLENDALEROAD KING OF PRUSSIA PA 19406 1415 REGIONAL ADMINISTRATOR.REGION IV U.S. NUClEAR REGULATORYCOMMISSION 611 RYAN PLAZADRIVE, SUITE 400 AAUNGTOM,TX 601 14064 REGIONAL ADMINISTRATOR,REGION II U.S. NUCLEAR REGULATORY COMMISSION 101 MARIETTASTREEr NW, SVITE 2900 ATLANTA,GA 30323 REGIONALADMWISTRATOR,REGION V U.S. NUCLEARREGULATORYCOMMISSON 1450 MARIAlAN'E WALNUTCREEK CA 94596.5368 REGIONALADMINISTRATOR,REGION 18 U.S. NUCLEAR REGULATORYCOMMISSION 799 ROOSEVELT ROAD GLEN ELLYN,IL 60137 OPERATOR UCENSING BRANCH DIVISIONOF UCENSEE PERFORMANCE AND OVAUIYEVALUATION U.S. NUCLEAR REGVIATORYCOMMISSION WASHWGTON, DC 205554001 ATEMENT ROUTINE USE(S):
The information may be ddclosed to an appropriate Federal State and local agency In the event the Information indicates a violation of potential violation of law and in the course of an administrative or Iudicial proceeding, In addeon, this information may be transferred to an appropriate
- Federal, State, or local agency to the extent reievan; and necessary for an NRC decision aboul you.
WHETHER DISCLOSURE IS MANDATORYOR VOLUNTARYAND EFFECT ON INDMDVALOc NOT PROVILXNG INFORMATION: Disclosure is voluntary.
tf the requested Information is not prodded, however, the apptcabon for a facilityoperator's or senior operators license may be denied.
SYSTEM MANAGER(S) AND ADDRESS:
Chief, Operator Ucensing Branch Office of Nuclear Reactor Regulation U.S. Nuclear Regulatory Commission Washington, DC 20555.0001.
PRIVACYACT'ST Pursuant To 5 U.s.c. 552a(e) (3), enacted inlo law by section 3 of Ihe Privacy Acl of 1974 (Pubfic law 93-579), the following statement ls furnished to individuals who supply Information to the U.S. Nuclear Regulatory Commission on NAC Form 398.
This Information is maintained in a system of records designs'led as NRc.t6 and described at 55 Federal Register 33978 (August 20, 1990), or the most recent Federal Register pubacation of the Nuclear Regu'latory Commission's 'Repubbcation of systems of Records Notices that is avrutabte at the NRC Public Documenl Room, Gelrnan Bugding, Lower Level, 2120 L Stree'I NW, Washing! on, D.C.
AUTHQRITY: section 107 and 161 oi of the Atomic Energy Act of 1954, as amended (42 U.s.c. 2137 and 2201@i).
PRINCIPAL PURPOSE(S):
information entered on this form is used lo determine whether the physical condcicn and general heath of Ihe apphcanl are such that they will not cause operational errors endangering public heahh and safety.
The intorrnation may be used by the NAC staff to determine if Ihe indMdual meets the requirements of 10 CFR 55!o tave an examination or to be Issued an operator's hcense.
NACFORM396 (692)
12.
13.
14.
15.
16.
17.
18.
19.
INSTRUCTIONS FOR COMING NRC FORM 398, PERSONAL QUALIFICATITATEMENT-LICENSEE T8%EMAINVALID,THIS FORM MUST NOT BE ALTEREO TYPE OF APPLICATION a.
NEW-X IF YOU ARE A NEW APPLICANT.
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 EKCEPTION. ALSO, THIS BLOCK IS TO BE MARKED IF PREVIOUS NEW APPLICATIONWAS WITHDRAWN. PLEASE WRITE "WITHDREW'EXTTO 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.
b.
RENEWAL-X IF YOU ARE RENEWING CURRENT LICENSE.
c.
UPGRADE - 'X'F YOU HOLD A RO UCENSE AND ARE NOW APPLYING TO UPGRADE YOUR LICENSE TO A SRO.
d.
MULTI-UNIT- "X IF YQU CURRENTLY HOLD A UCENSE AT YOUR FACILITYAND ARE APPLYING TO AMENDYOUR CURRENT UCENSE 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 LIMITEDTO FUEL HANDLING. ENTER THE MONTHANDYEARTHE GENERIC FUNDAMENTALSEXAMINATIONSECTION QF THE WRITTEN EXAMINATiONWAS PASSED.
IF THE GFES WAS NOT TAKEN,YOU MUST HAVEPASSED AN NRC LICENSING EXAMINATIONON 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 - INDICATEBOTHACADEMICANDVOCATIONAL/TECHNICAL POST HIGHSCHOOLEDUCATION. FOR MAJORAREA(S) OF STUDY, INDICATETHE NUMBER OF YEARS SPENT IN EACH COLLEGE CURRICULUM AND THE HIGHEST DEGREE RECEIVED, USING THE DEGREE CODE PROVIDED.
FOR VOCATIONAL/TECHNICALEDUCATION, INCLUDING PROGRAMS SUCH AS NUCLEAR POWER SCHOOL, MILITARY 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).
FACILITYOPERATOR TRAININGPROGRAM - CHECK THE APPROPRIATE BOXIN ITEMS 12a AND12b. IF "YES IS CHECKED IN BOTH ITEMS 12.a AND 12,b, THEN ITEMS 13 (TRAINING),14 (EXPERIENCE), AND 15 (EXPERIENCE DETAILS) DO NOT 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 MEANS ACCREDITATIONBYTHE 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 REGULATORY 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 QF WEEKS SPENT IN EACH TYPE OF TRAINING. THE NUMBER QF WEEKS IS PROVIDED,IN ADDITIONTO BEGINNING AND COMPLETIQN DATES, TO ACCOUNT FOR INTERMITTENTTRAINING(FOR EXAMPLE,4 WEEKS OF CLASSROOM TRAININGSPREAD OVER A2.MONTH PERIOD).
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 LICENSE APPLIED FOR CANNOT BE DOUBLE COUNTED UNDER EXPERIENCE (ITEM 14).
ALLREQUALIFICATIQNTRAININGTIMEIS TO BE ACCOUNTED FOR IN THE REQUALIFICATIONITEM 13.6. PLEASE DO NOT DOUBLE UST 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 FQR WHICH THE LICENSE IS SOUGHT IS REQUIRED. FOR EACH POSITION HELD.
COMPLETE ITEM 15.
DD NOT DOUBLE COUNT TIME.
IF YOU HAD OVERLAPPING DUTIES, THE MONTHS SHOULD REFLECT THE PROPORTIONATE AMOUNTOF TIMEYOUWERE ASSIGNED TO THOSE PARTICULARDUTIES. IN NO CASE SHOULD THE NUMBEROF MONTHS REPORTED FOR A PARTICULARTIME PERIOD EXCEED THE NUMBER OF MONTHS THAT ARE IN THAT TIME 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 LICENSE IF FIRST RENEWAL. (2) ENTER DATE AND RESULT OF MOST RECENT NRC ADMINISTEREDREQUALIFICATIONEXAMINATION.
COMMENTS - USE THIS SPACE TO INCLUDEANYEXTRAINFORMATIONOR CITIFICATIONFOR OTHER ITEMS ON THE APPLICATIONFORM.
IF THE SPACE PROVIDED IS NOT SUFFICIENT, YOU MAYATTACH EXTRA INFORMATIONWITH YOUR APPLICATION.
NRC FORM 3962 CERTIFICATION OF MEDICALEXAMINATIONBY FACILITYLICENSEE MUST ACCOMPANYTHIS APPUCATION 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)
NRO FoRM 999 (9 92I
PRIVACYACT STATEMENT pursuant to U.G.G. 552a(e)!3), enacted into la'v Ly section 3 of tho privacy Act of 1974 rpublic Law 93-79), the ioliowing is furnished to individuals who supply information to the U.S. Nuclear Regulatory Commission 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 ommission'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)).
I 2.
PRINCIPAL PURPOSES.
The information willbe collected an:I 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 ifthe indi"idual meets the requirements of 10 CFR Part 55 to be issued an operator's license; (b) provide researchers with information for statistical ovaluaticns related to selection, training, and examination ot facility operators; (c) piovide facility management with sufficient informalion to enroll the individuals in the licensed operator requalification program; (d) provide for examination and testing material and obtain results from contractors.
4.
'iVHETHER DISCLOSURE IS MANDATORYOA 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:
REGIONAL ADMINISTRATOR,REGION I U. S. NUCLEAR REGULATORY COMMISSION 475 ALLENDALEROAD KING OF PRUSSIA, PA 19406-1415 REGIONAL ADMINISTRATOR,REGION IV U. S. NUCLEAR REGULATORY COMMISSION 611 RYAN PIZZA DRIVE, SUITE 400 ARLINGTON,TX 7601 1%064 REGIONALADMINISTRATOR,REGION II U. S. NUCLEAR REGULATORY COMMISSiON 101 MARIETTASTREET NW, SUITE 2900 ATlANTA,GA 30323 REGIONALADMINISTRATOR,REGION V U. S. NUCLEAR REGULATORY COMMISSION 1450 MARIALANE WALNUTCREEK, CA 94596-5368 REGIONALADMINISTRATOR,REGION III U. S. NUCLEARREGUlATORYCOMMISSION 799 ROOSEVELT ROAD GLEN ELLYN, IL-60137 OPERATOR LICENSING BRANCH DIVISIONOF LICENSEE PERFORMANCE AND QUAUTYEVALUATION U.S. NUCLEAR REGUlATORY COMMISSION WASHINGTON, DC 205554001
U.S. NUCLEAR REGULATOAYCOMMISSION
,NRC FORM 398 (6-92) il0 CFR 55.31. 55.35.
55.47, and 55.57 PERSONAL QUALIFICATIONSTATEMENT-LICENSEE TO REMAINVALID.THIS FORM MUST NOT BE ALTERED
- 1. APPLICANT'S FULLNAME (Last. First, Middle) ANDADDRESS (include ZIP Code)
APPROVED BYOMB: NO. 31500090 EXPIRES: 12.31 94 ESTIMATED BUADEN PER RESPONSE TO COMPLY WITH THIS INFORMATION COLLECTION REQUEST: 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 PAOJECT (3150 0090), OFFICE OF MANAGEMENTANDBUDGET, WASHINGTON,DC 20503
- 4. TYPE OF APPLICATION (Check applicable boxesl HOT DATE RECEIVED (To be completed by NRCJ COLO
- 2. CmZENSHIP
- a. UNITED STATES
- b. OTHER (Specifyl
- 5. TYPE OF UCENSE APPLIED FOR
- 3. BIRTH DATE MONTH DAY YEAR
- 5. NEW
- b. AENEWAL
- c. UPGRADE
- d. MULTIUNIT (AMEJ(D TO JNCLUDEADDJTJOHAL U/VITJ
- e. REAPPUCATION I ~ FIRST 2-SECOND 3 ~ THIRD
- 6. PREVIOUS LICENSE(S) HELD I. WAIVERREQUESTED(JustifyonReversel
- 1. WRITTEN (Categoryl 2 - OPERATING (Categoryl
- 3. EUGIBILITY 4 ~ MEDICAL 5 ~ OTHER
- 9. DATE PASSED GENERIC FUNDA.
MENTALSEXAMINATIONSEC'(ION (JF APPLICABLEJ MM YY I
- a. OPERATOR
- b. SENIOR OPERATOR
- b. LICENCE NUMBER 55.
c.
X Al N A
u II OA'r H AX "I I, I
I
- d. FACILITYDOCKET NUMBER 50.
- 7. NAMEAND ADDRESS OF APPLICANT'S EMPLOYER (include ZJP Codel
- 10. CURRENT POSITION AT FACILITY
- 8. NAME OF APPLICANT'S FACIUTY 9, ADDITIONALFACILITYDOCKETS (Multi.unit Licenseesl FACILITYDOCKET NUMBER
- a. PLANT SUPERINTENDENT
- b. ASSISTANT PLANT SUPERINTENDENT
- c. SHIFT SUPERVISOR
- d. STAFF ENGINEER
- e. SHIFT TECHNICALADVISOR/SHIFTENGINEER INSTRUCTOR
- 0. SENIOR CONTROI. ROOM OPERATOA IL CONTROL ROOM OPERATOR I. AUXILIARYUNIT OPER.*
ATOR/TRAINEE/(URSINE BUILDING/EQUIPMENT OPERATOR (NOJ/ L(CENS.
ED OPERA TORJ j, OTHER (SpecifyJ
- 11. EDUCATION
~. HIGH SCHOOL GRADUATE GED EQUIVALENCY NO O. NUMBER OF YEARS OF COLLEGE
- o. MAJOR AREA(S) OF STUDY ENGINEERING (FJELOSJ OTHER NvuMA Or vtAPS teGNCST OlOXIt Ivycootu DEGREE CODES (To be used for H(GHEST DEGREE obtainedl 0 ~ NONE I ~ CEATIFICATE
~ ASSOCIATE 3 ~ BACHELOR 4 ~ MASTER 5 ~ DOCTORAL
- d. VOCATIONAL/TECHNICAL NVMBEA OF MONTHS CEATIII AT AECEIVED
- 12. FACILITYOPERATOR TRAININGPROGRAM
~. GRADUATE OF INPO ACCAEOITEO OPERATOR TRAININGPROGRAM THATIS BASED UPON A SYSTEMS APPAOACH TO TAMNLNG YES O, CEADFIEOONNACFOAM~tar-SIMULAnokfacrttty CEAFIRCATION'IOANAC APPROVED SIMVLATIONfACILITYIS USED IN THE OPEAATOA TRAININGPROGRAM YES NO
- 13. TRAINING(SINCE LRSTAPPLICATION-SEE INSTRUCT(ONSJ R
M O.
V Of WEEXS
- 14. EXPERIENCE (OO /VOTDOUBLE COUNT-SEE INSTRUCT(ONSJ 0
u Of 'AE EBS I NUCLEAR POWER PLANTFUNDAMENTALS 2
PLANT SYSTEMS CLASSROOM OBSERVATION 3OPERATING PRACTICE CONTROL ROOM OPERATIONS ON SHIFT SIMUlATOAOPERATING /includes Classrooml SIMULATORNAMES a.
ICiiii AkW4 I ~ RO 2 - 5OOW/PPWO 3
EWS/PPWS 4 ~ ERS/CRW 5 ~ OTHER (Specify)
COMMERCIALNUCLEAR (including Research/Test Reactorl 10 ~ REACTOR OPERATOR (Licensedl 11 ~ SENIOR OPERATOR (Licensedl 12 ~ SHIFT SUPERVISOR fLicensedl EniiD A
V PROGRAM COMPLETED YES NO 4 SRO INSTAUCTION EXTRA Pf ASON ON SHIFT )N CONTAOLBOOM II WffirMINIMVMI TIME ON SHIFT ABOVE tc'o POWER ikiM Mi 6AEQUALIFICATION 7 OTHER (Speci fyl r N MB A OF SIGNI ICANT ONTROL MANIPVLATIONS VLA 13 ~ STAFF/SHIFT ENGINEER gicensedl 14
~ AUXJEQUIP. OPERATOA (Nonii'censedl 15 ~ PlANTSTAFF 16 ~ OTHER (Specifyl FOSSIL 6 ~ OPERATOR 7 ~ SUPERVISOR 8 ~ PLANTSTAFF 9 - OTHE(1 (Speci fyl NAC FORM 398 (6.92)
Enclosure 3
DESCRIPTION OF CHANGES NRC Form Number Item Number Change 396 The 10 CFR Part 55 referenced in the upper left hand corner was corrected.
398 512 g13 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 412 is NOW "Facility Operator Training Program."
This was "Experience."
Item f13 is NOW "Training."
514 415 This was "Facility Operator Training Program."
Item 514 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
$ 16 is NOW "For Renewals Only."
418 "Attach" should be "attached."