ML18302A339

NRC-2018-000457 - Resp 1 - Final

ML18302A339
Person / Time
Issue date:	10/29/2018
From:	Stephanie Blaney NRC/OCIO
To:	Tarver J - No Known Affiliation
References
FOIA, NRC-2018-000457
Download: ML18302A339 (11)

Text

NRC FORM 464 Part I U.S. NUCLEAR REGULATORY COMMISSION NRC RESPONSE NUMBER (04-2018) 1 2018-000457 11 1

RESPONSE TO FREEDOM OF INFORMATION ACT (FOIA) REQUEST

RESPONSE

TYPE D INTERIM I./ I FINAL REQUESTER:

DATE:

!Julian Tarver 11 1012912018 DESCRIPTION OF REQUESTED RECORDS:

I Copies of Forms 14,494, and 913 D

0 D

D 0

D D

D D

PART I. ** INFORMATION RELEASED Ttie NRC has made some, or all, of the requested records publicly available through one or more of the following means:

(1) https://www.nrc.gov; (2) public ADAMS, https://www.nrc.gov/reading-rm/adams.html; (3) microfiche available in the NRC Public Document Room; or FOIA Online, https://foiaonline.regulations.gov/foia/action/public/home.

Agency records subject to the request are enclosed.

Records subject to the request that contain information. originated by or of interest to another Federal agency have been referred to that agency (See Part I.D - Comments) for a disclosure determination and direct response to you.

We are continuing to process your request.

See Part I. D -- Comments.

AMOUNT

$0.00 D

D D

PART I.A -- FEES You will be billed by NRC for the amount indicated.

You will receive a refund for the amount indicated.

Fees waived.

D D

Since the minimum fee threshold was not met, you will not be charged fees.

Due to our delayed response, you will not be charged search and/or duplication fees that would otherwise be applicable to your request.

PART 1.8--INFORMATION NOT LOCATED OR WITHHELD FROM DISCLOSURE We did not locate any agency records responsive to your request. Note: Agencies may treat three discrete categories of law enforcement and national security records as not subject to the FOIA ("exclusions"). See 5 U.S.C. 552(c). This is a standard notification given to all requesters; it should not be taken to mean that any excluded records do, or do not, exist.

We have withheld certain information pursuant to the FOIA exemptions described, and for the reasons stated, in Part II.

Because th.is is an interim response to your request, you may not appeal at this time. We will notify you of your right to appeal any of the responses we have issued in response to your request when we issue our final determination.

You may appeal this final determination within 90 calendar days of the date of this response. If you submit an appeal by mail, address it to the FOIA Officer, at U.S. Nuclear Regulatory Commission, Mail Stop T-2 F43, Washington, D.C. 20555-0001. You may submit an appeal by e-mail to FOIA.resource@nrc.gov. You may fax an appeal to (301) 415-5130. Or you may submit an appeal through FOIA Online, https://foiaonline.regulations.gov/foia/action/public/home. Please be sure to include on your submission that it is a "FOIA Appeal."

PART 1.C -- REFERENCES AND POINTS OF CONTACT You have the right to seek assistance from the NRC's FOIA Public Liaison by submitting your inquiry at https://www.nrc.gov/reading-rm/

foia/contact-foia.html, or by calling the FOIA Public Liaison at (301) 415-1276.

If we have denied your request, you have the right to seek dispute resolution services from the NRC's Public Liaison or the Office of Government Information Services (OGIS). To seek dispute resolution services from OGIS, you may e-mail OGIS at ogis@nara.gov, send a fax to (202) 7 41-5789, or send a letter to: Office of Government Information Services, National Archives and Records Administration, 8601 Adelphi Road, College Park, MD 20740-6001. For additional information about OGIS, please visit the OGIS website at https://www.archives.gov/o9§.

NRC FORM 464 Part I (04-2018)

U.S. NUCLEAR REGULATORY COMMISSION RESPONSE TO FREEDOM OF INFORMATION ACT (FOIA) REQUEST PART I.D -- COMMENTS NRC RESPONSE NUMBER 1

• 201s-000457 11 1

RE~~~SE D INTERIM I./ I.

FINAL Our response belatedly acknowledges receipt of your request. The three requested forms are.enclosed.

Signature - Freedom of Information Act Officer or Designee Stephanie A. Blaney i

): Digitally signed by Stephanie A. Blaney J "'Gate: 2018.10.29 08:54:00 4'00' I

NRCFORM14 (10-2017)

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NRCMD10.130 l~'\\

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REPORT OF UNSAFE,OR.

uNHEAL rH*i=uL woRKIN<l cQN01r10Ns U.S. NUCLEAR REGULATORY COMMISSION 1 Assigned Report Number I

2. Person Completing Form (Check one)

Q.. Employee :.

D. ~epr!se!ltative of employee bl!l_ie~es _tt:aat ~ _c.on~ition in the workplace violates safe~ an~

occupational l:lealth standards. v

3. Name of Facility_.

6. Have you repe>rt~d this.condit~~ri to you~ ~~p~*ivlsol?

D '\\ies Di' No';

7. Describe the hazard~. Include 'materials and,equip.meni inv~lved 'a'rid the aj,pro>i:imate 'number of employees' expos~d /,r**

threatenedbythecondition.

8. Forward to: D NRC Occupational SafE!ty and H~al_th, Ma.n~~:~r,.

9.

• Has anyone attempted to correct the condition? If yes, give details.

OvesONo

11. May your name be revealed?

OvesONo If no is checked, the safety officer will detach the bottom portion of th!s form before distribution is made.

~----~--------~-~--~------~

Employee's Name Employee's Work Phone Number (include area code)

• I

... ----~-------------------------.....

I Employee's Slgriature Date of Employee's Signature (MM/DDNYYY)

N~C FO.R~ 14 (10-2017)

Page 1 of2

NRCFORM 14 (10-2017) i NRCMD 10.130 U.S. NUCLEAR REGULATORY COMMISSION

. REPORT OF UNSAFE OR

. UNHEALTHFUL WO~Kl~G CClNC>ITIONS (Continued)

• PROCEDURES Every effort should be made to correct identified hazards as soon as possibie. Hazards sho.uld first be reported tq your immediate supervisor, since it is usually the most expedient means of abatement. However, hazards may also be h~ported either verbally or in writing to the local coll~teral 'duty safety officer, safety and health committee, or the.

NRC Safety and Occupational Health Program Manager at Headql,larters. You also have the right to report workplace hazards to the Occupation'al Safety and Health Administration (OSHA), although it is preferred that hazards be reporteci to the NRG Safety Office first, so they can be promptly investigated and abated.

• When subrniUing a rE;lport of unsafe or i.J.nnealthful working conditions, you have the right to request thatyour name

. not be disclosed to anyone except an authorized re'presentathie 6fthe Secretary of Labor 'ct>,S8A):. *. : ', *.

Upon receipt of a report of unsafe or unhealthful working conditions, the manager or collateral duty safety officer will:.

A. Assign a report number and enter the report on NRC Form 911, Log of Reported Unsafe or Unhealthful Working Conditions.

B. Detach the employee's name fro_rn the bQttom of the for.m, if anonymity is requested.

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C. Investigate !;llleged hazards within the apprc;>priate timeframe.

• 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> - for imminent danger conditions

• 3 working days - for serious conditions

• 20 working days - for other than serious conditions D. Forward the inspection report to the individual responsible for abatement.

• E. Forward the completed inspection report to the local safety and health committee for review.

F. Notify the employee of the results ofthe insp~ction; in writing, within 15 days after completion of the*,nspection for Safety violations 'or withfr130 days for heaith violations.

G. Retain a copy of the completed form on file for 5 years.

H. Notify the local safety and health committee when nece~sary ~orrective actions or interim protective measures are not taken in a timely manner.

NRC FORM 14 (10-2017)

Page 2 of2

NRCFORM913 (09-2017)

MD 10.130 NRC SELF EVALUATION QUESTIONAIRE NRC Safety and o*ccupational Health Program

. U.S. NUCLEAR.REGULATORY COMMISSION Respond.Yes or No to each question that related to your responsibilities. If during the reyiew there was no activity related to the-question, mark the response as No Activity. If the question addressed.issues for which you.have not been given responsibilities, mark the response as Never Applies. Enter Audit Trail Notes to explain how you determined your response.*

Core Area:

.1 OSH Management Date (MM/DD/YYYV):_

ACTIVITY EVALUATION 1.1. Has the office appointed a Collateral Duty,Safety Officer(s)?

Instructions: Revie*w appointment Jetter(s) on file for the Collateral Duty Safety Officei(s).

(Evidence: Reviewer notes)

Citation:

29 CFR 1960.S(e), Agency Responslbllltles 1 :2. *- is a safety and health committee chartered for the office?

Instructions: Review safety and heatth*committee records.

(Evidence: R~vlewer note's)

Citation: 29 CFR 1960.37(a),

Committee Organization NRC FORM 913 (09-2017)

CHOOSE YES,* NO, NO ACTIVITY, OR NEVER APPLIES Select

• Select Select Office Inspected

• Auditor:*

AUDIT TRAIL NOTES i,,'

Page 1 ofS

NRC FORM913 (09-2017)

MD 10.130

• ACTIVITY EVALUATION 1.3. Does the office maintain related safety and health committee documents?

Instructions: Review safety and health committee records for the past year. (NOTE:

Documents include meeting minutes, written correspondence, responses to employee reports of hazards, and OSHA Fonn 300A, "Summary of Work-Related Injuries and fffnesses.').

(Evidence: Reviewer notes)

Citation: 29 CFR 1960.37(g},

Committee Organization 1.4. Does**the office:post required OSHA program'information,.NRC Form 900, "NRG Safety and Occupational Health Program," on official bulletin board(s)?

Instructions: Observe the office's official bulletin board(s) for OSHA.program lnfonnation.

(Evidence: Observation notes)

Citation: 29 CFR 1960.12(c),

Dissemination of Occupatlonal Safety and Health Program Information.

NRC FORM 913 (09-2017)

• U.S. NUCLEAR REGULATORY COMMISSION NRC SELF EVALlJATION QUESTIONAIRE

. NRC Safety and Occupational Health Program (Continued)

CH00SE YES, NO, NO ACTIVITY, OR NEVER APPLIES Select Select AUDIT TRAIL NOTES Page 2 of 5

NRC FORM913 (0!1-2017)

MD 10.130 U; S. NUCLEAR REGULATORY COMMISSION NRC SELF EVALUATION QUESTIONAIRE NRC Safety and Occupational Health Program (Continued)

Core Area:. 2 Inspections/Hazard Abatements...... _

I Select Office Inspected ACTIVITY EVALUATION 2; 1. Does the office immediately post the NRC Form 219, ~Notice of Unsafe or

• Unhealtnful Workplace Conditions," at :or near each affected ania until the condition. has-been abated.or-for three working days,.whichever is later?

Instructions:* Review NRC Form 911, "Log of

. Reported Unsafe or Unhealthful Worl<ing

. Conditions," and Interview 3-5. affected employees to deterinine'ifthe NRC Foim 219 was posted in Identified areas.

(Evidence:.Reviewer/Interview notes)

Citation: 29 CFR 1960.30 (a), Abatement of Unsafe !)r-Unhealthful Working Conditions 2.2.

• Does the CDSO maintain NRC Form 911; "Log of Reported Unsafe or tjnhealthfu/ Working Conditions?"

Instructions: Compare NRC Form 911, "Log o.f Reported Unsafe or Unhealthful Working Conditions," to:NRC Form 14, "Report of Unsafe or Unhealthful Worl<lng Conditions."

(Evidence:. Reviewer notes)

Citation:. 29 Cf'.R 1960.28 (d)(1) and (2),

Employee Reports of Unsafe or Unhealthful Working Conditions NRC FORM 913 (09-2017)

CHOOSE YES; NO, NO ACTIVITY, OR NEVER APPLIES Select Select-AUDIT TRAIL NOTES Page 3 of 5

NRC FORM913 (09-2017)

MD 10.130 U. S. NUCLEAR REGULATORY COMMISSION NRC SELF EVALUATION QUESTIONAIRE NRC Safety and Occupational Health Program (Continued)

Core Area: 3 Incident Recording and Reporting I Select Office Inspected ACTIVITY EVALUATION 3.1. Does the office document all reported injuries and illnesses on OSHA Form 301; "Injury and Illness Incident Report,"iii ECOMP and.NRC Form 436, *

"Report of Work_-Related Injuries and Illnesses?"

Instructions: Compare NRC Form 436, "Report of Work-Related lnjµries and

.Illnesses, ";and. OSHAForms 300, "Log of Work-Related Injuries and Illnesses," for the past 12 months.

(Evidence: Reviewer notes)

Citation: 29 CFR 1904.4, Recording Criteria and 19Q4.29, Forms.

3.2.. Does the CDSO maintain OSHA Log 300, "Log of Work-Related Injuries and Illnesses," annually"and'retain for 5 years?

Instructions: Reviewthe OSHA 300-Logs for the past 5 years.

• (Evidence: OSHA Logs)

Citation: 29 CFR 1904.4, Recording Criteria; 1904.29, Forms and 1904.33,

• Retention *and* Updating 3.3. Does the office complete and post annually the OSHA Form 300A,

• Summary of Work-Related Injuries and*

illnesses?"

Instructions: Review OSHA Form. 300A for the past year.

(Evidence: Review 300A forms)

Citation: 29 CFR 1960.67, Federal Agency Cerjlflcatlon of Injury and Illness Annual Summary NRC FORM 913 (09-2017)

CHOOSE YES, NO, NO ACTIVITY, OR NEVER APPLIES Select Select

• Select AUDIT TRAIL NOTES Page 4 of 5

NRC FORM913 (09-2017)

MP 10.130 Core Area: 4 Training ACTIVITY EVALUATION 4.1. Do Collateral Duty Safety Officers.

receive required CDSO training?

Instructions: Review the CDSO(s) training,

• records for the past year.

(Evidence: Training records}

Citation: 29 CFR 1960.58 Training of Coliateral Duty. Safety and Health

• Personnel and Committee members 4.2. Do safety and health committee members receive *training required for safety and health committee members?"

Instructions: Review training records for three safety and heatth committee members for the past year.

(Evidence: Training records)

Citation: 29 CFR 1960.58, Training of Collateral Duty Safety and Health Personnel and Committee Members NRC FORM 913 (09-2017)

U; S. NUCLEAR.REGULATORY COMMISSION*

f*

NRC SELF EVALUATIO"' QUESJIONAIRE NRC Safety and Occupational H~alth Program (Continued)

I I ~el~ct.Office lnspecte~.

CHOOSE YES, NO, NO ACTIVITY,

(

OR NEVER APPLIES i

AUDIT TRAIL NOTES I

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Page5of 5

NRC FORM494 U.S. NUCLEAR REGULATORY COMMISSION (09-2012)

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'Iii U.S. NUCLEAR REGULATORY COMMISSION HEADQUARTERS

• MOTOR POOL FLEET INSPECTION AND VEHICLE TRIP

SUMMARY

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~*MUST B'E COMPLETED.*:

I

• • I DATE INSPECTION PERFORMED (MMIDDNYYY):

VEHICLE LICENSE NUMBER:

INSPECTED (YES) OR (NO)

LEAKS (CHECK BENEATH VEHICLE):

0-'Yes D No*

I DESCRIPTION:

CHECKED.AND ACTION TAKEN:

FUEL, OIL AND WATER Q Yes 0No**

(WINDSHIELD WIPER FLUID):

LIGHTS, SIGNALS, 0Yes ON~

WINDSHIELD WIPERS, HORN:

TIRES (INCLUDING SPARE)

Oves 0No MECHANICAL PROBLEMS/SERVICE REQUIRED (ATIACH ALL R_ECEIP-TS AND CHARGE SLIPS):

• (

) FUEL ADDED GALLONS

(

)

OILADDED QUARTS CONDITIONAL (REPORT ANY IRREGULAR CONDITIONS, SUCH AS DENTS, SCRATCHES, ETC. USE DIAGRAM ON BACK TO INDICATE DENTS, SCRATCHES, ETC.):

ADM/DAS/ASC STAFF CONDUCTING INSPECTION:

VEHICL~ TRIP ~UMMARY

-~---

. -~-*-*--*-----~- ---

h>FFICIAL PURPOSE OF TRAVEL:;

f..** '.

DESTINATION:

!POINT OF ORIGIN (OWFN)(TWFN) OR OTHER:

/'*BEGINNING MI.LEAGE::

t~ENDING MILEAGE:

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• -~ ~ ~ _,.,,. --*~ :.._.

__ :1 r: ** ~OTAL MILEAGE: .. ']

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-- _.... *--*~'_,.;.~c-.:.',. *_.;

CONDITION (REPORT ANY IRREGULAR CONDITIONS; SUCH AS pENTS; SCRATCHES, ETC'. USE DIAGRAM ON BACK TO INDICATE DENTS, SCRATCHES, ETC.):

EXTERIOR CLEANING NEEDED

(

)

INTERIOR CLEANING NEEDED

(.

)

f*PRINTED NAME OF TRAVELER:*

NRC FORM 494 (09-2012)

• USE REGULAR UNLEA*DEb FUEL (87 (J.CTANE) '.ONLY "

• . *G$A=P~0H1BIT$ SMOK/NG WALL GSA VEHICLES*.

• SEAL BEL.TS MUST*BE PROPERLY FAS*TENED AT ALL TIMES WHEN VEHICLE IS IN MOTION *

..,... *NRC *PROH1Br($ TEXT MESSAGING WHILE DRIV/N(j GOVERNMENT :VEHICLE~

Page 1

NRC FORM 494 (09-2012)

Page2

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