ML19057A167
| ML19057A167 | |
| Person / Time | |
|---|---|
| Issue date: | 03/26/2019 |
| From: | Office of Nuclear Security and Incident Response, NRC/OCIO |
| To: | |
| ANNETTE STANG | |
| Shared Package | |
| ML19039A205 | List: |
| References | |
| Download: ML19057A167 (1) | |
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U.S. NUCLEAR REGULATORY COMMISSION (MM-YYYY)
OPERATIONS CENTER FUEL CYCLE AND MATERIALS
.4
- 't.J.
° EVENT NOTIFICATION MI VVORKSHEET d
- 4.
4r APPROVED BY OMB: NO. 3150-XXXX Estimated burden per response to comply with this voluntary collection request:
provided will be used for evaluation of licensee event description, facility status Send comments re ardin
burden estimate to the Information Services Branch Commission, Wasa
g gton, DC 20555-0001, or by e-mail to InfqcoIlecls.Besourcegnicaoy, Office of Information and Regulatory Affairs, NEOB-10202, (3150-XXXX),
Washington, DC 20503. If a means used to impose an information collection control number, the NRC may not conduct or sponsor, and a person is not collection.
EN #
EXPIRES: (MM/DDIYYYY) 30 minutes.
The information and for input to the public website.
(T-2 F43), U.S. Nuclear Regulatory and to the Desk Officer, Office of Management and Budget, does not display a currently valid OMB required to respond to, the information NRC OPERATIONS TELEPHONE NUMBERS: PRIMARY - 301-816-5100 or 800-532-3469*, BACKUPS - [1st ] 301-951-0550 or 800-449-3694*,
[2nd] 301-415-0550 and [3rd] 301-415-0553. *Licensees who maintain their own ETS are provided these telephone numbers.
FAX - 301-816-5151, EMAIL - hoo.hoc@nrc.gov Notification Time Facility or Organization License #
Name of Caller/Title Call Back #
Event Time & Zone Event Date Location of Event (Include County and State)
Portion of Plant Affected (If applicable)
EVENT CLASSIFICATIONS EVENT TYPES INCIDENT REPORTS (30.50, 40.60, 70.50)
GENERAL EMERGENCY" FUEL CYCLE 20.2201
LOSS / THEFT
(a)
PROTECTIVE ACTION PREVENTED SITE AREA EMERGENCY MEDICAL / ACADEMIC 20.2202
ACTUAL / THREATENED (b)(1) UNPLANNED OVEREXPOSURE
CONTAMINATION ALERT TRANSPORTATION 20.2202
ACTUAL / THREATENED (b)(2) SAFETY EQUIPMENT RELEASE
FAILURE NOTIFICATION OF UNUSUAL EVENT" WASTE MANAGEMENT 21.21
DEFECT / NONCOMPLIANCE
(b)(3) MEDICAL TREATMENT WITH CONTAMINATION INCIDENT REPORT INDUSTRIAL/ COMMERCIAL 26.791
(b)(4)
FIRE / EXPLOSION TRANSPORATION EVENT FOREIGN EVENT 35.3045
MEDICAL EVENT
70.52 CRITICALITY / SNM LOST INFORMATION ONLY OTHER (Specify) 36.83
IRRADIATOR EVENT
70.52 ACTUAL / ATTEMPTED THEFT OTHER (Specify)
- ONLY UNDER OLD 1981 ORDER 39.77
RUPTURED WELL
CRITICALITY CONTROL 4-LOGGING SOURCE
HOUR (BULLETIN 91-01) 39.77
IRRETRIEVABLE WELL
CRITICALITY CONTROL 24-LOGGING SOURCE
HOUR (BULLETIN 91-01) 40.26
TAILINGS / WASTE
OTHER NON-CFR DAM FAILURE
REQUIREMENT NOTIFICATIONS YES NO WILL BE Anything Unusual or not understood?
Yes (Explain below)
No NRC REGION STATE(s)
Did all systems function as required?
Yes
No (Explain below)
LOCAL 111 OTHER GOVERNMENT AGENCIES Additional Information on page 2? Yes
No PRESS RELEASE Event Description (Include Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continue on Page 2)
NRC FORM 361A (MM-YYYY)
Continued on next page
Page
U.S. NUCLEAR (MM-YYYY)
FUEL CYCLE AND MATERIALS EVENT NOTIFICATION WORKSHEET (Continued)
REGULATORY COMMISSION OPERATIONS CENTER EN #
RADIOLOGICAL / CHEMICAL RELEASES: CHECK OR FILL IN APPLICABLE ITEMS Isotope Activity Physical Form Chemical Form Stack Liquid Effluent Other (Specify)
Monitor Reading Alarm Setpoint ONGOING RELEASE TERMINATED RELEASE OFFSITE RELEASE ONSITE AREAS EVACUATED OFFSITE PROTECTIVE ACTION RECOMMENDED PERSONNEL EXPOSURE / CONTAMINATION DATA Number of Personnel Exposed Number of Personnel Contaminated Maximum External Dose Maximum External Level Maximum Internal Dose Maximum Internal Level Critical Organ (if known)
Critical Organ (if known)
DEGRADED CRITICALITY SAFETY CONTROLS FOR ACCIDENT SCENARIO(S) (BULLETIN 91-01)
ALL BUT SINGLE DEFICIENT SAFETY
SAFETY SIGNIFICANCE
>45% MINIMUM CRITICAL MASS ALL CONTROLS LOST CONTROLS LOST ANALYSIS
UNKNOWN
PRESENT OR READILY AVAILABLE Number and Types of controls necessary under normal operating conditions Number and Types of controls which functioned properly under upset conditions Number and Types of controls necessary to restore a safe situation Safety Significance of Events Safety Equipment Status Status of Corrective Actions Event Description (Continued) (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.)
NRC FORM 361A (MM-YYYY)