ML19057A169
| ML19057A169 | |
| Person / Time | |
|---|---|
| Issue date: | 03/26/2019 |
| From: | NRC/OCIO, NRC/OGC |
| To: | |
| ANNETTE STANG | |
| Shared Package | |
| ML19039A205 | List: |
| References | |
| Download: ML19057A169 (2) | |
Text
Page of NRC FORM 361N
U.S. NUCLEAR REGULATORY COMMISSION (MM-YYYY)
OPERATIONS CENTER c)R REGN%
NON-POWER REACTOR (NPR) e-5
EVENT NOTIFICATION WM
4°. VVORKSHEET APPROVED BY OMB: NO. 3150-XXXX
EXPIRES: (MM/DD/YYYY)
Estimated burden per response to comply with this voluntary collection request: 30 minutes.
The information provided will be used for evaluation of licensee event description, facility status and for input to the public website.
Send comments regarding burden estimate to the Information Services Branch (T-2 F43), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-XXXX), Office of Management and Budget, Washington, DC 20503 lf a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.
EN #
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 Unit Name of Caller/Title Call Back #
Event Time & Zone Event Date Power/Mode (At Time of Event)
Power/Mode (At Time of Notification)
Reactor Type Max Power Max Pulse Pulse Inserted During Event EVENT CLASSIFICATION REPORTABLE CONDITION (varies by facility TS)
Offsite Medical
AMED GENERAL EMERGENCY
GEN/AAEC TS Deviation
ADEV Loss Comm/Asmt/Resp ACOM SITE AREA EMERGENCY
SIT/AAEC TS Required S/D
ASHU Invalid Specified System Act
AINV ALERT
ALE/AAEC RPS Actuation (scram)
ARPS ]jjjjjjj
Suspicious Activity UNUSUAL EVENT
UNU/AAEC Offsite Notification
APRE Security Event SAFEGUARDS EVENT (73 App G)
Degraded Condition
ADEG 111 MATERIAL/EXPOSURE
B???? ]jjjjj
AUNA INFORMATION ONLY
NNF ]jjjjj
Specified System Actuation AESF OTHER UNSPECIFIED REQMT
(see last column)
Safe S/D Capability
AINA OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)
Control of Rad Release
AINC NONR 1111 Accident Mitigation
AIND NONR 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)
NOTIFICATIONS YES NO WILL BE Anything Unusual or not understood? Yes (Explain above)
No HQ NPR STAFF Did all systems function as required?
Yes
No (Explain above)
STATE(s)
LOCAL
]jj Mode of operation until corrected (if applicable)
OTHER GOV AGENCIES
]jj Estimate for restart date:
MEDIA/PRESS RELEASE jjjji]
Additional Information continued on next page?
Yes
No NRC FORM 361N (MM-YYYY)
Continued on next page
Page
U.S. NUCLEAR REGULATORY COMMISSION (MM-YYYY)
OPERATIONS CENTER NON-POWER REACTOR (NPR)
EVENT NOTIFICATION WORKSHEET (Continued)
EN #
RADIOLOGICAL RELEASES: CHECK OR FILL IN APPLICABLE ITEMS (specific details/explanations should be covered in event description)
LJ Liquid Release LJ
Gaseous Release I
1
Unplanned Release I
I
Planned Release LJ
Ongoing Li
Terminated I I
Monitored Unmonitored H
Offsite Release LI
T.S. Exceeded LJ
Areas Evacuated Personnel Exposed or Contaminated Offsite Protection Actions Recommended "State release path in description Release Rate (Ci/sec)
% T.S. Limit HOO Guide Total Activity (Ci)
% T.S. Limit HOO Guide Noble Gas 0.1 Ci/sec 1000 Ci iodine 10 pCi/sec 0.01 Ci Particulate 1 pCi/sec 1 mCi Liquid (excluding tritium and dissolved noble gas) 10 pCi/min 0.1 Ci Liquid (tritium) 0.2 Ci/min 5 Ci Total Activity List of Safety Related Equipment not Operational Event Description (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continued from Page 1)
NRC FORM 361N (MM-YYYY)