ML20029A214
| ML20029A214 | |
| Person / Time | |
|---|---|
| Issue date: | 01/24/1991 |
| From: | Kammerer C NRC OFFICE OF GOVERNMENTAL & PUBLIC AFFAIRS (GPA) |
| To: | Luna J TENNESSEE, STATE OF |
| References | |
| NUDOCS 9102050068 | |
| Download: ML20029A214 (10) | |
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4 UNITED s1 ATEs j
g NUCLEAR REGULATORY COMMISSION 5
ij W ASHINGTON, D. C. 20$$$
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January 24, 1991 Mr. J. W. Luna, Comissioner Department of Health and Environment 344 Cordell Hull Building Nashville, TN 37203
Dear Mr. Luna:
This will confirm the discussion Mr. Richard L. Woodruff, Region II Agreement State Officer, Mr. James L. Milhoan, Deputy Regional Administrator, Region II and I held with you, your staff, and Mr. David Gregory from the Governor's Office on November 29, 1990.
This discussion provided our preliminary coments concerning our follow-up review of the Tennessee-Radiation Control Program.
As a result of our follow-up review of the State's program and the routine exchange of information between the Nuclear Regulatory Comission (NRC) and the State of Tennessee, the staff must continue to defer a finding of adequacy and compatibility at this time.
Problems still remain in three of the Category I Indicators that were brought to your. attention following our 1989 review:
(1) Status and Com (3)patibility of Regulations; (2) Status of the Inspection Program; and Inspection Frequency.
In addition, tile status _of the Staffing Level Indicator and the Staff Continuity Indicator have continued to deteriorate.since the 1989 review. The status of these Indicators and our follow-up recomendations are provided as DLelp,sure 1 In response-to this letter, we would like to have your coments on the actions that Tennessee will take in response to our recomendations contained in Enclosure 1.
The status of the Indicators and.our recomendations were discussed with Mr. Mobley and his staff during our exit meeting with him. Mr. Mobley was'also advised at-the time that a response to the above findings and_ the Enclosure 1 recommendations
-would be requested by.this office. We recomend The Department establish a plan which specifies how and when the program will satisfactorily-address all of our recommendations.
In addition, we request that the State provide the NRC Regional Office with a quarterly report that depicts: (1) status of the Tennessee regulations that are needed for compatibility; (2) status of the vacant staff positions that are r.eeded to carry out program functions; and (3)!the status.of the-inspection. backlog by license category and inspection frequency.
-We were encouraged by your positive comments that two of the vacant positions in the Division of Radiological Health will be filled and that the status of the other two vacant positions was also under consideration. We were clso encouraged by the coments from Mr. Scharber that the Division's proposal to reclassify and upgrade the technical positiont is being actively pursued. We believe these actions are needed and this office will give priority to the acceptance of Tennessee applicants in our training courses to help new personnel to become proficient in Health Physics and regulatory practices.
9102050068 910124 VT fif{.()Od PDR STPROESGTgDR
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JAll 2 4 1991 An explanation of our policies and practices for reviewing Agreement State programs is included as Enclosure 2.
Also for your information, a copy of our 1989 review comments 7s encl 6 sed as Enclosure 3.
A copy of this letter and the enclosures are provided for placement in the State Public Document Room or otherwise to be made available for public information.
I appreciate the courtesy and cooperation extended by your staff to us during the review.
I am looking forward to your comments regarding our recommendationc on regulations, status of the inspection program, staffing level, staff continuity and inspection frequency.
Sincerely, arlton Kannerer, Director State Programs Office of Governmental and Public Affairs
Enclosures:
1.
Summary of Assessments and Comments 2.
Application of NRC Guidelines 3.
Letter dated March 20, 1990 cc w/encis:
J. Taylor, Executive Director for Operations, NRC S.~ D. Ebneter, Regiona1' Administrator,
. Region 11 David Gregory, Governor's Office State of Tennessee M. Mobley, Director, Division of Radiological Health L NRCi Public' Document' Room State Public Document Room State Liaison Officer
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_ ENCLOSURE 1 FOLLOW-UP RECOMMENDATIONS ON TECHNICAL ASPECTS OF THE TENNESSEE RADIATION CONTROL PROGRAM FOR AGREEMENT MATERIALS Scope of Review This program follow-up review was conducted in accordance with the Comission's Policy Statement for reviewing Agreement State Programs published in the Federal Register on June 4,1987, and the internal procedures established by the Office of Governmental and Public Affairs, State Programs. The review included discussions with program n.anagement and staff, inspector accompaniments, visits to the Regional Ared Offices, and the evaluation of the State's response to an NRC e,uestionnaire that was sent to the State in preparation for the follow-up review. The review covered only those Indicators that received comments following our 1989 review.
Prior to the follow-up review, Mr. Carl Kamerer, Director, State Programs and Mr. James Milhoan, Deputy Regional Administrator, Region 11 met with Mr. Harlan Mathews, Deputy to the Governor, on October 12, 1990, concerning the status of the Tennessee Radiation Control Program.
Following this meeting, Governor McWherter replied in a letter dated November 1,1990 that, "It is important to me that Tennessee's program of regulation and inspection operate at a level to adequately protect the public health and safety of our citizens.
I am confident Comissioner Luna and his staff will make every effort to correct.any deficiencies in the current program."
This follow-up review was conducted during the periods of November 6-8, 1990, and November 13-16, 1990, as follows. Office visits and licensee visits were condur'ed in the Knoxville Office on November 6-7, 1990.
Office visits inspector accompaniments were conducted in the L
Chattanooga Office on November 8,1990; and the Memphis Office on l
November 13, 1990. The remainder of the review was conducted in the l
Nashville Office on November 14-16, 1990.
An exit meeting to discuss the results of the follow-up review was held in Comissioner Luna's Office on November 29, 1990.
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Conclusion:==
1 A statement of adequacy and compatibility was withheld following our 1989 review. Our comments end recommendations consisted of four Category 1 Indicator recomendations (two of major significance), and six Category 11 Indicator recommendations. During this follow-up review, only five of the 10 recommendations were satisfactorily resolved. The two Category I recommendations of major significance were not fully resolved.
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s The staff recommends that a finding of adequacy and compatibility be withheld until the State has made satisfactory improvements in the Category I recomendations of major significance:
(1) Status and Compatibility of Regulations; (2) Status of the Inspection Program.
In addition, problems continue to exist with respect to Inspection frequency, staffing level and staff continuity.
Follow-up Assessments To The 1989 Corra;nts And Reccommendations All ten of the 1989 comments and recommendations were reviewed.
Satisfactory actions were taken in response to our recommendations except as follows:
1.
Status and Compatibility of Regulations is a Category I Indicator.
1989. Recommendation The State needs to update its regulations to maintain compatibility.
Further updating will be necessary in 1991 as follows:
N C Rule J
Subject Certification of Dosimetry Processors 10 CFR Part 20 Decomissioning Rule 10 CFR Parts 30, 40 and 70 We recommend that the Department review its-rulemaking procedures with a view towards streamlining the procedures where possible and eliminating unnecessary delays.
Current Status l'
Progress was' made by the State-in updating their Regulations; however, some of the rules that were. drafted have not been adopted. The status of those rules that are needed for compatibility are as follows:
" Elimination of Exemption-for Glass Enamel and Glass Enamel Frit," 10 CFR 40.13(c)2), effective September 11, 1984.
The State Attorney General (AC) rejected this rule. The AG determined that exemptions such as this proposed rule could not be allowed under the current Radiation Control Act.
The import of these materials is regulated by the NRC rather than the State; therefore, the State maintains that this rule is not needed.
During the exit meeting with the Program Director and his staff on November 29, 1990, Mr. Hobley related that the state had several " exemptions" in the regulations from previous actions, and that he was considering an amendment to the Radiation Control Act that would allow for exemptions.
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"Well; Logging Requirements," 10 CFR 39, effective July 13, 1987.
Departmental Attorneys rejected the proposed rule on August 23, 1990 and-requested that the rule be rewritten.
The rule was revised and sent back to the department in October of 1990. - No further action has been taken.
Ado) tion of this' rule is needed to maintain compatibility witi NRC within the "three years" policy for adoption of rules.
Program staff related during the exit meeting that Tennessee does not currently have any "well logging" type licensees.
"Deconinissioning," 10 CFR 30.35, effective June 27, 1988.
The State initially adopted these provisions in 1982, prior to the NRC rule. The State rules have been submitted to NRC for t. compatibility determination.
" Emergency Preparedness," 10 CFR 30.32, 30.34, and 30.72; effective April 7, 1990.
The State draf ted proposed rules but never submitted them for a rulemaking. The State is awaiting further guidance from NRC on the compatibility requirements.
I Follow-up-Recommendation
-It is-recommended that the State continue to update the regulations that are needed for compatibility and provide a quarterly report to the NRC, Region II Office on the status of the L
rules ~that are-needed for compatibility.
l 2.
~ Staffing level is a Category II Indicator.
L 1989 Recommendation The program has one. technical position vacancy that is critical to the program,'and~we recommend that the position be filled as soon as possible.
Current Status The State filled the vacant position by transferring other personnel into the position as needed; however, a Statewide
" hiring freeze" prevented the position from being filled on a pennanen t ' basis. The Program now has four vacant technical positions that need to be filled, positions that are needed to carry out program functions.
During the exit meeting, Mr. Luna stated that the " freeze" on two of the positions had been lifted and he believed that the other frozen positions could also be lifted.
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Follow-up Recommendation We recomend that the State lift the " hiring freeze" on the program technical positions-and fill all the positions that are needed to carry out program functions. We also request that a quarterly report be provided to the NRC, Region II Office that depicts the status of the staffing level and the vacant positions.
3.
Staff Continuity is a Category II-Indicator.
1989 Recomendation i
We recomend that the job classifications and respective salary ranges be reviewed and upgraded as needed to provide better staff continuity.
L Current Status The Division submitted a reclassification proposal on February 2, 1990, and again on October 10, 1990.
Additional information on the status of this proposal was not available at the time of the follow-up review. As noted above, the program continues to loose technical personnel and there are now four vacancies in the program.
There has been considerable turnover in the licensing staff. The licensing person' located in the Knoxville Office left the program and the function was transferred back to the Nashville Office.
It was noted that the licensing staff that remained has gained considerable experience at the licensing functions; however, three-out of the four. staff persons are categorized as Environmental Specialist-2 positions. More consideration should.be given to upgrade some positions to ES-3 and ES-4 positions which will provide more. growth potential-for the license reviewers and improve staff continuity. This was discussed with the Program Director.
Follow-up Recomendation
,We recomend that= the State proceed with the reclassification proposal and make every effort to provide better staff continuity
-in the Division nf Radiological Health.
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Status.of the Inspection Program is a Category I Indicator.
1989 Recomendation We recomend that the State reevaluate their inspection policies and develop a plan to eliminate the inspection backlog. The plan should include goals and milestones for each regional office and monthly written reports to program management that sumarizes, by region, the inspections-performed, status of enforcement actions, and the status of the insp:ection backlog.by priority.
4 4-5 Current Status The State has reevaluated sorne of their inspection policies as evidenced by the decision to resume inspections of Priority II-IV type licenses. The inspection backlog _has improved since the review; however, most of the improvement was "on paper" due to a temporary revision of the term " overdue inspections." The revised inspection policy lists the new inspection priorities, but does not establish " milestone" timeframes for elimination of the backlog. Mr. Mobley stated that he receives " quarterly" reports en the status of the' backlog, ifased upon information gathered during the follow-up review, the State currently has approximately nine facilities (Priority I-IV) that are overdue-by more than 50 percent of their inspection L
frequencies, and ninety-six licenses (Priority V) that have never received an initial-inspection. Also, three of the technical position vacancies are located in the area compliance offices which further impedes efforts to eliminate the inspection backlog, and to carry out the Program mandates.
follow-upRecommendation We recommend that the State revise their plan to eliminate the inspection backlog to include " milestone" timeframes. The plan should address specifically those licenses that are overdue by more than-50 percent of their inspection frequency, and those that have never been inspected. We also request that quarterly reports be sent to the NRC, Region II Office that depicts the status of the overdue inspections backlog by license category and inspection frequency in years.
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Inspection Frequency is a Category I Indicator.
,19_89 Recommendation We recommend that the State's inspection priority t' be changed to
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a five year routine frequency.
Current Status The State revised some, but not all, of the inspection priority V (four year frequency) licenses to be -inspected on a routine four-
-year frequency rather than the old five percent per year basis.
The State has experienced some difficulty in making adjustments to l
their inspection priority system because of a different license category system.
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6 Revision of the State's priority system was discussed relative to the reduction of the backlog and modifications to allow for initial inspections of all licenses, and thereafter only for cause for those inspection priorities equivalent to NRC priorities of 6 and 7.
Follow-up Recommendation We recomend that the State complete the revision of the license insoection frequency (priority) system for Priority V licensees.
This may also require some modification to the State's license category system.
EXIT MEETING An exit meeting was held in Mr. Mobley's Office prior to the exit with Comissioner Luna. The details and status of each 1989 coment were discussed with Mr. Mobley, Mr. West, Mr. Graves, Mr. Hanney and Ms. Short.
Prior to the staff meeting, a brief background statement on the Tennessee Radiation Control Program was provided to Ms. Anne Paine, Reporter for the Nashville Tennessean. Mr. Mobley also provided copies of the 1989 NRC comment letter and the State's responses to that-letter. Ms. Paine indicated that she would like to attend our exit meeting with Comissioner Luna or at least have a brief sumary after the exit meeting.
An exit meeting to discuss the results of the follow-up review was held in Comissioner Luna's Office on November 29, 1990 at 1:00 p.m., CST.
Comissioner Luna determined that Ms. Paine would be allowed to be present during the exit meeting. Other attendees are as follows:
J. W. Luna Comissioner, Department of Health and Environment Russell White Deputy Comissioner David Gregory Governor's Staff Ben Smith Governor's Planning Office Wayne Scharber Assistant Comissioner for the Environment Steve Blackburn Administrator for the Environment Linda Tidwell Public Information Officer, Tennessee Department of Health and Environment Michael H. Mobley Director, Division of Radiological Health Carl Kamerer Director, State Programs, GPA James L. Milhoan Deputy Regional Administrator, RII Richard L. Woodruff State Agreements Officer, RII The current status of each of the 1989 comments was summarized with Comissioner Luna. The Commissioner was informed that a finding of Adequacy and Compatibility would be withheld until additional progress is made concerning the Category I coments that were made following the 1989 review.
7 A brief discussion of the Category 1 indicators, followed by a discussion of the staffing level was conducted.
In summary, the Connissioner related that the " hiring freeze" on two of the vacant positions had been lif ted and he believed that the " freeze" on the other positions would also be lifted. He also related that the State would consider the Division's reclassification proposal.
Mr. Kammerer informed Commissioner Luna that NRC would provide our comments by letter within three weeks.
ENCLOSURE 2 APPLICATION OF "GUIDEIINES FOR NRC REVIEW OF AGREEMENT STATE RADIATION CONTROL PROGRAMS" The " Guidelines for NRC Review of Agreement State Radiation Control Programs,"
were published in the Federal Recister on June 4,1987, as an NRC Policy Statement. - The Guidelines provice 29 indicators-for evaluating Agreement State program areas.
Guidance as to their relative importance to an Agreement State program is provided by categorizing the indicators into two categories.
Category I' indicators address program functions which directly relate to the State's ability to protect the public health and safety.
If significant problems exist in several Category I indicator areas, then the need for improvements may be critical.
Category II indicators address program functions which provide essential technical and administrative support for the primary program functions.
Good performance in meeting the guidelines for these indicators is essential in order to avoid the development of problems in one or more of the principal program areas, i.e., those that fall under Category I indicators.
Category II indicators frequently can be used to identify underlying problems that are causing, or contributing to, difficulties in Category I indicators.
It is the NRC's intention to use these categories in the following manner.
In reporting findings to State management, the NRC will indicate the category of each comment made.
If no significant Category I comments are provided, this will indicate that the program is adequate to protect the public health anc; safr+v and is compatible with the NRC's program.
If one or more significant Categc.y I comments are provided, the State will be notified that the program deficiencies may seriously affect the State's ability to_ protect the public health and safety and that the need of improvement in particular program areas is critical.
If, following receipt and evaluation, the State's response appears satisfactary in addressing the significant Category I cocinents, the staff may offer findings of adequacy and compatibility-as appropriate or defer such offering until the State's actions are examined and their effectiveness confirmed in a subsequent review.
If additional information is needed to evaluate the State's actions, the staff may request the information through follow-up correspondence or perform a follow-up or special, limited review.
NRC staff may hold a special meeting with appropriate State representatives.
No significant items will be left unresolved over a prolonged period. The Commission will be informed of the results of the reviews of the individual Agreement State programs and copies of the review correspondence to the States
= will be placed in the NRC Public Document Room.
If the State program does not improve or if additional significant Category I deficiencies have developed, a staff finding-that the program is not adequate will be considered and the NRC may institute proceedings to suspend or revoke all or part of the Agreement in accordance with Section 274j of the Act, as amended.
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UNITED STATES
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NUCLEAR REGULATORY COMMISSION
. ENCLOSURE 3
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March 20,-1990 Mr.: J. W. Luna, Comissioner Department of Health and Environment 344 Cordell Hull Building Nashville,,TN 37203
Dear Mr. Luna:
This will confirm the discussion Richard L. Woodruff, NRC State Agreements Officer, held on December 15, 1989 with Wayne K. Scherber, Kenneth W. Bunting and Michael H. Mobley following our review and evaluation of the. State's Radiation Control Program.
As a result of our. review of the State's program and the routine exchange of information between the Nuclear Regulatory Comission (NRC) and the State of Tennessee, the staff is unable to make a finding of adequacy and compatibility at this time. Significant problems were found in two Category 1 Indicators. These and other coments and recomendations are addressed below.
Status and Compatibility of Regulations is a Category I Indicator. For these regulations deemed a matter of compatibility by NRC, State regulations should be amended as soon as practicable but no later than three years. Re as follows:- (1)gulations ti.at are needed to maintain compatibility are
" Transportation Regulations Com 10 CFR Part 71, effective September 6, 1983; (2)patibility with IAEA,"
" Elimination of Exemption for Glass Enamel and Glass Enamel Frit," 10 CFR 40.13(c)(2),
effective September 11,1984;(3) Yedical Records and Reports of
.Misadministrations," 10 CFR-35.33, effective April 1,1987; and (4) " Requirements for Well-Logging,".10 CFR Part 39. effective July.13,1987. These rules were identified -in a letter to the State dated April.15,1988 following our previous routine review, and again following a visit with you.and our-subsequent letter of Nerch 21, 1989..
. Copies of our letter of March 21, 1989 and the attachments are provided as Enclosure 1.
Program staff have drafted proposed anendments for each rule required for compatibility, and some of the rules were adopted; however, your staff continues to encounter difficulties in moving the
' proposed amendments throegh the administrative process,, We have concerns about the ability of the Department to effect timely rule changes that-are needed for compatibility. We recomend that the Departinent review its rulemaking procedure with a view towards streamlining the procedures where possible eliminating unnecessary delays.
o Status of the Inspection Program is a Category I Indicator. The State has 137 licenses that are overdue for inspection representing 25 percent of the total specific licenses issued. Of the total overdue, 36 have inspection priorities I thru IV and the remaining (101).are priority V
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,1icenses. Of the' 36 (priority I-IV) overdue, 2 are overdue by more.than 50 percent of their initial inspection frequency. The State cannot g u l i, q]
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J. W. Luna 2
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locate one priority 1Y licensee that is overdue for initial inspection by 27 months.
In addition, program management has verbally suspended all routine material license inspections except for " fee category 9" licenses untti the x-ray inspections due for 1989 have been completed. We recommend that the State re-evaluate their inspection policies and develop a plan to eliminate the inspection backlog. The plan should include goals and milestones for each regional office and monthly written reports to program management that sumarizes by region, the inspections performed, status of enforcement actions, and the status of the inspection backlog by priority.
Staffing Level is a Category II Indicator. The program h6s one technical position vacancy in the Licensing Section which is having a detrimental affect on the licensing actions that are needed for an effective regulatory program. The program has 537 licenses, of which 18 licenses are considered to be major licenses, requiring highly trained and experienced technical license reviewers. W noted that a significant backlog has developed in the Licensing Sect'on, in addition to the inspection backlog addressed above. We understand that a hiring freeze has been imposed statewide except for criti:a1 positions. We believe that this technical position vacancy is cri:ical to the program, and we recomend that the position be filled as soan as possible.
Staff Continuity is a Categcry 11 Indicator. The Program has lost seven trained, experienced, technical staff members since the last review.
This represents approximately 30 percent of the technical staff. One senior license reviewer retired, one license reviewer returned to graduate school, one person got married..and four persons resortedly left the program for higher salaries. Based upon information gatiered during our reviews of other Agreement State Programs, it appears that your Environmental Specialist classifications do not compare favorably with the " Health physics" type classifications found in the industry and other Agreement States.
In general, the Tennessee salary ranges for the technical staff are below those salary ranges found in other southeastern States. The starting salary is more than $4,000 below the average starting salary in all Region 11 States, and the highest salary is more than $5,000 below the average highest salaries of all Region II States.
This information was provided to Mr. Mobley during the review, and also provided as Enclosure 2.
We recommend that the job classifications and l
respective salary ranges be reviewed and upgraded as needed to provide better staff continuity.
l l-contains a sumary of the staff assessments and coments that i
were developed from the other indicators used for review of the program.
Those coments were discussed with Mr. Mobley and his staff during our exit meeting witn him. Mr. Mobley was advised at the time that a response to the above findings and the Enclosure 3 comments and l
recommendations would be requested by this office.
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An explanation of our policies and practices for reviewing Agreement l
State programs is included as Enclosure 4 A copy of this letter and the
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enclosures are provided for placement 1.: the State Public Document Room l
or otherwise to be made available for public information.
As we discussed, it is important for the Department to initiate prompt actions to update your Radiation Control Program regulations, and to reduce the inspection and licensing backlogs.
I also urge that high priority be given to assure that sufficient staff is available for the program.
I appreciate the courtesy and cooperation extended by your staff to our representatives during the review.
I am looking forward to your comments regarding regulation, status of the inspections program, staffing level, staff continuity, and your staff responses to the Enclosure 3 recommendations.
Sincerely, original signed by Carlton Kaminerer l
rarlton rammerer, Director State Programs Office of Governnental and Public Affairs
Enclosures:
1.
Letter dated March 21, 1989 2.
Salary Schedule 3.
Sumary of Assessments and Comments 4
Application of HRC Guidelines i
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'000e4 March 21,1949
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Mr. J. W. Luna, Consissioner Department of Kosith and Enyfronment e
Corde11 Ku11 Eui161n Naahv111e TN '3M19gM02
Dear Commissioner Luna:
This is to confim the discussion' NRC representatives held o 1989, with you and selected members of your staff following our review v to the state's Radiation Control Prograa. Your staff was repNsented by W. K. Scharber and M. H. Mobley. The NAC was represented by A. L. Woodruff and J. C. Lubenau.
We appreciated the opportunity to brfef you on the Agreement States Program and to discuss with you our respective regulatory roles.
It ws: especially leasin to our staff to hear your comments supporting the Division of adiolo ical Health and in particular special st position vaca,ncy would be fhyour coments that the invironmental led.
As you know,1988 routine review in that the *$ tate Regulatio our Januaw Protection A ainst Radiation" w re in need of revision.
Some progress L
i has been sad with respect to updating the State's repulations; however, additional revisions are still needed.
It is extreme y insertant that
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Agreement $ tate Ngulations be updated to safatain compatiatitty with NRC's-regulations. We believe the State should set a priority of
. placing Mvised n ulations in effect this year.so that the Tennessee program is competi le with NRC.
Mr. Mobley has been infomed of the a scific Mgulations that need Mvising.
We will continue to monitor the State s progress in this area $ and progress made on other consents made in our letter of Aptf11.1984.
Copies of the April 15,1984 letter and the State's reply dated September 9.-1984 are enclosed for your infomation.
As dis ussed with Mr. Mobley, we believe that the nexa routtnc rsytew of the program will be ar.hedulsJ fur DeLeaker 1989.
Again we appreciated your positive comments and we are looking forward to
- working with you as partners under the Agreement States Program. If you have arty questions, please do not hesitata to contact me.
' Sincerely, MIM 8lP8d bCatitoe Xammerst tariton Kament, Dfnctor State Office Local and Indfan Tribe Programs
- of Governmental and Public Affairs j
-Inclosums: (seepage 2)
Enclosure'l 1
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Mr. J. W. Lune Courtisstener i
Enclosures:
- 2. Cenenent Letter Wated rf1 18, ifM t.
State Re y dated Sep r9 1988 3.
hRC kknowledg,ement dated DecH6er 27, 16 M cet Yfeter 8tello. Esseutive Director for Operations NRC Nicole L. Ernst Acting Regtenal AbinIstrator, R!!
MichaelH.Mobleyloleg(calHattth Ofrecter Division of Rad NRC M1fc Docurent Roor.
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DCl05URt 1 Co*[KT5 AND RECO*ENDAT10N5 ON TECHNICAL A!.PFCTS 0F THE TINXC$$tt RADIATION CONTROL PROGRAM FOR AGREEMENT MTERIAL5
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puAGEMENT AND ADMINISTP.ATION Administrative Procedures is a Cat
- gory !! Indicator.
The following coment with our recomendation is made.
Coment The Radiation Control Program should establish written intemal procedures to assure that the staff perferes its duties as required and to provide a high degree of unifomity and continuity in regulatory practices for functions required of the program.
A.
The exchange of infomation is an important func' tion of the program.
We noted that the State had 70 incidents during this review period that were reported to NRC.
However, a sumary of the incidents was not available during the review. Another copy of the All Agreement State letter. *Exchan Radioactive Materials,"ge of Information on Incidents Invo'ving dated July 22,19M was provided to Mr. West and Mr. Mobley.
The suggested format for documention of incidents found in the letter is adaptable to a word processing system and allows for standardization and rettfevability of the incident information by both our Agencies.
B.
We noted that the State does not have a specific procedure addressing the collection and processing of application fees and only the Administrattyt Supervisor could provide details of the fee assessPent and collection procedure.
Another copy of the All Agreement State letter, ' Suggested Content of Agreement State Adeinistrative and Technical Procedures," dated May 13,1987, was provided to Mr. Mohley and Mr. West.
Recomenda tion We recomend that the State reassess and develop their aeinistrative procedures to provide a high degree of uniformity and continuity for functions required of the program and we al!c rnomend that the State adopt the standard format for repor',(ng incidents to NRC.
COMPL1 ANCE Inspection Procedures is a Category !! Indicator.
The following coment is made with our recomendation.
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Coment During our previous review, we recomended that the State review their inspection procedures for consistency with the NRC guides, revise as needed, and (splement the procedures into the espliance program.
The state repliad that a review of the State's currant inspection procedures was in progress. Neverer during this etview, we were informed that this project was never com,pleted.
Recomenda tion We recommend that the State complete their assessment and revision of the inspection procedures and ir.slement the procedures into the compliance program. We would liite to have your 6chedule for comple-tion of this project.
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EkCLO5URE 2 APPL 1tATION OF '&UlDELINE5 FOR NRC REY![W 0F AGRIIMENT STATE RADIATION CONTROL PROGRAMS' he ' Guidelines for NRC Review of Apreement State Radf ation Control Programs',
were pubitshed in the Federal Peg ster on June 4 IgS7, as an NRC Policy
$tatement.
The Guide provides 29 indicators for e, valuating Agreement State Guidance as to their relative importance to an Agreement State program areas.
program is provided by categorfring the indicators into two categorfes.
Category 1 indicators address program functions which directly relate to the State's ability to protect the public health and safety.
If significant problems exist in one or more Category I indicator areas, then the need for irprovements may be critical.
Category !! indicators address program functions which provide essential technical and administrative support for the priury program functions. Good perfornnce in meeting the guidelines for these indicators is essential in crder to avoid the development of problems in one or more of the principal program arets, i.e., those that fall under Category I indicators. Category !!
indicators frequently can be used to identify underlying problems that are causing, or contributing to, difficulties in Category 1 indicators.
It is the NRC's intention to use these categerfes in the following manner.
In reporting findings to $ tate management, the NRC will indicate the category of each ecment ude.
If no significant Category I coments are provided, this will indicate that the program is adequate to protect the public health and safety and is coepatible with the NRC's program.
If one or more significant I
Category I coments are provfded, the State will be notified that the program deficiencies my seriously affect the State's ability to protect the public health and safety and that the need of improvement in particular program areas is critical.
If, following receipt and evaluation, the $ tate's tesponse appears satisfactory in addressing the significant Category I coments, the
- staff my offer findings of adequacy an0 coepatibility as approprfate or defer such offering until the State's actions are examined and their effectiveness l
confirmed in a subsequent review.
If additional information is needed to evaluate the $ tate's actions the staff ma follow up correspondence or p,erfort follow y request the information through up or special, Ifatted review. NRC staff my hold a special meeting with appropriate state representatives.
l No significant iters will be lef t unresolved over a prolonged period.
The l
Comission will be informed of the results of the reviews of the individual Agreement $ tate programs and copies of the review correspondence to the states will be placed in the NRC Public Document Roca.
If the State progree does.not improve or if additional significant Category I deffefencies have developed, a staff finding that the program is hot adequate will be considered and the NRC may institute proceedings to suspend or revoke all or part of the Agreement in.
accordance with Section 274j of the Atomic Energy Act of 1954 as amended.
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ENCLOSURE 2 l
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r COMMENTS AND RECOM4ENDATIONS ON TECHNICAL ASPECTS OF THE TENNESSEE RADIATION CONTROL PROGRAM FOR AGREEMENT MATERIALS Scooe of Review l
This program review was conducted in accordance with the Comission's Policy Statement for reviewing Agreement State Programs published in the Federal Register on June 4,1987, and the internal procedures established 1
by the Office of Governmental and Public Affairs State Programs.
The review included discussions with program manageme,nt and staff technical evaluation of selected license files and compliance files (cas,ework), and the evaluation of the State's response to an NRC questionnaire that was sent to the State in preparation for the review.
The regulatory program review meeting with Tennessee representatives was held during the period DG ember 11-15, 1989 in Nashv111er Tennessee. The State tres represented by Michael H. Mobley, Director, Division of Radiological Health: Charles P. West, Assistant Director; Johnny C. Graves, Supervisor, Licensing and Registration; and Edward L. Hanny, Supervisor, Inspections and Enforcement. A review of selected license and inspection files was conducted by Richard L. Woodruff, Regional State Agreements Officer (RSAO), Region II; and Jack W. Hornor, RSA0, Region V on December 11-14 1989, and assisted by John Pelchat, Region II on December 11 and 12,1989. A sumary meeting regarding the results of the regulatory program review w6s held with Wayne K. Scherber, Assistant Commissioner, Department of Health and Environment; Kenneth W. Bunting, Director, Bureau of Environment; and Michael H. Hobley on December 15, 19E9.
Conclusion A finding of adequacy and compatibility is being postponed until the State's radiation control regulations have been amended, and the overdue inspectiors have been adequately addressed.
Status of Previous NRC Coments and Recommendations Coments and recomendations from NRC's previous review were sent to the State in a letter dated April 15, 1988, and again following our Mid-Review Visit conducted on January 4-6, 1989. All coments have been closed out except for the following.
Status and Compatibility of Regulations.
Staff coments and recommendations were provided again in our cover letter to this report.
l Training.
The State has utilized numerous opportunities to provide training courses to designated staff merters.
These courses were sponsored by NRC, other agencies, and the State. The State has I
ENCLOSURE 3 l
v e-
Inclosure 3 2
4 utilized quarterly, technical staff meetings to provide cross training between the regions. These are acceptable steps to improve the training program for the staff.
Evaluation NRO of the effectiveness of this training effort will be made uring ' inspector accompaniments
- and ' visits' to the State's Regional Ctapliance Offices which will be scheduled later in 1990.
Inspection Procedures have been compiled and assembled tito a draft Procedures Manual.
This manuel was provided M the rnfewer prior to the exit meetings. Work on this manual is continuing.
Current Review Coments and Recomendations All 2g indicators were reviewed in depth and the State satisfies the guidelines in 19 of these indicators.
Specific comments and recomendations are as follows:
.1.
Status and Compatibility of Regulations is a Category I Indicator.
The following coment with our recommendation is of major significance.
Coment For those regulations deemed a matter of compatibility by NRC, State regulations should be amended as soon as practicable but no later than.three years.
Regulations that are needed to maintain compatibility are as follows:
(1) ' Transportation Regulations Compatibility with IAEA "f Exerption for Glass Enamel and Glass 10 CFR Par 1983; (2) " Elimination o Enamel Frit,' 10 CFR 40.13(c)(2), effective September 11, 1984:
(3) " Medical Records and Reports of Misadministrations,for Well 10 CFR 1987; and (4) " Requirements 35.33, effective April 1 ffective July Logging," 10 CFR Part 39, e 13, 1987. These rules sere
' identified in a letter to the State dated April 15, 1988 following our previous routine review and again following a visit with you andoursubsequentletterofMarch 21, 1989.
Copies of our letter of March 21, 1989 and the attachments are provided as Enclosure 1.
Program staff have draf ted proposed amendments for each - rule required for compatibility. and seme of the rules were adopted =
however, your staff continues to en-:ounter difficulties in moving the proposed amendments through the administrative process. We have concerns about the ability of the Department to effect timely rule:
- changes that are needed for compatibility.
Recommendation The State needs to update its regulations to maintain compatibility.
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3 Further updating will be necessary in 1991 as follows:
Subject NRC Rule Certification of Dosimetry Processors 10 CFR Part 20 Decomissioning Rule 10 CFR Part 30, 40 and 70 We recomend that the Department review its rulemaking procedures with a view towards streamlintrig the procedures where possible eliminating unnecessary delays.
2.
Staffing Level is a Category II Indicator.
The following coment with our recomendation is made.
Coment The program has one technical position vacant in the Licensing Section which is having a detrimental. affect on the licensing actions that are needed for an effective regulatory program.
The program has $37 licenses, of which 18 licenses are considered to be major licenses, requiring highly trained and experienced technical license reviewers.
We noted that a significant backlog has developed in the Licensing Section, in addition to the inspection backlog addressed above.
We understand that a hirin been imposed statewide except for critical positions. g freeze has Recomendation This technical position vacancy is critical to the program, and we recomend that the position be filled as soon as possible.
3.
Staff Continuity is a Category II Indicator. The following coment with our recomendation is made.
Comment The Program has lost seven trained, experienced, technical staff members since the last review.
This represents approximately 30 percent of the technical staff.
One senior license reviewer retired, one license reviewer returned to graduate school one person got married, and four persons reportecly left the pro, gram for higher salaries. Based upon information gathered during our reviews of the Agreement State Programs, it appears that your Environmental S)ecialist classifications do not compare favorably with the " Health Piysics" type classifications found in the industry and other Agreement States.
In general the Tennessee salary ranges for the technical staff are below th,ose salary ranges found 'n other southeastern States.
The starting salary is more than $4,000 below the average starting salary in all Region 11 States, and the highest salary is more than $5,000 below the average highest salaries of all g
Region II States.
This inforr.ation was provided to Mr. Mobley during the review, and also provided as Enclosure 2.
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4 Recomendation We recomend that the job classifications and respective salary ranges be reviewed and upgraded as needed to provide better staff continuity.
- 4. ' Status of the Inspection program is a Category I Indicator.
The following comment with our recomendation is of major significance.
Coment The State has 137 licenses that are overdue for inspection representing 25 percent of the total specific licenses issued.
Of the total overdue, 36 have inspection priorities I thru IV and the remaining (101) are priority V licenses. Of the 36'(priority I-IV) overdue, 2 are overdue by more than 50 percent of their initial inspection frequency.
The State cannot locate one priority IV licensee that is overdue for initial inspection by 27 months.
In addition, program management has verbally suspended all routine material license inspections except for " fee category 9' licenses until the x-ray inspections due f or 1989 have been completed.
Pecomendation We recomend that the State re-evaluate their inspection policies and develop a plan to eliminate the inspection backlog.
The plan should include goals and milestones for each regional office and monthly written reports to program management that sumarizes by region, the inspections performed, status of enforcement actions, and the status of the inspection backlog by priority.
5.
Inspection Frequency is a Category I Indicator.
The following coment with our recommendation is provided.
Coment The Radiation Control program should have an inspection priority system with the minimum inspection frequency including initial inspections no less than the NRC system. The NRC inspects 'In Vitro Laboratories ( 200 microcuries)" initially at six months, and on a five year frequency thereaf ter. The State established an ins priority of Y to the In Vitro Laboratories ( 200 microcuries)pection i
which are inspected at six months initially and routine inspections are conducted at a 5 percent per year basis. This allows the routine inspections to be conducted at a greater inspection interval than the interval used by NRC.
Recomendation
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We recomend that the State's inspection priority V be changed to a
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five year routine frequency, l
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5 6.
Inspectors' Performance and Capability is a Category 1 Indicator.
The following coment with our recomendation is provided.
Coment The Compliance Supervisor or the Program Director should conduct annual field evaluations of each inspector to assess performance and assure application of appropriate and consistent policies and guides.
Information provided by the staff indicates that sore inspection accompanirents were conducted by the Compliance Supervisor and one accorrpaniment by the Program Director since the last review.
However, all of the inspecters were not accompanied during the review period.
Recomendation We recommend that the Compliance Supervisor or the Program Manager conduct field evaluatir>ns of each inspector to assess performance and assure application of appropriate policies and guides on an annual basis.
7.
Administrative Procedures is a Category !! Indicator. The following comment with our recomendation is made.
Coment The Radiation Control Program should establish written internal policy and administrative procedures to assure that program functions are carried out as required and to provide a high degree of uniformity and continuity in regulatory practices.
a.
A draft Procedures Manual has been compiled and was provided to the reviewers on the fuurth day of the review. As noted by the technical staff, the manuel is in draft form and considerable refinement is needed.
When completed the manuel is to be distributed to the Nashville and the Regional staffs.
b.
The Assistant Director maintains a listing of all NRC Information Notices (ins) received and determines the routing and distribution of each document.
Information Notices usually contain information that is usefull to all of the technical staff including license reviewers, inspectors and their technical managers.
Technical documnts should be made available to all technical staff members and distributed to the regional offices.
From our discussions with program staff, it appears that the routing and distribution system needs refinement along with a uniform central filing system for all technical documents.
Inclosure 3 6
- lt Recomendation i
We recommend that the staff continue their efforts to revise and refine the draft Procedures Manual to assure that program functions are carried out as required and to provide a high degree of uniformity and continuity in regulatory practices.
This includes additional review and refinement of the routing, distribution and filing system for all technical documents.
B.
Menagement is a Category !! Indicator.
Ths following coment with our recomendation is made.
Comeg Where regional offices are utilized by the Radiation Control 1
- Program, offices. program management should conduct periodic audits of these Apparently some visits were made to the regional offices by program managemen,t during the review period; however, these o
visits were not considered to be audits and additional infomation concerning the scope of the visits was not provided during the review.
3 Recomendation We recomend that program management conduct periodic internal audits of their regional offices to determine if the program functions are being carried out as intended, in accordance with State policies, and document the audit findings.
c 9.
Licensing Procedures is a Category !! indicator.
The following coment with our recomendation is provided.
Coment L
The Radiation Control Program should have internal licensing policy and procedures consistent with current NRC practice.
Due to staffing levels and staff turnovers in the-licensing section, a i
license renewal backlog has developed.
In lieu of issuing ' timely renewals * (NRC practice) for routine renewals the State elected to extend the expiration date on all licenses e,xcept for the " fee category g" type licenses by one year. This action would allow the program to keep current on the major licensing actions and r
amendments, and train new license reviewers.
However, due to a l
continued staff vacancy and additional staff turnovers, the program is faced with extending routine license renewals for the second year t
beyond the nomal five year license term.
Some of these licenses have already been extended for the second time without the benefit of a technical review.
In addition, the program now has a backlog of 58 licenses (16 new applications, 32 amendments, and 10 renewals) that are in need of licensing actions. Other considerations should be factored into the license renewal policy such as type of license
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workload for at least five years, staff resources available (near term) and the long term staffing requirements.
Recomendst ton We recomend that thE 'one year renewal extension' policy be re-evaluated with consideration being given to the license category and the num6er of extensions permitted. Also, loped including an overall written plan for reducing the backlog should be deve milestone timeframes and monthly status reports to management that sumarizes the licensin status of the backlog. g actions taken by type of license, and the
- 10. Inspection Reports is a Category II indicator.
Jhe following coment with our recomendation is provided.
Coment Reports should uniformly and adequately document the result of inspections.
The State uses two forms for documentin results one
- generic" form and a " Radiography" form.g inspection The cover pagesforbothformsareinneedofrevisiontodeletetheacronym
.10SHA," revise 'the " Type of Inspection" to include (Initial, Routine, Special,- Announced, and Unannounced) notations, and add a provision for 'Next Inspection Due." The body of the
- generic" form should be revised to allow for discussions of the ALARA program t
interviews (worke n, user, etc.), audits. (internal-or cor records review period (or sampled), receipt of material,porate).
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transportation / shipping requirements.
The generic form should also be supplemented with specialized enclosures designed specificall for Medical, Teletherapy, Pharmacy, and Academic type inspections.y I -
The Industrial Radiography-form should also be revised to reflect the new regulation requirements and audits.
Recomendation We reconsnend that the inspection report forms be revised for uniformity and-to adequately document inspection results, and' accommodate new changes in the regulatory requirements.
Sumary Discussion with State Representatives A summar meeting =y meeting to present the results of the regulatory program review was held with Wayne K. Scharber, Assistant Comissioner.
Department of Health and Environment; Kenneth W. Bunting, Director Bureau of Environment; and Michael H. Mobley, Director Division of Radiological Health.
The scope of the review was discussed along with I
NRC staff coments on Status and Compatibility of Regulations Status of Inspection Program, Staffing Level, Staff-Continuity, and staff findings regarding adequacy and compatibility.
In response, Mr. Scherber related
inclosure 3 8
that he appreciated our connents and he would brief Connissioner Luna on our concerns and the seriousness of our findings.
In closing, NRC's mechanism for reporting the results of the review were discussed in detail.
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s.
APPLICATION OF " GUIDELINES FOR NRC REVIEW OF AGREEMENT STATE RADIATION CONTROL PROGRAMS" The " Guidelines for NRC Review of Aqreement State Radiation Control Programs" were published in the Federa Register on June 4 1987, as an NRC Policy Statement.
The Guide provides 29 Indicators for eva,luating Agreement State program areas.
Guidance as to their relative importance to an Agreement State program is provided by categorizing the indicators into twe cateprits.
Category I indicators address program functions which directly relate to the State's ability to protect the public health and safety.
If significant problems exist in one or more Category I indicator areas, then the need for improvements may be critical.
Category !! indicators address program functions which provide essential l
technical and administrative support for the primary program functions.
Good performance in meeting the guidelines for these indicators is essential in order to avoid the develo principal program areas, i.e.,pment of problems in one or more of the those that fall under Category I indicators.
Category II indicators frequently can be used to identify underlying problems that are causing or contributing to difficulties in Category I indicators.
It is the NRC's intention to use these categories in the following manner.
In reporting findings to State management, the NRC will indicate the category of each coment made.
If no significant Category I coments are provided, this will indicate that the program is adequate to protect the public health and safety and is compatible with the NRC's program.
If one or more significant Category I coments are provided, the State will be notified that the program deficiencies may seriously affect the State's ability to protect the public health and safety and that the need for improvement in particular and evaluation, the State' program areas is critical.
If, following receipt s response appears satisfactory in addressing tie significant Category I coments, the staff may offer findings of adequacy and compatibility as appropriate or defer such offering until the State's actions are examined and their effectiveness confimed in a subsequent j
review.
If additional information is needed to evaluate the State's actions, the staff may request the information through follow-up correspondence or perform a special limited review.
NRC staff may hold a special meeting with appropriate State representatives.
No significant items will be lef t unresolved over a prolonged period.
The Commission will be informed and copies of the review correspondence to the States will be i
placed in the NRC Public Document Room.
If the State program does not improve or if additional significant Category I deficiencies have developed, a staff finding that the arogram is not adequate will be considered and the NRC may institute proceecings to suspend or revoke all or part of the Agreement in accordance with Section 274j of the Atomic Energy Act of 1954,,
as amended.
(
l ENCLOSURE 4
.