ML20053B187
| ML20053B187 | |
| Person / Time | |
|---|---|
| Issue date: | 05/24/1982 |
| From: | Sreniawski D NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION III) |
| To: | |
| Shared Package | |
| ML20053B181 | List: |
| References | |
| NUDOCS 8205280152 | |
| Download: ML20053B187 (2) | |
Text
Appendix NOTICE OF VIOLATION Holzer Medical Center License No. 34-06002-01 As a result of the inspection conducted on April 19, 1982, and in accord-ance with the NRC Enforcement Policy, 47 FR 9987 (March 9, 1982), the following violations were identified:
1.
License Condition No. 17 requires that licensed material be possessed and used in accordance with the statements, representations, and procedures contained in certain referenced applications and letters.
The referenced letter dated December 23, 1977, states in Item 8 that the Medical Isotope Committee will meet quarterly.
Contrary to the above, the Medical Isotope Committee did not meet between February 13, 1979, to April 10, 1980, and not again until March 26, 1981.
In addition, no meeting was held during the second quarter of 1981.
This is a Severity Level V violation (Supplement VI).
2.
License Condition No. 17 requires that licensed material be possessed and used in accordance with the statements, representations, and procedures contained in certain referenced applications and letters.
The referenced letter dated December 23, 1977, states in Item 14-15 that personnel in non-radiology departments (nursing, housekeeping, and security) who may occasionally come into contact with radioactive material will receive instruction appropriate to their duties which will include safety practices, applicable rules and regulations, and response to emergency situations.
In addition, the referenced letter dated March 13, 1978, states the training will be given initially and annually.
Contrary to the above, training has not been given to security personnel who routinely receive and deliver radioactive packages to the nuclear medicine department.
This is a Severity Level V violation (Supplement VI).
3.
10 CFR 35.14(b)(5)(v) requires that your sealed sources possessed and used as per Schedule A of 10 CFR 35.100 under Group VI be physically inventoried quarterly to account for all the sources received and possessed.
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Appendix 2
Contrary to this requirement, you have failed to conduct the required inventory since October 16, 1978.
This is a Severity Level V violation (Supplement VI).
4.
10 CFR 35.14(b)(5)(1) requires that each source or device possessed and used as per Schedule A of 10 CFR 35.100 under Group VI be tested for contamination and/or leakage at intervals not to exceed six months.
Contrary to the above, cesium-137 brachytherapy sealed sources have not been leak tested since October 20, 1978.
This is a Severity Level V violation (Supplement VI).
5.
10 CFR 35.14(e) requires that scaled calibration or reference sources possessed pursuant to 10 CFR 35.14(d) be tested for leakage and/or contamination at intervals not to exceed six months.
Contrary to this requirement, as of the date of the inspection, you have failed to leak test your 196 microcurie cesium-137 reference source at the required intervals.
Specifically, leak tests were per-formed on October 4, 1978, March 26, 1981 and March 1982. These intervals exceed six months.
This is a Severity Level V violation (Supplement VI).
Pursuant to the provisions of 10 CFR 2.201, you are required to submit to this office within thirty days of the date of this Notice a written state-i ment or explanation in reply, including for each item of noncompliance:
(1) corrective action taken and the results achieved; (2) corrective action to be taken to avoid further noncompliance; and (3) the date when full com-pliance will be achieved. Consideration may be given to extending your 7
response time for good cause shown.
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Dated D. J. Sreniawski, Chief /~"~\\
Materials Radiation Protection j
Section 2 1
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