ML20083G092

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Public Version of Rev 2 to Health Physics Dept Emergency Plan Implementing Procedure HDP-ZZ-01200, Radiation Work Permit Program & Receipt Form
ML20083G092
Person / Time
Site: Callaway Ameren icon.png
Issue date: 11/14/1983
From: Kanyo J, Polchow J
UNION ELECTRIC CO.
To: Edison G
NRC
Shared Package
ML20083G086 List:
References
HDP-ZZ-01200-01, HDP-ZZ-1200-1, NUDOCS 8401060041
Download: ML20083G092 (26)


Text

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DATE 11/14/83 PAGE 1

of 2

UNION ELECTRIC COMPANY CALLAWAY PLANT HEALTH PHYSICS DEPARTMENTAL PROCEDURE INDEX HEALTH PHSYICS

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Procedure Date Deficiency Reso.

Number Title Rev.

Issued Pace Date Deot.

HDP-22-01200 Radiation Work Permit 2

11/09/83 Hith Phy Program HDP-ZZ-01300 Internal Dosimetry Program 0 10/18/83 Hlth Phy HDP-ZZ-01400 External Dosimetry Program 0 10/18/83 Hlth Phv HDP-ZZ-01401 Dosimetry Procram for 0

11/01/82 10/19/82 Hith Phy Byeroduct and Soecial Nuclear Material (Superceded by HDP-ZZ-01400)

HDP-ZZ-01500 Radiolooical Posting and 0

08/04/83 07/27/83 Hith Phy Acess Control HDP-ZZ-03000 Radiolocical Survev 0

09/08/83 08/31/83 Hlth Phy Program HDP-ZZ-04000 Health Physics GR1 06/06/83 10/22/82 Hlth Phy Instrumentation Program HDP-ZZ-04500 Health Physics / Chemistry 0

10/29/83 10/10/83 Hlth Phy Comouter and Counting System HDP-ZZ-05009 Iniured Contaminated 0

10/08/82 Hlth Phy Personnel (Superceded by EIP-ZZ-00224 date 04/29/83)

HDP-ZZ-05010 Fuel Buildinc GR1 01/06/83 12/30/82 Hlth Phy Evacuation Plan HDP-ZZ-05011 Fuel Receiot 0

10/15/82 Hlth Phy Emercency Plan HDP-ZZ-06000 Contamination Guidelines 0

07/23/83 07/12/83 Hlth Phy and Limits 8401060041 831228 PDR ADOCK 05000483 F

PDR

DATE 11/14/83 PAGE 2

of 2

HEALTH PHYSICS Procedure Date Deficiency Resp.

Number Title Rev.

Issuci, Pace Date Dept.

HDP-ZZ-06010 Personnel Monitorino 0

10/01/82 09/27/82 Hlth Phv

  • for Contamination (Suoerceded by HTP-ZZ-06010, dated 09/08/83)

HDP-ZZ-06017 Rad / Chem Technician 0

10/03/83 09/23/83 Hlth Phy Heal.th Physics Ouali-fication Program HDP-ZZ-08000 Resoiratory Protection 0

09/08/83 08/31/83 Hlth Phv Program HDP-ZZ-08700 Confined Soace Entry GR1 09/08/83 Hlth Phy Program

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HDP-ZZ-01200 October 18, 1983 Revision 2 CALLAWAY PLANT HEALTH PHYSICS DEPARTMENTAL PROCEDURE HDP-ZZ-01200 RADIATION WORK PERMIT PROGRAM d b O hvit.J~

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Procsd. No.

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2 Table of Contents Section Page Number 1.0 Purpose and Scoce 1

2.0 Definitions 1

3.0 Precautions and Limitations 2

4.0 Procedure 3

4.1 Recuestino a RWP 3

4.2 Preparation of a RWP 4

4.3 ALARA Review and Acoroval of a RWP 5

4.4 Posting and Updating of RWPs 6

4.5 Suspension and Termination of RWPs 7

4.6 RWP Access Control 8

4.7 Non-Dose-Tracking RWPs 10 5.0 References 11 6.0 Records 12 RWP Recuest Form List of Personnel Authorized to Work on SRWP RWP Preparation Guidelines Radiation Work Permit Health Physics Access Control Loq RWP Sign-In Sheet 4

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RADIATION WORK PERMIT PROGRAM l 1.0 PURPOSE AND SCOPE 1.1 Provide instructions to plant personnel on how to reauest a Radiation Work Permit

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(RWP).

1.2 Provide instructions to Health Physics per-sonnel on the preparation, ALARA review, ap-proval, maintenance, and termination of the RWP using either the Nuclear Data RWP sof tware or the manual back-up system.

1.3 Provide instructions to Health Physics per-sonnel on the use of the ND Access Control comouter software or the manual back-up sys-tem to control access of personnel working under the authorization of a given RWP.

l.4 Provide instructions to Health Physics per-sonnel in the preparation, approval, and maintenance of non-dose-tracking RWPs.

l 2.0 DEFINITIONS l 2.1 RADIATION WORK PERMIT (RWP)

A RWP is an authorizing and dose-tracking document that provides instructions in radi-ological safety to plant personnel.

A RWP is recuired for a job, work project, or task which is to be performed in areas where ac-tual or potential radiological hazards exist.

l 2.1.1 Snecific Radiation Work Permit (S RWP)

A RWP for a specific job, work project or task.

This RWP allows access to only those personnel designated by the Work Supervisor.

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2 l 2.1.2 General Radiation Work Permit (GRWP)

A RWP for an area where radiological condi-tions are relatively stable.

Personnel al-Jowed access to this RWP are not designated individually, but are categorized by work group or iob function.

l 2.1.3 Non-Dose-Tracking RWP A Health Physics generated document that provides instructions to personnel who have entered the RCA under a GRWP and are enter-inq a room or area in the RCA where radi-ological conditions dictate protective recuirements in addition to those specified on the GRWP.

l 3.0 PRECAUTIONS AND LIMITATIONS 3.1 It is the responsibility of each person who enters the Radiological. Controlled Area (RCA) or a Radiological Posted Area (RPA) to know and comply with the requirements of the applicable RWP, and to maintain their radiation exposure As Low As Reasonably Achievable ( ALARA).

3.2 RWPs prepared using the manual back-up sys-tem shall be transferred to the computer format as soon as the computer-based system becomes available for use.

3.3 Personnel may only work under one RWP at a

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time.

3.4 Consideration should be given to preparing a separate SRWP for each major phase of a job (area / job preparation, work activity, and area /iob disassembly) when a significant portion of the man-rem occurs in the pre-paration or disassembly phase.

l 3.5 Posted computer-generated RWPs do not have to be signed.

Only the original computer-generated RWP in the RWP Master file recuires signatures.

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z l 4.0 PROCEDURE l 4.1 REQUESTING A RWP 4.1.1 RWPs are recuired for the following types of activities:

4.1.1.1 Entries into and work performed in posted airborne radioactivity areas, high radiation area s, radiation areas, contamination areas, and very high radiation areas.

4.1.1.2 Work involving maintenance, inspectior, or adiustments to any system or component which contains, stores, transoorts or collects radioactive materials.

4.1.1.3 Entry into the Radiological Controlled Area (RCA).

4.1.1.4 Handling of certain radioactive sources con-taining licensable cuantities or concentra-tions of by-product material or special nu-clear material, as designated by the Sup-erintendent, Health Physics.

4.1.2 Persennel reauesting a RWP shall do so by compl eting the RWP Reauest Form (Attachment

1) and forwarding to the Health Physics Of fice.

4.1.2.1 Recuests for RWPs should be submitted at least 72 hours8.333333e-4 days <br />0.02 hours <br />1.190476e-4 weeks <br />2.7396e-5 months <br /> prior to the scheduled job start time.

However, unanticipated work ac-tivities shall be handled on a case by case basis.

4.1.3 The Work Supervisor designated on the RWP Recuest Form shall complete and forward to the Health Physics Office a List of Person-nel Authorized to Work on SRWP (Attachment l

2) prior to the scheduled job start time, i

and shall be responsible for ensuring those personnel meet the following reauirements:

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2 4.1.3.1 Have unescorted access status to the RCA or a RPA by successful completion of Callaway Plant Rad Category I and II training, or be continuously escorted by an individual that has unescorted access, status.

4.1.3.2 Personnel shall have dosimetry, a whole body count and resoiratory fit test as reautred by the Internal Dosimetry, External Dosimetry, and Respiratory Protection Programs.

4.1.3.3 Have the necessary exposure margin for anticipated job or area exposure.

4.1.3.3.1 Extension of exposure limits shall be recuented in accordance with HDP-ZZ-01400, External Dosimetry Program or HDP-ZZ-01300, Internal Dosimetry Program, as applicable.

l 4.2 PREPARATION OF A RWP 4.2.1 Health Physics Operations shall determine the radiological conditions at the vork site by use of one or more of the following:

4.2.1.1 Performance of a pre-job radiological survey where radiological conditions of the work area are suspect, unknown, or may have changed since the last routine survey.

4.2.1.2 Use of previous radiological surveys that reflect the radiological conditions of the work area.

4.2.2 Health Physics Ooerations shall prepare a RWP using the completed RWP Recuest Form and the computer-based RWP system.

4.2.2.1 Prepare a RWP using Transaction 02 (RWP Heal th Physics Information Entry) of the RWP sof tware and RWP Preparation Guidelines (Attachment 3).

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J 4.2.2.2 Use Transaction 03 (RWP Employee Authoriza-tion) of the RWP software to authorize per-sonnel for entry on a SRWP using the List of Personnel Authorized to Work on a SRWP sub-mitted by the Work Supervisor.

4.2.2.2.1 Personnel authorized to work under a SRWP may be changed at anytime upon reauest of the Work Supervisor or another supervisory member of the same department.

4.2.3 When the RWP sof tware is unavailable for use, a manual back-up system shall be used to prepare a RWP using the completed RWP Recuest Form and a Radiation Work Permit form (Attachment 4).

4.2.3.1 Instructions for oreparing a manual RWP are found in the RWP Preparation Guidelines.

4.2.3.2 A List of Personnel Authorized to Work on a SRWP shall be included with the manual RWP.

l 4.3 ALARA REVIEW AND APPROVAL OF A RWP 4.3.1 A cooy of the RWP(s), radiological survey sheets, and the RWP Recuest Form shall be forwarded for ALARA review in accordance with HTP-ZZ-01102, Pre-Job ALARA Planning and Briefing.

NOTE An ALARA review is not recuired for Emergency or Priority 1 Work Recuests.

4.3.1.1 Additions or changes to the RWP necessitated by the ALARA review shall be incorporated.

4.3.1.2 The eerson performir.g the ALARA review shall sign the "ALARA Review" entry on the RWP and return all documentation to the Health Phys-ics Office.

4.3.2 A Rad / Chem Foreman (Health Physics Opera-tions or Health Physics Technical Support) shall approve the RWP by signing the "HP Foreman Accroval" entry on the RWP.

Procsd. No.

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2 4.3.2.1 SRWPs with an estimated man-rem > 1.0 shall be approved by the Superintendent, Health Physics, who shall sign the "HP Foreman Approval" entry on the RWP.

4.3.2.2 The RWP shall also be approved using

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Transactions 05 (RWP Ready for Approval) and 06 (RWP Aoproval) of the RWP sof tware.

l 4.3.3 The Shif t Suoervisor shall approve the RWP by signing the " Shift Supervisor Aoproval" entry on the RWP.

4.3.4 The signed RWP, radiological survey sheets, and the RWP Recuest Form shall be retained by Health Physics Operations in a RWP Master file in the Health Physics Office.

l 4.4 POSTING AND UPDATING OF Rh7s 4.4.1 Cocies of RWPs and associated radiological surveys shall be posted or made available by Health Physics at the following locations:

4.4.1.1 Health Physics Acce.ss Control and/or any other access control point to the RCA or RPA through which. access can be gained to the work site.

4.4.1.2 At or immediately outside of the work site for SRWPs.

4.4.2 RWPs shall be updated when radiological con-ditions in the work area change, the sche-dul.ed completion date is extended, or a major change to the work procedure occurs.

4.4.2.1 A periodic review of all RWPs shall be per-formed by a Rad / Chem Foreman (Health Physics Operations) to determine the need for new radiological surveys at the work site and a I

subsecuent update to the RWP.

4.4.2.2 The Work Supervisor shall inform Health Physics Operations when an extension of the comoletion date is necessary or the work procedure chances..

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Z 4.4.3 Updates to a RWP sha.13 be made us'ing Tran-saction 07 (Health Physics RWP Information Edit) of the RWP software.

4.4.3.1 Whenever a RWP is updated, all posted copies of the RWP shall be replaced with the up-dated RWP and the outdated RWP copies shall be destroyed.

4. 4. 3.1.1 A cooy of the updated RWP shall also be placed in the RWP Master file, and the out-dated RWP copy sha31 remain in the file.

l 4.5 SUSPENSION AND TERMINATION OF RWPS 4.5.1 RWPs may be suspended, when it is necessary to temporarily curtail work on a particular iob, using Transaction 08 (RWP Suspension) of the RWP software.

4.5.1.1 Copies of RWPs that have been suspended shall be removed from all posted locations and destroyed.

4.5.2 Reactivate a suspended RWP using Transaction 06 (RWP Approval) of the RWP software.

4.5.2.1 Radiological surveys shall be performed at the work site or area and a new copy of the RWP Dosted prior to reactivating a suspended RWP.

4.5.3 RWPs shal] be terminated on the scheduled completion date or when notified by the Work Suoervisor that work under the RWP has been

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completed prior to the scheduled completion date.

4.5.3.1 Prior to terminating a RWP, obtain a printout of the following lists and place in the RNP Master file.

4.5.3.1.1 All options on Transaction 26 (RWP Exposure and Man-Hour List) for a SRWP.

4.5.3.1.2 Option " List Total Exposure and Man-Hours for RWP" on Transaction 26 for a GRWP.

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2 4.5.3.2 Terminate a RWP using Transaction 10 (RWP Tarmination) of the RWP software.

4.5.3.2.1 Place the Termination Report generated by Transaction 10 in the RWP Master file.

4.5.3.3 RNPs may be extended beyond the original scheduled completion date.

This will nor-mally be done when, due to unforeseen cir-cumstances or delays, the original comple-tion date cannot be met.

4.5.3.3.1 Extensions shall be reauested by the Work Supervisor prior to the current completion date.

4.5.4 Forward the RWP Master file for a terminated RWP to the Rad / Chem Foreman (ALARA) for post-job ALARA review.

l 4.6 RWP ACCESS CONTROL 4.6.1 Access to the RCA or RPAs outside the RCA, where Access Control software is available,

-shall be controlled as follows:

l 4.6.1.1 Personnel shall read the RWP under which they are entering the RCA or RPA and shall review the radiological surveys associated with that RNP.

4.6.1.1.1 Personnel shall sign the Health Physics Ac-cess Control Log (Attachment 5).

NOTE Signing the Health Physics Access Control Log indicates 1

that the individual has read, understands, and will comply w!th al.1 recuirements of the RWP.

4.6.1.1.2 The Heal.th Physics Access Control Log shall be retained by Health Physics.

4.6.1.2 Transaction 02 (Central Control Point Setup) of the Access control software shall be used to enter oersonnel into the RCA or RPA.

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4.6.1.2.1 Personnel shall give the individual manning the computer terminal their exposure iden-tification number, PIC reading, and the num-ber of the RWP under which they are enterinq

' he RCA or RPA.

c CAUTION Failure to heed warnings in regard to personnel exceeding or nearing ex-oosure alert limits could result in personnel overexposure to radiation.

l 4.6.1.2.2 Personnel receiving the warning that an ex-posure alert limit has been exceeded or is being neared shall not be allowed access un-til a reouest for increased exposure is sub-mitted or exposure stay time calculations have been performed.

4.6.1.3 Transaction 02 (Central Control Point Setup) of the Access Control software shall be used to exit personnel from the RCA or a RPA.

4.6.1.3.1 Personnel shall give the individual manning the computer terminal their exposure iden-tification number and PIC reading.

4.6.1.3.2 Personnel receiving the warning that an ex-posure alert limit has been exceeded or is being neared should submit a reauest for in-creased exposure prior to their next RCA or RPA entry.

1 4.6.2 Access to the RCA or RPAs outside the RCA, where or when Access Control software is unavail able, shall be controlled as follows:

4.6.2.1 Personnel sha31 read the RWP under which they are entering the RCA or RPA and shall review the radiological surveys associated with that RKP.,.

Proc 2d. No.

HDP-ZZ-01200 Rev.

2 4.6.2.2 Personnel shall record all necessary in-formation on the RWP Sign-In Sheet (Attachment 6) orior to entry.

NOTE S'Jning the RWP Sign-In Sneet indicates that the in-dividual has read, under-

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s stands, and will comply with all recuirements of the RWP.

4. 6. 2. 3 Personnel shall record remaining information on RWP Sign-In Sheet upon exit from RCA or RPA.

I 4.6.2.4 Health Pnysics Technical Support shall col-lect RWP Sign-In Sheets and track personnel exposure in accordance with RTP-ZZ-01433, t

Processing of Panasonic TLDs and Maintaining Personnel Exposure Records.

l 4.7 NON-DOSE-TRACKING RWPS 4.7.1 Health Physics Ooerations shall generate and

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maintain a non-dose-tracking RWP when rooms or areas within the RCA recuire protective reouirements in addition to those necessary for access to the RCA under a GRWP.

4.7.1.1 This RWP shall be prepared for each room or area in accordance with the guidance given in section 4.2 except as follows:

4.7.1.1.1 RWP Number is Building - Room / Corridor No./l Level.

(i.e. A-1310, F-2047) i Where:

F - Fuel Building C - Control Building A - Auxiliary Building RW - RadWaste Building HMS - Hot Machine Shop l

l l 4.7.1.1.2 Job is "GRWP Entry."

4.7.1.1.3 Location agrees with location portion of RWP Number.

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4 l 4.7.1.1.4 No entry is made for the following:

Task Category, Job Supervisor, Man-Hours, Man-Rem, or Component Codes.

l 4.7.1.1.5 No RWP Reauest Form is provided.

4.7.1.2 The prepared RWP is approved by signature of a Rad / Chem Foreman (Heal th Physics Opera-tions) and shall be retained by Health Phys-ics Operations in the RWP Master file in the Health Physics Office.

4.7.1.3 A cocy of the RWP and the latest radiclogi-cal survey of the room or area shall be posted at the entrance to the room or area.

l 4.7.1.4 The RWP shall be updated whenever a routine survey, as recuired by HDP-ZZ-03000, Radi-ological Survey Program, is performed.

4.7.1.4.1 The RWP shall be updated using Transaction 02 (RWP Health. Physics Information Entry) and the latest radiological survey data.

l 4.7.1.4.2 A Rad / Chem Foreman (Health Physics Opera-tions) shall review the updated RWP and as-sociated radiological survey and approve by signing the RWP.

4.7.1.4.3 The aporoved RWP shall be placed in the RWP Manter file, and the outdated RWP shall be removed from the file and dastroyed.

l 4.7.1.4.4 A cocy of the updated RWP and radiological survey sha13 be posted at the entrance to the room or area, and the outdated RWP shall be destroyed.

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5.0 REFERENCES

l 5.1 HDP-ZZ-01300, Internal Dosimetry Program.

l 5.2 HDP-ZZ-01400, External Dosimetry Program.

5.3 HTP-ZZ-01102, Pre-Job ALARA Planning and I

Briefing.

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2 5.4 HTP-ZZ-01433, Processing of Panasonic TLDs and Maintaining Personnel Exposure Records.

l 5.5 HDP-tZ-03000, Radiological Survey Program.

5.6 Operator's Manual, Nuclear Data (RWP/1000) l Software.

l 6.0 RECORDS l 6.1 O.A.

RECORDS 6.1.1 Contents of RWP Master File shall be sent to file upon completion of post-job ALARA l

review.

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4 RWP RE0 DEST FORM JOB DESCRIP, TION (Include any component identification numbers):

JOB LOCATION:

SCHEDULED START DATE/ TIME:

SCHEDULED COMPLETION DATE/ TIME:

TASK CATEGORY (Check One):

ROS Routine Operations & Surveillance SPM Special Plant Maintenance RPM Routine Plant Maintenance WPR Waste Processing ISI Inservice Inspection REO Refueling Operations RESPONSIBLE DEPARTMENT WORK. SUPERVISOR:

DEPARTMENTS WORKING JOB ESTIMATED MAN-HOURS (Time at job site only):

WR NUMBER:

RWR NUMBER:

LIST MAJOR WORKSTEPS (Include steps that could cause radiological conditions at work site to change; i.e., Breach / drain of a radioactive system, grinding, welding, cutting, etc.)

I WORK SUPERVISOR / PLANNER

/ DATE TO BE FILLED IN BY HEALTH PHYSICS:

RWP NUMBER:

JOB. NUMBER:

LOCATION CODE:

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RWP #

LIST OF PERSONNEL AUTHORIZED TO WORK ON SRWP NAME SOCIAL SECURITY NUMBER NAME SOCIAL SECURITY NUMBEF a

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.2 ATTACHMENT 3 RWP Preparation Guidelines This attachment provides guidance in the preparatics of RWPs using either the RWP software (computer generated) or the manual back-up (handwritten) method.

Instructions on the specific use of the RWP software, which is part of the Nuclear Data ALARA Exposure Management System, to perform the tasks set forth in this attachment are found in the Operator's Manual.

Use the table below to enter, select, or assign items to a RWP.

Required RWP Entry Guidance RWP Number Year - Sequential number - G/S (gc ral/ specific)

(i.e. 83-001-S). The first hyphen may be omitted to allow the sequential number to exceed 999 if necessary. The second hyphen may be onunited, and a letter designator used when multiple RWP's are required for one RWP request.

Task Category RWP Request Form i

Job RWP Request Form.- More than one RWP may be pre-pared per RWP Request if job scope is broad or significant man-rea occurs in the preparation or disassembly phase of the job.

Location RWP Request Form Job Supervisor RWP Request Form Scheduled Start / Completion RWP Request Form - Completion date for GRWP's Date and Time shall not exceed 12-31-XX.

Man-Hours RWP Request Form MAN-REM Best estimate of whole body exposure rate per-sonnel at work site will be subjected to multi-plied by the number of man-hours. Also include man-rem for jeb preparation and dir. assembly if necessary and within job scope.

Storing Man-Hours and Man-Rem Yes - for Specific RWP.

on a daily basis (RWP software

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No - for a General RWP unless directed otherwise by HP supervision.

Component Code and : Exposure Use component identification number off RWP per component (RWP software Request Form for code. The equal amount for each only) component method should be used unless the % for individual comocnents is known.

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2 REQUIRED RWP ENTRY GUIDANCE Radiological Conditions Determine using radiological survey data.

Comment section should include as applicable, the following:

Location and level of any radiation HOT SPOTS.

Location and level of highest contamination.

Presence of contaminated liquid.

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Specific work steps where rad conditions could worsen.

Frequency of air sampling while work is in progress.

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" Continuous air sampling required."

" Lapel air samples required."

" Frequency of air samples to be determined at job site by HP."

"See survey attached: or "upon entry."

" Neutron survey required upon entry."

Protective Clothing Use Protective Clothing Selection Guide found in HTP-ZZ-06014, Selection and Use of Protective Clothing.

Respiratory Protection Use HTP-ZZ-08003, Selection of Respiratory Protection Devices.

Dosimetry Use HDP-ZZ-01400, External Dosimetry Program.

ALARA Review Yes for all RWP's Health Physics Coverage Start of Job - Ensures proper work area radio-logical controls are established, understood, and followed by workers Ensures work area radiological End of Job conditions are assessed when work is completed.

Periodic radiological evaluations Intermittent of work area to assess worker compliance with RWP and that radiological ccnditions have not changed significantly.

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2 REQUIRED RWP ENTRY GUIDANCE Requires c atinuing surveillance Health Physics Coverage Cortinuous and awareness of woric - radiological con-ditions as well as knt.__ng exposure status of workers.

Mandatory for:

HRA or VHRA Potential for uncontrolled s'pread of con-l tamination.

Movement of irradiated fuel.

i Potential for significant increase in rad-I iation levels or airborne activity.

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Special Instructions Requirements of HTP-ZZ-06001. HRA/VHRA Access, delineated if applicable.

" Neutron survey for dose calculations required."

" Pick up Internal Exposure Card at HP Office" when:

Respiratory Protection devices required or total % MPC>25.

Note steps where respiratory protections devices required For GRWP's:

"RWP posted at specific room or area lists additional protection requirements."

Page 3 of 3 Attachment 3

Prec. No. HDP-ZZ-01200 UNION ELECTRIC COMPANY hv.

2 RADIATION WORK PERMIT

-DATE/ TIME RWP Number Job Supervisor Job

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Location Scheduled Start date/ time Scheduled completion Estimated O n-hours Estimated Man-rems RADIOLOGICAL CONDITIONS f

Contamination Levels: General Work Area:

DPM/100cm2 Smear date/ time (YY/MM/DD HH;MM):

Comment:

Dose Rate Levels: General Work Area:

mR/hr Survey date/ time (YY/MM/DD HH:MM):

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Airborne Levels: General Work Area:

MPC Sample date/ time (YY/MM/DD HH:MM):

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Protective Clothing Dosimetry l

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