ML20196K081

Transmits State Agreemnt Program Info (SP-98-095) Re Draft OSP Procedure SA-105, Reviewing Common Performance Indicator 5,Response to Incidents & Allegations

ML20196K081
Person / Time
Issue date:	11/30/1998
From:	Lohaus P NRC OFFICE OF STATE PROGRAMS (OSP)
To:	GENERAL, MINNESOTA, STATE OF, OHIO, STATE OF, OKLAHOMA, STATE OF, PENNSYLVANIA, COMMONWEALTH OF, WISCONSIN, STATE OF
Shared Package
ML20196K085	List: ML20196K081 ML20196K095
References
SP-98-095, SP-98-95, NUDOCS 9812110212
Download: ML20196K081 (15)

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ALL AGREEMENT STATES %DV S 0 B93 MINNESOTA, OHIO, OKLAHOMA, PENNSYLVANIA, AND WISCONSIN TRANSMITTAL OF STATE AGREEMENTS PROGRAM INFORMATION (SP-98095)

Your attention is invited to the enclosed correspondence which contains:

INCIDENT AND EVENT INFORMATION..... ....

PROGRAM MANAGEMENT INFORMATION....XX DRAFT OSP PROCEDURE SA-105, l

" REVIEWING COMMON PERFORMANCE INDICATOR #5, RESPONSE TO INCIDENTS AND ALLEGATIONS" TRAINING COURSE INFORMATION...............

l TECHNICAL INFORMATION........................ ... l OTH ER IN FORMATION........ .................. .......

Supp!ementary information: Enclosed for your review and comment is the draft OSP Procedure SA-105, " Reviewing Common Performance Indicator #5, Response to incidents and Allegations." The document has been drafted to incorporate procedures and guidance for the  ;

review conducted under the Integrated Materials Performance Evaluation Program. We would  ;

appreciate receiving your comments within one month of receipt of this document. ,

This information request has been approved by OMB 3150-0029, expiration 04/30/01. The estimated burden per response to comply with this voluntary collection request is 6 hour6.944444e-5 days <br />0.00167 hours <br />9.920635e-6 weeks <br />2.283e-6 months <br /> (s).

Forward any comments regarding the burden estimate to the Information and Records Management Branch (T-6 F33), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, and to the Paperwork Reduction Project (3150-0029), Office of Management and Budget, Washington, DC 20503. If a document does not display a currently valid OME control nurnber, the NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information.

POINT OF CONTACT: Kathleen N. Schneider TELEPHONE: (301) 415-2320 FAX: (301) 415-3502 INTERNET: KXS@NRC. GOV OriginalSigned Gy; PAUL H. LOHAUS Paul H. Lohaus, Deputy Director ,

Office of State Programs /

Enclosure:

l As stated Distribution: .- , , -

"5 b""

DIR RF 11OO DCD (SP03)r j I SDroggitis , PDR (YESi)(NO_)

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A/S File ,, - .- .- a

• See previous concurrence DOCUMENT NAME: G:\KXS\SP98095.WPD /4 G:\LJR\SA105.

Tm recelwe a cope of this document, indneste in the box: ac - mfetque attachment / enclosure *c . copy with attachment / enclosure 'N - No copy OFFICE OSP OSF4%/, t n OSP:Q/)ofl l l NAME KSchneider:nb/gd PLohaudi W GE NBangart W' '

DATE 11/13/98* 11/13/9d* ' ' 11/3D /98 9812110212 981130 OSP OFFICIAL FILE: SP-A 4 /

PDR STPRG ESGGEN PDR

ALL AGREEMENT STATES I MINNESOTA, OHIO, OKLAHOMA, PENNSYLVANIA, AND WISCONSIN TRANSMITTAL OF STATE AGREEMENTS PROGRAM INFORMATION (SP )

Your attention is invited to the enclosed correspondence which contains:

INCIDENT AND EVENT INFORMATION..........

ROGRAM MANAGEMENT INFORMATION... XX DRAFT OSP PROCEDURE  ;

SA-105, " REVIEWING COMMON PERFORMANCE  :

INDICATOR #5, RESPONSE TO INCIDENTS AND ALLEGATIONS" TRAININ COURSE INFORMATION...............

TECHNICAL NFORMATION.. ............. ...........

OTHER INFO ATI O N . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Supplementaryinformati n: Enclosed for your review and comment is the draft OSP Procedure SA-105," Reviewing Com on Performance Indicator #5, Response to incidents and Allegations. The documen has been drafted to incorporate procedures and guidance for the review conducted under the ntegrated Materials Performance Evaluation Program. We request your comments by o e month of receipt of this document.

This information request has b en approved by OMB 3150-0029, expiration 04/30/01. The estimated burden per response o comply with this voluntary collection request is 6 hour6.944444e-5 days <br />0.00167 hours <br />9.920635e-6 weeks <br />2.283e-6 months <br /> (s).

Forward any comments regardi the burden estimate to the Information and Records l

Management Branch (T-6 F33), S. Nuclear Regulatory Commission, Washington, DC  ;

20555-0001, and to the Paperwor Reduction Project (3150-0029), Office of Management and '

Budget, Washington, DC 20503. I document does not disp!ay a currently valid OMB control number, the NRC may not conduct o sponsor, and a person is not required to respond to, a j collection of information. )

POINT OF CONTACT: Kathleen N. Schneider TELEPHONE: (301) 415-2320 FAX: (301) 415-3502 INTERNET: S@ NRC. GOV Paul H. Lohaus, Deputy Director Office of State Programs i

Enclosure:

As stated Distribution: 1 DIR RF CD (SP03)

SDroggitis R (YES_L) (NO_)

A/S File l DOCUMENT NAME: / G:\LJR\SA105.

G:\KXS\SP98ZZZ.WPg TMoceNo e copr of this document, Indicate in the box: *C"A ithout attachment / enclosure *E" . Copy with attachment / enclosure "N" = No copy OFFICE OSP 6i) O%@ OSP:D \

NAME KSchneider:nb PLohltuhl RBangart \ j DATE 11/ \'5 /98 11/ jf /98 11/ /98 I OSP OFFICIAL FILE: SP-A-4

< p CE:

i t UNITED STATES l l j t

NUCLEAR REGULATORY COMMISSION e WASHINGTON, D.C. 2006H001

%e..../ November 30, 1998 ALL AGREEMENT STATES l MINNESOTA, OHIO, OKLAHOMA, PENNSYLVANIA, AND WISCONSIN I TRANSMITTAL OF STATE AGREEMENTS PROGRAM INFORMATION (SP 98095 )

Your attention is invited to the enclosed correspondence which contains:

INCIDENT AND EVENT INFORMATION.. ....... I PROGRAM MANAGEMENT INFORMATION....XX DRAFT OSP PROCEDURE SA-105,

" REVIEWING COMMON PERFORMANCE INDICATOR #5, l RESPONSE TO INCIDENTS AND l ALLEGATIONS" TRAINING COURSE INFORMATION.. ...........

TECHNICAL INFORMATION................... ...... .

OTH ER IN FORMATION.................... . ............

Supplementary information: Enclosed for your review and co'mment is the draft OSP Procedure SA-105, " Reviewing Common Performance Indicator #5, Response to incidents and Allegations." The document has been drafted to incorporate procedures and guidance for the l review conducted under the Integrated Materials Performance Evaluation Program. We would appreciate receiving your comments within one month of receipt of this document.

This information request has been approved by OM3 3150-0029, expiration 04/30/01. The estimated burden per response to comply with this voluntary collection request is 6 hour6.944444e-5 days <br />0.00167 hours <br />9.920635e-6 weeks <br />2.283e-6 months <br /> (s).

Forward any comments regarding the burder, estimate to the Information and Records Management Branch (T-6 F33), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, and to the Paperwork Reduction Project (3150-0029), Office of Management and Budget, Washington, DC 20503, if a document 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, a collection of information.

POINT OF CONTACT: Kathleen N. Schneider TELEPHONE: (301) 415-2320 FAX: (301) 415-3502 INTERNET: KXS@ NRC. GOV 1

) h4 '

x V' Paul H. Lohaus, Deputy Director Office of State Programs

Enclosure:

As stated l

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1 OSP Procedure Approval Reviewing Common Performance Indicator #5 Response to Incidents and Allegations - SA-105 j l

l Issue Date:

Expiration Date:

l Richard L. Bangart Director, OSP Date:

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Paul H. Lohaus l Deputy Director, OSP Date:

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\

l Lance J. Rakovan Procedure Contact, OSP Date:

1 NOTE

, The OSP Director's Secretary is responsiblefor the maintenance of this master copy docurnent aspart of the OSP Procedure Manual Any changes to theprocedure willbe the responsibility of l the OSP Procedure Contact. Copies of OSPprocedures will be distributedfor information.

Procedure

Title:

Reviewing Common Page:1 of 7 (y .

Performance Indicator #5, Response to Issu Daw

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• Incidents and Allegations Procedure Number: SA-105 i I. INTRODUCTION A. This document describes the procedures for conducting reviews of NRC Regional offices and Agreement States usmg Common Performance Indicator #5, Response to Incidents and Allegations [NRC Management Directive 5.6,IntegratedMaterial Performance Evaluation Program (IMPEP), November 25,1997].

B. As used in this procedure, the term " incident" applies to an event that may have caused, or threatens to cause, conditions described in 10 CFR 20.2202 through 20.2204,10 CFR 30.50,10 CFR 34.24, CFR 34.30,10 CFR 35.33,10 CFR 36.83, 10 CFR 39.77,10 CFR 40.60,10 CFR 70.50, or the equivalent State regulations. If a State defines this term in a different fashion, this should be noted during the course of the review.

C. As used in this procedure, the term " allegation" means a declaration, statement, or assertion ofimpropriety or inadequacy associated with regulated activities, the validity of which has not been established. This term inciudes all concems identified by sources such as the media, individuals or organizations. Excluded from this definition are matters being handled by more formal processes such as 10  ;

CFR 2.206 petitions, hearing boards, and appeal boards, for example. If a State defines this term in a different fashion, this should be noted during the course of the review.

II. OBJECTIVES A. To assure that actions taken in response to incidents or allegations are appropriate, well coordinated, and timely.

B. To verify that Regions and Agreement States have in place appropriate incident and allegation response procedures.

C. To confirm that corrective actions in response to incidents and allegations are adequately identified by licensees and that appropriate follow-up measures are taken to ensure compliance.

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SA-105: Reviewing Common Performance Indicator #5, ,

Issue Date-Response to Incidents and Allegations .

1 D. Forincidents:  ;

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1. To assure that the level of effort in responding to an incident is commensurate with potential health and safety significance.

2. To confirm ti.at follow-up inspections are scheduled and completed, if necessary.

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3. For Regional reviews, to confirm that notification to the Office of Nuclear I Material Safety and Safeguards (NMSS), the Office of Analysis and Evaluation of Operational Data (AEOD), as appropriate, is usually performed in a timely fashion.

4. For Agreement State reviews, to confirm that notification to the NRC, as appropriate, is usually performed in accordance with the Nuclear Materials Events Database (NMED) Handbook (OSP Procedure SA-300, Reporting Material Events, February 25,1998).

5. To verify that the information provided by the Agreement States on incidents and events for NMED is complete and accurate.

E. In addition to the general sampling of allegations, to verify that Agreement States are properly handling all allegations referred to the State from the NRC (e.g., that safety issues are properly addressed, length of time to close an allegation is appropriate, feedback is provided to allegers, etc.).

III. BACKGROUND A. This procedure applies to all incident response and allegation activities centered primarily in the period of time since the last Regional or State review. Incidents and allegations that began in periods prior to the review cycle should be included, but only if significant activity continued into the current review period.

B. This procedure specifically excludes non-Atomic Energy Act licensees, and incident response, or allegation follow-up actions conducted by or referred to NRC l

Headquarters personnel for decision.

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5A-105: '* ** ; *' '

Reviewing Common Performance Indicator #5, Issue Date:

Response to Incidents and Allegations IV. ROLES AND RESPONSIBILITIES A. The team leader for the Regional or State review will determine which team member (s) is assigned lead review responsibility for this performance indicator. In order to limit knowledge of allegers' identities, only NRC staff will review NRC Regional Office allegations.

B. The principal reviewer is responsible for reviewing relevant documentation, conducting staff discussions, and maintaining a reference log of all licensing or inspection files reviewed and Regional or State personnel interviewed.  ;

V. GUIDANCE A. Review Scope The principal reviewer will determine the scope of the review based on preliminary discussions with NMSS/OSP/ Regional / State allegation coordinators and inspection or compliance program managers (as appropriate). At a minimum, the reference log of all licensing inspection or allegation files reviewed and Regional or State personnel interviewed will include:

1. licensee name

2. licensee address l 3. a numerical file reference (such as license number, or inspection report number)

4. inspection priority of the license

5. the lead inspector (if any) l

6. type of inspection (i.e., reactive, closeouts, announced, unannounced, team,

! other, etc.)  ;

7. date ofinspection i

8. date issued

9. type of license operation (i.e., program code or license category).

The logs should be prepared in a sanitized fashion, if necessary, in order not to compromise the confidentiality of allegers, or others. (Note: The logs for the allegation reviews will not be part of the IMPEP review report).

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SA-105: Reviewing Common Performance Indicator #5, '* * # *' '

Issue Date-Response to Incidents and Allegations B. Evaluation Procedures The principal reviewer should refer to Pan III, Evaluation Criteria of Management Directive 5.6, for specific evaluation criteria. The Directive's Glossary defines the terms " Incidents" and " Allegations."

The reviewer should examine a representative number (approximately 10 each) of significant materials program incident response and allegation activities conducted by Regions or Agreement States. For Agreement States, priority should be given to evaluating in detail all allegations referred to the State from the NRC within the constraints of Section III. A. and B., above.

For Agreemer.t States, the reviewer will need to consult with the State as to the existence of confidentiality agreements (or other similar aechanisms) in place that may limit the review of specific files. The State may have to remove cenain information from documents to protect the identity of allegers.

For Regions, the latest audit conducted by NRC's Agency Allegation Advisor (AAA) should be obtained in preparation for the review. Normally, the annual AAA review will be conducted at the same time as the IMPEP review for a particular Region. In order to increase flexibility and efficiency, the principal reviewer may,in appropriate cases, adopt a portion of the AAA audit to augment the IMPEP report for the Regions.

C. Review Guidelines The responses generated by the Regions or States to relevant questions in the Integrated Materials Performance Evaluation Program (IMPEP) questionnaire l should be used to focus the review. For Regional reviews, the Operations Branch

! in the NMSS Division ofIndustrial and Medical Nuclear Safety should be contacted for lists ofincidents or allegations to be included in the review. NRC's i

Office of Enforcement and AEOD are also potential sources for this information.

l A detailed printout of all State NMED data for the review period should be obtained.

For the States, the principal reviewer should work with the Regional State Agreements Officer in obtaining the listing of allegations transferred from the NRC to the Agreement State for response in selecting the appropriate files for review.

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SA-105: Reviewing Common Performance Indicator #5, Issue Date: '

Response to Incidents and Allegations l l

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l Any incidents or allegations identified for follow up from the last periodic meeting l should be reviewed.

D. Review Details l

The review of each file should be made in conjunction with the reference and resource materials specified in Paragraph E., below.

For incident response, the principal reviewer should evaluate the following:

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1. Promptness ofinquiries made to evaluate the need for on-site inspections.

2. Promptness of on-site inspections of incidents requiring reporting to the  !

Agency in less than 30 days. l

3. Appropriate follow up ofincidents during the next scheduled inspection, including ensuring the adequacy, accuracy, and completeness of licensee-  !

provided information. l

4. Inclusion ofin-depth reviews ofincidents during inspections on a high-priority basis, as warranted. When appropriate, follow-up activities should include re-enactments and time-study measurements (normally within a few days).

Inspection results should be documented and enforcement action taken in accordance with NRC or State policy and procedures.

5. Pertinent infonnation about incidents which could be relevant to other licensed operations (e.g., equipment failure, improper operating procedures) is provided l' to licensees, the NRC (for Agreement States), and/or Agreement States (for NRC Regions or Agreement States, as appropriate).

6. Information on incidents involving equipment failure is provided to the agency responsible for evaluation of the device for an assessment of possible generic design deficiency.

7. Determination that the number and type of event reports recorded in NMED and the number and type of event reports on record at an NRC Region or Agreement State are identical.

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l SA-105: Reviewing Common Performance Indicator #5, '* E" ' *' '

Issue Date*- i l Response to Incidents and Allegations \

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8. Information obtained during the Region's or State's review is compared with other information obtained from the licensee to identify and resolve any differences.

9. The public is provided access to NRC/ State and licensee i. cords on the review as permitted within the constraints oflaws for protection . ipersonal, private, and proprietary information.

For allegations, the reviewer should evalt. ate the following:

1. Priority given to allegations with potential safety significance.

2. Receipt of an allegation is acknowledged to the alleger. ,

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3. The allegation is discussed with the alleger, if known, to obtain additional information.

4. In accordance with State mies and policy, allegers' identities are successfelly i protected.

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5. Adequate evaluation / inspection of the allegation to assess its validity and whether licensee health and safety issues are present.

6. Appropriate regulatory action taken.

7. Notification to allegers that the allegation is closed, and that allegers are informW of the progress of allegations every six months for unresolved allegations.

8. Appropriate length of time to close allegations.

9. For allegations referred to an Agreement State from the NRC, that the State's procedures for handling allegations compare to guidance in Management Directive 8.8, documenting any significant differences and determining if the State's procedures are equally as effective as NRC's.

10. For Agreement State reviews, whether the program for processing allegations l encourages those with safety concems to express those concems to the Agreement State program.

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i SA-105: Reviewing Common Performance Indicator #5,. '****'*

Issue Date*-

Response to Incidents and Allegations In addition to other items mentioned above, the reviewer should determine that:

1. Appropriate regulatory action was taken for items of noncompliance.

2. Letters to licensees are written in appropriate regalatory language, and they specify the time period for licensee response indicating corrective actions and actions taken to prevent recurrence.

3. The licensee's response was reviewed for adequacy and/or what subsequent action was taken by compliance supervision.

4 E. Reference and Resource Materials.

The reviewer should be familiar with, or have available, copies of NRC Management Directive 8.8, Management ofAllegations, and the Region's or State's inspector field notes, report forms for inspections and investigations, and appropriate NRC/ State regulations. In particular, the reviewer should be familiar with the contents of OSP Procedure SA-300, Reporting Afaterial Events, and related NRC Inspection Manual Chapter 1246. A printout of the NMED data should be obtained for each Region and State.

F. Discussion of Findings with Region or State.

The reviewer should follow the guidance given in OSP Procedure SA-100, Integrated Afaterial Peformance Evaluation Program, for discussing technical findings with reviewers, supervisors, and management.

VI. APPENDICES Attachment A - IMPEP Incident Reviewer Guidance Attachment B - IMPEP Allegation Reviewer Guidance VII. REFERENCES

1. NRC Management Directive 5.6, Integrated Material Performance Evaluation Program, November 25,1997.

2. OSP Procedure SA-100, Integrated Afaterial Performance Evaluation Program, undated.

3. OSP Procedure SA-300, Reporting Afaterial Events, Febmary 25,1998.

Appendix A  ;

IMPEPINCIDENT REVIEWER GUIDANCE NRC REVIEW BY: DATE: NS OR REGION:

STATE INCIDENT IDG NUMBER OR ODIER FILE IDENT1FICATION:

UCENSEE

LICENSE #

l-IDCATION OR SITE OF EVENT:

l DATE OF 1STCONTACT: DATE OFINCIDENn DATE OFINVEST1GA110N: INVEST 1 GAT 10NTYPE: SITED PHONED NEXTINSPD NONED D OVEREXPOSURE D DAMAGETOEQUIPMENTORFACIUTY

= D REIEASEOFRAM D EQUIPMENTOR PROCEDURE FAILURE D LOST /STOIEN/ ABANDONED RAM D IEAKING SOURCE D CONTAMINATIONEVENT D TRANSPORTATION

(- D IDSS OF CONTROL D MISADMINISTRAT10N O OTHER*

i BRIEF

SUMMARY

OF INCIDENT t

EVENTMET AOR REPORTING REQUIREMENTS? Y N POSSIBLEGENERICPROBLEM7 Y N STATES ACDON:

FINAL DISPOSI110N:

. NO. COMMENTS FOR REPORT APPENDIX l

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l INVESTIGATOR L

j SUPERVISORY REVIEW BY: DATE: j FINDINGS DISCUSSED WITH ON:

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Appendix A (C:ntinued) '

ITEM O.K. COMMENTS INITIAL RESPONSE PROMPTNESS APPROPRIA1ETYPE OF RESPONSE (ON-SITE.TElf0N NEXTINSPECTION.ETC.) )

i INVESTIGATION DEFIN OFINVEST1GATION DOCUMENTATION OFINVEST1GATION (REPORTS, TELCON DOCUMENTATION, ETC)

REGULATORY ACI1ONS (CITATIONS. UCENSE RESTRIC110NS, CORRECTIVE REQUIREMENTS)

SUPERVISORY OVERSIGHT OF INVESTIGATION FOLIDWTHROUGH ANDCIASEOITT INVESTIGATION ENTERED AND CIDSED OUT IN STATES TRACKING SYSTEM UCENSEES REPORTS AND CORRECTIVE ACTIONS REVIEWED AND/OR VERIFIED Cl.OSE-OUT DOCUMENTATION COMPLETE WITH DATE ANDSIGNATURE INCIDENT REVIEWED AT NEXTINSPECTION INCIDENT REPORTCROSS REFERENCED TO 1 UCENSE/ COMPLIANCE FILE l 1

REPORTING REQUIREMENTS j NRC AND/OR AGREEMENTSTATES AOR REPORTED ACCORDING TO CRITERIA MIS ADMINISTRATION REPORT CRITERI A MET RECIPROCITY LICENSE REPORT MEDIA HANDLING OTHER: l QUEST 10NS FOR INVESTIGATOR OR SUPERVISOR:

1

Appendix B IMPEP ALLEGATION REVIE%IR GUIDANCE NRC REVIEW BY: DATE: A/S OR REGION:

STATE INCIDENT lhG NUMBER OR OTHER FILE IDENTIFICATION:

UCENSEE: UCENSE #

IDCAT10N:

DATEOFISTCONTAC.T : DATE OF ALLEGED EVENT:

DATE OFINVESTIGATION: INVEST 1 GAT 10NTYPE: SITED Pi1ONE D NEXTINSPO NONED ALLEGAllON PERTAINING TO POSSIBLE:

O UNREPORTEDOVEREXPOSURE O FAULTY EQUIPMENT  ;

O UNREPORTED RELEASE OF RAM O FALSE STATEMENTS OR RECORDS l O UNQUAUFIED USERS OR INADEQUATE TRAINING O DEUBERATEVIOLA110N j O INADEQUATE PROCEDURES OR POSTINGS O DISCRIMINATION l

O ODIER* I BRIEF

SUMMARY

OF ALLEGATION RULE OR UCENSE CONDITION ALLEGEDLY VIOLATED:

STATE'S ACTION: _

I FINAL DISPOSITION:

l NO. COMMENTS FOR REPORT l

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I INVEST 1 GATOR SUPERVISORY REVIEW BY: DATE:

FINDINGS DISCUSSED WTUI ON:

i Appmdix B (Centinued) '

11EM O.K. COMMENTS INITIAL RESPONSE ALMGATION HANDLED PROFESSIONAll.Y PROMPTNESS (PRIORITY GIVEN TO SERIOUS ALIEGAT10NS)

APPROPRIATETYPE OF RESPONSE (ON-SI1E.1ELCON, NEXT INSPECTION, ETC.)

DOCUMENTATION OF AMEGAT10N DETAILS OF AUIGA110N (WHAT, WHERE, WHERE, WHO?)

CONFIDENTIALLY OF ALLEGER PRESERVED INVESTIGA110N DEPTH OF INVESTIGAT10N DOCUMENTATION OFINVESTIGATION REPORTS, TElION DOCUMENTAT10N, ETC)

DESCRIITON OF EVIDENCE EXAMINED REGULATORY ACI1ONS(CITATIONS,UCENSE RESTRICTIONS, CORREC11VE REQUIREMENTS)

SUPERVISORY OVERSIGHT OF INVES11GATION ,

FOLLOW THROUGH AND CLOSE OlJT ALLEGER PROVIDED WITH RESUL13 OF INVEST 1GATION INVESTIGA110N ENTERED AND CLOSED OUT IN j STATES TRACKING SYSTEM UCENSEES REPORTS AND CORRECTIVE ACI1ONS l l REVIEWED AND/OR VERIFIED  !

CIDSE-OUT DOCUMENTAT10N COMPLETE WITH DATE AND SIGNATURE SUBSTANT1ATED ALLEGATION REVIEWED AT NEXTINSPECTION l AUEGATION OR INCIDENT REPORTCROSS i- REFERENCED TO UCENSE/COMPLI ANCE FILE l.

MEDIA HANDUNG l INCIDENT REPORTING REQUIREMENTS MET OTHER*

QUESTIONS POR INVESTIGATOR OR SUPERVISOR:

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