ML20214T613
| ML20214T613 | |
| Person / Time | |
|---|---|
| Site: | Crane  |
| Issue date: | 06/04/1987 |
| From: | Collins S NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | Hukill H GENERAL PUBLIC UTILITIES CORP. |
| References | |
| NUDOCS 8706100347 | |
| Download: ML20214T613 (17) | |
Text
f 1
O Y
JUN 4 1587 Docket No. 50-289 GPU Nuclear Corporation ATTN:
Mr. H. D. Hukill Vice President and Director of TMI-1 P. O. Box 480 Middletown, Pennsylvania 17057 Gentlemen:
Enclosed is a copy of the revised NRC Form-398 (Enclosure 1), Personal Qualif-ications Statement - Licensee.
This revision was made to reflect the changes to 10 CFR Part 55 effective May 26, 1987.
This revised form requires new applicants to complate each category completely including all education, training and experience received up to the date of the application.
Renewal, upgrade, multi-unit and reapplication applicants are required to complete each category except they need only to indicate the educa-tion, training and experience received since their last application.
If any applicant indicates that he or she is a graduate of an INPO accredited operator training program AND that an approved simulation facility, i.e.,
(certified on NRC Form 474 or NRC approved), is used in the operator training program, then education, training and experience DOES NOT have to be completed.
New applications must include the number of significant control manipulations under Item 12.3.
Other changes are detailed in Enclosure 2. is a set of instruc-tions for the completion of all items on the NRC Form 398.
All applications for licenses are to be submitted on this revised form begin-ning May 26, 1987.
The enclosed applications are for your use. Additional copies can be obtained by writing to Vivian Miller, U.
S.
Nuclear Regulatory Commission, Document Management Branch, Maii Stop W-548, Washington, D.C. 20555.
t ;l 2' i
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OFFICIAL RECORD COPY OL MULTI LTR - 0039.0.0 05/29/87 0706100347 070604 PDR ADOCK 05000289 V
GPU Nuclear Corporation 2
If you have any questions regarding this form, please contact Robert M. Keller at 215-337-5211.
Sincerely, Origina1 Signed 37.8 Samuel J. Collins, Deputy Director Division of Reactor Projects
Enclosures:
As stated cc w/ enclosures:
W. Thompson, Training Manager Public Document Room (PDR)
Local Public Document Roon (LPDR)
Nuclear Safety Information Center (NSIC)
NRC Resident Inspector Commonwealth of Pennsylvania cc w/o enclosures:
R. J. Toole, Operations and Maintenance Director, TMI-1 C. W. Smyth, Manager, TMI-1 Licensing R. J. McGoey, Manager, PWR Licensing E. L. Blake, Jr., Esquire TMI-1 Hearing Service List bcc w/ enclosures:
OL Plant File Examiners i
1 RI:d5P RI:C.P R.
P 1
Lang /mjd/gcb Ke C
ns b n 87 Ty/"I 6/h/87 0FFICIAL RECORD COPY OL MULTI LTR - 0040.0.0 05/29/87
INSTRUCTIONS FOR COMPLETING NRC FORM 338. PERSON AL QU ALIFICATIONS STATEMENT-LICENSEE NEW APPUCANTS. COMPLETE EACH CATEGORY OF THE FORM COMPLETELY. FOLLOWING THE INSTRUC ALL EDUCATION. TRAINING AND EXPERIENCE THAT YOU HAVE RECEIVED UP TO THE DATE OF THIS APP RENEWAL. UPGRADED, MULTI. UNIT. AND REAPPUCATION APPUCANTS. CCMPLETE EACH CATEGORY OF FORM COMPLETELY. EX INO8CATE ONLY THE EDUCATION. TR AINING, AND EXPERIENCE YOU HAVE RECEIVED SINCE YOUR LAST APPUCATION. NOTE: See ite SPECIFIC INSTRUCTIONS FOR ITEMS 1119 11-EDUCATION; LN01CATE 80TH ACADEYtC AND VOCATIONAL! TECHNICAL POST HIGH SCHOOL EDUCATION FOR MAJOR AREAIS IN0lCATE THE NUMBER 05 YEARS SPENT IN EACH COLLEGE CURRICULUM AND THE HIGHEST DEGREE PROVl0ED. FOR VOCATIONAL / TECHNICAL EDUCATlON. INCLUDE PROGRAMS SUCH AS NUCLEAR POW CON 0lTIONING/ REFRIGERATION. DIESEL MECHANIC SCHOOL. ETC. IN01CATE THE NUMBER OF MONT A CERTIFICATE OR DEGREE W A$ AWARDEO iF ADDITION AL SP ACE IS NEECEO. CONTINUE UNDFA ITEM 17
[
12-TR AINING. 4N THl$ ITEM INotCATE THE TRAINING YOU H AVE RECEIVED TO MEET THE REQUIREME BREAK 00WN OF TRAININGIN THIS CATEGORY P ARALLELS THE ANS STANDAROS PLEASE REFER TO T CLARIFICATION. INCLUDE BOTH BEGINNING AND COMPLETION DATES AND THE TOTAL NUMBER OF W ING. NUMBER OF WEEKS IS PROV10ED. tN A00tTION TO 8EGINNING ANO COMPLETION DATES. TO ACCO S MAY IN.
(FOR EXAMPLE. FOUR WEEKS OF CLASSROOM TRAINfNG SPREAD OVER A TWO MONTH PERICOI. THEREFORE 01CATE A LARGER TIME SPAN THAN THE ACTUAL NUMBER OF WEEKS SPENT IN FULL TIME TR AINING. T l
APPUED FOR CANNOT BE 0008LE COUNTED UNDER EXPERIENCE. ITEM 13.
i ALL RECUAUFICATiON TRAINING TIME IS TO BE ACCOUNTED FOR IN THE REQUAUFICATION ITEM. PLEASE AVO tNG ALL THE TIME SPENT IN REQUAUFICATION TR AINING UNDER ITEM 12.6. RECU ALIFICATICN. EVEN THOUG i
]
t OR SIMULATOR TIME.
13-EXPERIENCE: FOR EACH POSITION HELO. COMPLETE ITEM 16. 00 NOT DOUBLE COUNT TIME. IF YOU HAD OVE MONTHS SHOULO RECLECT THE PROPORTIONATE AMOUNT OF TIME YOU WERE ASSIGNED TO THOSE PARTICUL THE NUMBER OF MONTHS REPORTED FOR A PARTICULAR TIME PERIOD EXCEED THE NUMBER OF MONTHS THAT A 14-FAC1UTY OPERATOR TRAINING PROGR AM. iNOiCATE e GRAOUATE OF INPO ACCREOfTED OPERATOR TRAINING PROGR AM; AND b.CER.
TIFiED (ON NRC FORM e7e1 OR NRC APPROVED SIMULATION SACtWTY IS USED IN THE OPER ATOR TRAINING PROGR A j
IN BOTH ITEMS e AND b. THEN ITEMS 11. EDUCATION.12. TRAINING.13. EXPERIENCF ANO 16 rupsaigrer (WAILS rso NOT H AVE TO SE COMPLE E0; D:Ut nr. WJCAi!Cn3 K.5T IT!a Igun Tnt vetR OF tlG4tFICANT CONTRfit PA't!PULAi!0NS UNutil If t912.L NOTE: INPO ACCREDITED MEANS ACCRE0tTATION SY THE NATIONAL NUCLEAR ACCRE0lTING BOARD.
15-FOR RENEWALS ONLY: ENTER THE APPROXIMATE NUMBER OF HOURS SINCE PREVIOUS RENEWAL OR ISSUANCE OF UCEN R ENEWAL.
16-EXPERIENCE DETAILS: INCLUDE POSITION TITLE. TIME PERIOO FROM/TOLFACluTY AND A BRIEF DESCRIPflCN OF OUTIES PERFCR WHILE SERVING IN THAT POSITION. 4F MORE SPACE IS NEEDEO USE ITEM 17, OR IF NECESSARY ATTACH AOOITIONAL INFORMATION.
I 17-COMMENTS: USE THIS SP ACE TO INCLUDE ANY EXTR A INFORMATiON OR CLARIFICAT10N FOR OTHER ITEMS ON THE APPUCAT!O l
iF THE SPACE PROVICEO IS NOT SUFFIC;ENT, YOU MAY ATTACH EXTR A INFORM ATION WlTH YOUR APPUCATION.
18-NRC FORM 396. CERTIFICATION OF ME01 CAL EXAMINATION BY FACIUTY UCENSEE. MUST ACCOMPANY THIS APPUCATION.
i 19-SIGN ATURES: SIGN AND OATE ITEM 19e 08TAIN YOUR TRAINING COOR0lNATOR'S SIGNATURE AND THAT OF YOUR SENIOR MAN AGE.
MENT REPRESENTATIVE ON SITE.
OETACH THESE INSTRUCTIONS AND SUBMIT THE COMPLETED NRC FORMS 338. IN TRIPUCATE (ong. net and two cooes> ANO 396 TO THE APPROPRIATd REGIONAL ADMINISTR ATOR.
PRIVACY ACT STATEMENT Pursuant to U.S.C. 552eieH31. enacted ento law by Section 3 of the Pnvecy Act of 1974 (Public Law $3-571f. the fostowing is furnished to en-dividuele who evoody enformation to the U.S. Nucteer Requietory Commession on NRC Form 358. This information is memtemed in a system of records designated as NRC 16 and deocnbod at e6 Federal Register e6717 ISeptember 21, 19811.
1 AUTHORtTY. Section 107 and 161(l) of the Atomic Energy Act of 1964. es einended 142 U.S.C. 2137 and 2201 till.
- 2. PRINCIPAL PURPOSES. The informenon will be collected and evelveted for determenmg licenomg esegeb. hey and to generete statistical date l
and reports on licensmg actions.
I 3 ROUTINE USES. Information entered on thee form may be used to: les determme if the mdividuet meets the roouirements of 10 CFR Part 55 to be issued en operefor e license: (bl provide researcher, with information for statistical evolustione rotated to selection. training and
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eneminetton of f ecstety operatore: Ici provide f actitty management with sufficient informetson to enroit the individuele in the licensed oPeretor requalification progrem: (dl provide for esaminetton and testmg metenal and obtain results from contractors.
4 WHETHER OlSCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INOlvlDUAL OF NOT PfilOVIDtNG INFORMAflON: Disclosure J
I is vo6untary. However, if the information roovested is not provided. NRC well not be oboe to evoluete whether the epohcotion meets the requirements of 10 CFR Part 55.
5 SYSTEMS MANAGERS AND ADORESSES Reg onal Admsnestrator. Regeon i Regional Admwustrator. Peg.on 11 U S. Nucleet Requietory Commess.on U.S. Nucteer Regulatory CommSsson 631 Part Avenue 101 Morette Street. Suete 2300 (snq of Prussee PA 19406 Attente. GA Ytm Reg onal Admsarstrator. Req.on 111 Regiones Admnstrator. Region IV Reg.onal Admin.strator. Re9on v U S. Nucteer Requietary Commoon U.S. Nucieer Regutatory Common U S Nucteer Aequ story Com**on e
?M Rooseveat Road 611 Reen PLese Ornre. Su.ie 1000 1e50 More Lane. Su.te 210 l
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ENCLOSURE 2 l
SUMMARY
OF CHANGES TO NRC FORM 398 a
Moved "New" to below " Hot" and " Cold". '
Item 4.a Combined " Oral" an'd " Simulator" into " Operating". -
Item 4.f Deleted " Instructor Certification".
Item 5.d Added a new item " Facility Operator Training. -
Item 14 Program" and incorporated under this item the INPO accreditation block (originally under Training);
added a block for NRC approved or NRC Form 474 certified simulation facility.
Added a new item "For Renewals Only, Hours Operated Item 15 Facility". (This was originally under Experience).
Renumbered previous items 14 through 17 to 16 Items 16 through 19 through 19.
Changed to read "NRC Form 396, Certification of Item 18 Medical Examination by Facility Licensee is attached" to indicate that in order for the application to be complete the NRC Fom must be attached.
Any false statement or omissions in this document, Statement Added including attachments, may be subject to civil and criminal sanctions.
Changed the wording to read "... certify under Item 19.a penalty of perjury that the infomation in this document and attachments is true and correct.
I also..."
Changed the wording to read "... has Item 19.b successfully completed the facility licensee's requirements to be licensed as an Operator / Senior Operator pursuant..." Also added the wording "I also certify under penalty of perjury that the information in this document and attachments is true and correct." Changed signature block from
" Highest Level Of Corporate Management for Plant Operation" to " Senior Management Representative On Site."
Added the wording "I also certify under penalty Item 19.c of perjury that the information in this document ami attachments is true and correct. Changed signa':ure block from " Highest Level of Corporate Management for Plant Operation" to " Senior Management Representative On Site."
Under waiver category combined " Oral" and FOR NRC USE
" Simulator" into " Operating".
[
ENCLOSURE 3 l
1 v
l i
PERSONAL QUALIFICATIONS STATEMENT - LICENSEE
~
i NRC FORM 398 (REV 4/87)
NEW APPLICANTS ARE TO COMPLETE EACH ITEM OF THE NRC FORM 398 COMPLETELY, FOLLOWING INSTRUCTIONS BELOW.
THIS IS TO INCLUDE ALL EDUCATION, TRAINING, AND EXPERIENCE THAT APPLICANT HAS RECEIVED UP TO THE DATE OF THIS APPLICATION (NOTE EXCEPTION:
SEE ITEM 14).
RENEWAL, UPGRADE, MULTI-UNIT AND REAPPLICATION APPLICANTS ARE TO COMPLETE EACH ITEM OF THE NRC FORM 398 EXCEPT INDICATE ONLY THE EDUCATION, TRAINING, AND EXPERIENCE RECEIVED SINCE LAST APPLICATION (NOTE EXCEPTION: SEE ITEM 14).
A SEPARATE NRC FORM 398 FORM MUST BE SUBMITTED EACH TIME AN APPLICANT APPLIES FOR A LICENSE OR RENEWAL OF LICENSE.
FULL HAME AND CURRENT ADDRESS.
r ITEM 1 CITIZENSHIP.
If other than U.
S.
- Citizen, ITEM 2 citizenship must be specified.
DATE OF BIRTH.
ITEM 3 ITEM 4 TYPE OF APPLICATION.
i "X"
appilcable boxes:
1-Hot
- Applying for a license at
-a plant that has achieved initial criticality.
This should be completed for each application.
2-Cold
- Applying for a license at a plant that has not achieved initial criticality. This should be completed for each appilcation.
e.
New
- Applying for the first time at this facility OR If previously applied for a license but withdrew (write in "previously withdrew" next to New).
ALL ITEMS MUST BE COMPLETED ON A NEW APPLICATION AND SHOULD INCLUDE ALL EDUCATION, TR AINING AND E)'PERIENCE RECEIVED UP TO THE DATE OF THIS APPLICATION.
l THERE IS AN EXCEPTION TO THIS - SEE ITEM 14.
l
I ;
b.
Renewal
- Now holds a license and is renewing that same type of license.
ALL ITEMS MUST BE COMPLETED ON A RENEWAL APPLICATION BUT NEED ONLY INCLUDE THE EDUCATION, TRAINING AND EXPERIENCE RECEIVED SINCE THE LAST APPLICATION.
THERE IS AN EXCEPTION TO THIS - SEE ITEM 14.
- c. Upgrade
- Now holds an operator's license and is applying for a senior operator's license.
ALL ITEMS MUST BE COMPLETED ON AN UPGRADE APPLICATION BUT NEED ONLY INCLUDE THE EDUCATION, TRAINING AND EXPERIENCE APPLICANT RECEIVED SINCE LAST APPLICATION.
THERE IS AN EXCEPTION TO THIS -
SEE ITEM 14.
d.
Multi-unit
- Applying for a license on more than one Unit OR is a licensed operator on one unit and is applying to extend license to additional units.
(Notes all facility docket numbers are to be listed under Items 8 and 9).
ALL ITEMS MUST BE COMPLETED ON A MULTI-UNIT APPLICATION BUT NEED ONLY INCLUDE THE EDUCATION, TRAINING AND EXPERIENCE RECEIVED SINCE LAST APPLICATION.
THERE IS AN EXCEPTION TO THIS -
SEE ITEM 14.
e.
Reapp11 cation
- Previously took a licensing exam and was denied a license and is now reapplying for that same type of Ilconse at the same facility.
The reappilcation should identify those areas in which the appilcant demonstrated weaknesses during the previous examination and the additional training received to correct these specific deficiencies in Item 12.7 and/or Item 17.
ALL ITEMS MUST BE COMPLETED ON A REAPPLICATION APPLICATION BUT NEED ONLY INCLUDE THE EDUCATION, TRAINING AND EXPERIENCE RECEIVED SINCE LAST APPLICATION.
THERE IS AN EXCEPTION TO THIS - SEE ITEM 14.
I.
If denied a license for the 1-First first time, the applicant must wait two months from the date of denial letter before reapplying for a license.
If denied a license for 2-Second the second time, the applicant must wait six months from the date of denial letter before reapplying for a license.
If denied a license for 3-Third the third time, the appilcant must wait two years from the date of denial letter before reapplying for a license,
- f. Walver Request
- NOTE:
Justification for any walver request is required under Item 17.
1-Written
- To request a waiver on entire written exam or on part of the written exam.
(Category (s) for which waiver requested should be specified in space provided.)
2-Operating
- To request a waiver on en operating exam.
3-Eligibility
- To request a waiver on eligibility requirements.
4-Other
- To request any other waiver, i.e.,
medical.
TYPE OF LICENSE APPLIED FOR ITEM 5 s.
Operator
- Applying for en operator license.
b.
Senior Operator
- Applying for a senior operator license.
- c. Limited SRO
- Applying for a limited senior operator license (e.g. fuel handler).
PREVIOUS LICENSE (S) HELD ITEM 6
- To be completed if previously held a license (or Instructor i
certificate).
a.
Docket Number
- Docket number assigned for previous license (s) held (55-XXXXX).
Indicate if this license was for RO or SRO.
If this was for
- - = - - -
Instructor Cortificatien or Llaltod Senior Operator, please write in.
If a denial letter was issued, a docket number was assigned and should be Indicated in this block.
- b. License Number
- License number (s) previously held.
License number should include the present renewal number, if any, (i.e., XXXXX-3).
Date of Ilcense expiration.
- c. Expiration Date If seversi renewals have occurred, list only latest expiration date.
- d. Facility Docket No.
- Docket number of facility where applicant held license (50-XXX).
Note If previously held license / instructor certification at a training center, simulator, etc.,
where there is no facility docket number, write in the name.
NAME OF APPLICANT'S EMPLOYER ITEM 7 Name and address of current employer.
NAME OF APPLICANT'S FACILITY ITEM 8 Name and docket number (50-XXX) of facility where applying for a license.
ITEM 9 ADDITIONAL FACILITY DOCKETS If applying for multi-unit Ilconse ALL appilcable additional docket numbers must be entered.
CURRENT POSITION AT FACILITY ITEM 10 Note license type 11 required a.
Plant Superintendent by position.
b.
Assistant Plant Superintendent Note license type 11 required by position.
Position requires current
- c. Shift Supervisor senior license for a plant with fuel in the reactor, Note license type 11 required d.
Staff Engineer by position.
- e. Shift Technical Advisor / Shift Engineer-Note license type if required by position.
Note license typs if required f.
Instre: tor by position.
F f
3 Senior Control Room Operator
- Position requires current senior l
license for a plant with fuel in the j
reactor.
i
- h. Control Room Operator - Posit'lon requires current operator license for a plant with fuel in reactor.
1
- 1. Auxillery Unit Operator / Trainee /
Turbine Building /
Equipment Operator i
(non-licensed operator)- Ensure description is detailed enough to allow evaluation of position.
J. Other (Specify)
- Ensure description is detailed enough to allow evolustion of position.
Note license type if required by position.
f EDUCATION l
ITEM 11 s.
High School Graduate
- Graduated from high school.
GED Equivalency
- Received GED equivalency.
No
- Did not complete high school.
l
- b. Number of Years of College
- Number of years of college i
successfully completed.
l (Freshmen = 0 to 1 year Sophomore = 1 to 2 years Juniors 2 to 3 years l
Seniors 3 to 4 years Graduates 4 years or more)
- c. Major Aree(s) of Study-i Engineering
- Fleid of engineering mejored Inl number of years, andl highest degree obtelned.
O tlie r
- Other fleid mejored ins number of years, ands highest degree obtelned.
- d. Vocational / Technical Type of Training-Vor.ational/ technical training schools, including allitary schools, i
applicable to the operetlen of a l
pcwor plant.
Includo such
~
programs as nuclear power school, air conditioning / refrigeration school, diesel mechanic school, instrumentation and control maintenance, etc.
Number of Months-Calculate the approximate number of full months appilcant received actual training.
(4 weeks, 8 hours9.259259e-5 days <br />0.00222 hours <br />1.322751e-5 weeks <br />3.044e-6 months <br /> / day = 1 month)
Certificate Indicate if certificate was Received received for this training.
TRAINING
- Training is Indicated in weeks ITEM 12 based upon 40 hours4.62963e-4 days <br />0.0111 hours <br />6.613757e-5 weeks <br />1.522e-5 months <br /> per week.
Indicate training received to meet the requirements of ANSI N18.1/ANS3.1.
The breakdown below parallels the ANS standards.
Beginning and completion dates and the total number of weeks spent in each type of training must be included.
The number of weeks is provided to account for Intermittent training (for example, four weeks of classroom training spread over a two month period).
Therefore, the date column may Indicate a larger time span than the actual number of weeks spent in full-time training.
Time in training for the license applied for cannot be double counted under Experience, Item 13.
REQUALIFICATION training time is be accounted for in Item 12.6.
1-Nuclear Power Fundamentals (Classroom)
- Fundamental course that covers the theory of the nuclear fission process and reactor operations.
2-Plant Systems
- Systems Instruction to include both observation and classroom work.
This Instruction is plant specific.
Classroom
- Instruction covering nuclear power plant systems and system and component malfunctions.
Observation
- Planned systematic observation training on access'Ible plant equipment.
F,
3-Oporating Practico
- Trotning in cporating practicos in the control room for which the candidate ulll license and at a plant
=
referenced simulator if one is evallable.
Control Room Operations
- Observation of the operating practices and the operation of nuclear power plant from the central control room.
Not Ilconse candidates must manipulate the controls under direct supervision of a licensed operator at the Individual's duty station for a verlety of plant operations.
Cold license candidates are to participate in the plant preoperational testing program.
Actual time assigned to the operating shift should be counted in 12.5 below.
Simulator Operations (Includes Classroom)
- Practice in manipulating plant controls during normal, abnormal and emergency conditions on a plant referenced simulator.
Simulator Name(s)
- Specify the simulator (s) where training was received.
If more than two simuistors specify the two most recent only.
Startup Certification "X"
Yes or No.
(Notes For Completed facilities with plant referenced simuistors, certification of startup training will be provided by the facility organization.
For those facilities without a plant referenced simulator, startup certification must be obtained from the organization at which the startup demonstration was performed.)
1 Humber of Reactivity Manipulations
- Number of actual reactivity manipulations in which the appilcant was involved broken down by plant and simulator.
(Details should be provided in Comments, Item 17.)
4-SRO Instruction
- Instruction in the duties of a senior operator.
-B-5-Extra Person on Shift - Must be a alnimum of three months on shift performing the actual duties of the alconsed position applied for.
These duties are performed under the direct supervision of Ilconsed personnel on normal shift rotation.
This should be in a structured, documented program.
'I Do not double count this time In 12.3 or as operating experience.
6-Requalification
- ALL requallfleetions training, including classroom and simulator time.
7-Other (Specit3'
- Ensure description is detailed enough to allow evaluation.
Include number of research reactor startups, if performed.
l EXPERIENCE
- Experience is indicated in months.
ITEM 13 For each position held, list the month / year to cover the period you were quellfled for that position.
The number of months must reflect the time spent actually exercising the respon-sibilities of that position.
Item 16 should be completed for j
each position held.
DO NOT i
DOUBLE COUNT TIME.
If there 1
were overlapping duties, the number of months should reflect the proportionate 5
i amount of time assigned to those particular duties.
In j
no case should the number of l
months reported for a particular I
time period exceed the number of j
months that are in that time period.
Also, do not count time in training.
Military nuclear power experience should be listed in 1-5.
NAVY Non-nuclear allitary power experience should be listed under Fossil 6-9.
i Quellfled to operate the controls of a 1-RO l
Navy Propulsion or training reactor.
Authorized to supervise the operation of 2-E00W/PPWO Navy Propulsion plants.
j i
a) Graduate of INPO Accredited Operator Training Program "X" Yes or No 11 the applicant is a graduate of an INPO accredited operator training program.
(NOTE:
INPO accredited means accreditation by the National Nuclear Accrediting Board.)
b) Certified on NRC Form 474 (Simulation Facility Certification) or NRC Approved Simulation Facility is Used in the Operator Training Program "X" Yes or No if, in the operator training program, a certified on NRC Form 474 or NRC approved simulation facility is used.
ITEM 15 -
FOR RENEWALS ONLY - NOURS OPERATED FACILITY:
- The approximate number of hours appilcant has operated the facility under his existing Ilconse.
ITEM 16
- EXPERIENCE DETAILS Include position title, time period (from/to), and description of duties performed while serving in that position.
Item 17 should be used if more space is needed.
ITEM 17
- COMMENTS
- This space should be used to complete Information from previous items or clarification for other items on the application form.
If space provided is not sufficient, extra pages may be attached to l
appilcation.
ITEM 18
- NRC FORM 396, CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE
- Any appilcation for a license j
or renewal of Ilconse is not complete without NRC Form 396.
A medical is good for six months from the date the physician signs It.
For applications following a
)
voluntary withdrawal or license denial or en upgrade application, univers may be granted on a case basis if the original medical i
evaluation was performed within one year.
If walver is requested, Item 4.1.4 should be marked.
-9 Quellfled to direct and supervise the 3-EWS/PPWS operations of a Navy Propulsion plant.
4-ERS/CRW Quellfled to d3 rect and supervise Navy Propulsion plant operations outside the maneuvering area.
j 5-0THER (Specify)
Ensure description is detailed enough to allow evaluation.
FOSSIL 6-Operator Navy or commercial non-nuclear propulsion / power plant operation.
7-Supervisor Authorized to direct and supervise non-nuclear operators.
8-Plant Staff Non-nuclear power plant staff experience.
9-Other (Specify)
Ensure description is detailed enough to allow evaluation.
COMMERCIAL NUCLEAR (Including Research/ Test Reactor) 10-Reactor Operator (Licensed)
Must hold or have held valid NRC operator license.
l 11-Senior Operator (Licensed)
Must hold or have held valid NRC senior operator license.
12-Shift Supervisor (Licensed)
Must hold or have held valid NRC senior operator license.
4 13-Staff / Shift Engineer (Licensed)
Must be at the facility and involved in the day-to-day plant operational (engineering) staff work.
14-Aux./ Equip. (Nonlicensed)
Operator Personnel used in direct support of plant operations as directed by licensed operators.
i 15-Plant Staff Staff work other than that directly associated with plant operations.
j 16-Other (Specify)
Ensure description is detailed q
enough to allow evaluation.
4 i
ITEM 14 FACILITY OPERATOR TRAINING PROGRAM If "Yes" is checked in BOTH a) and b) then Items 11 (Education),
12 (Training), 13 (Experience), and 16 (Experience Details) DO NOT have to be completodi except new applications must still include the number cf significant control manipulations under Item 12.3.
11 -
ITEM 19
- SIGNATURES REQUIRED Any falso statement or ommission in this document, including attachments, cay be subject to civil and criminal sanctions.
- c. Date and signature of appilcant certifying under penalty of perjury that the information provided on NRC Form 398 is true and correct.
Appilcant's signature also authorizes the NRC to submit results of examinations to appilcant's employer.
b.
Date and signature of Training Coordinator AND Senior Management Representative on Site certifying, under penalty of perjury, that applicant has successfully completed the facility licensee's requirements to be licensed as an Operator / Senior Operator pursuant to 10CFR551 and that the applicant has a need for this license to perform assigned duties.
Also certifies that facility ul11 be available for examinations.
- c. RENEWAL ONLY - Must be signed and dated by Training Coordinator AND Senior Management Representative On Site certifying, under penalty of perjury, that appilcant meets the approved requalification program (with any exception noted in Comments, Item 17) as required by section 50.54(I-1) cf 10CFR50 and has discharged licensed responsibilities competently and safely.
i l