ML20247J505
| ML20247J505 | |
| Person / Time | |
|---|---|
| Issue date: | 10/26/2020 |
| From: | Kathy Modes, Stephen Poy, Roldon L NRC/NMSS/DMSST |
| To: | |
| MODES K/NMSS/MSST | |
| References | |
| Download: ML20247J505 (1) | |
Text
ALLEGATION CASEWORK REVIEW
SUMMARY
SHEET The completed summary sheet cannot include any information on the identity of the concerned individual (aka the alleger), personally identifiable information (PII), Privacy Act information, or other sensitive information. The reviewer cannot photocopy any information from the allegation file. Documentation needed for the IMPEP report should be retained on the summary sheet.
A/S or NRC Office: Reviewer: Date:
Allegation Number or Other File Identification: _________________________________
Licensee Name: __________________________________ License No.: ____________
Date of Alleged Event ________ Date of 1st Contact ________ Date of Investigation Investigation Type Site Phone Next Insp. None Allegation Pertaining to Possible Unreported Overexposure Faulty Equipment Unreported Release of RAM False Statement or Records Unqualified Users or Inadequate Training Deliberate Violation Inadequate Procedures or Postings Discrimination Other Brief Summary of Allegation Rule or License Condition Allegedly Violated State/NRCs Action(s) and Respective Date(s)
Final Disposition and Date of Completion No Comments Inspector/Investigator ________________________________________ _______________
Supervisory Review by: Date Findings Discussed with: Date