ML21007A214

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Louisiana Response to Impep Questionnaire
ML21007A214
Person / Time
Issue date: 01/05/2021
From: Kathy Modes
NRC/NMSS/DMSST
To:
Modes K
References
Download: ML21007A214 (22)


Text

Approved by OMB1 Control No.:

3150-0183 Expires:

02/28/2023 INTEGRATED MATERIALS PERFORMANCE EVALUATION PROGRAM QUESTIONNAIRE Reporting Period: April 2016-January 2021 Note: If there has been no change in the response to a specific question since the last IMPEP questionnaire, the State or Region may copy the previous answer, if appropriate.

A.

GENERAL

1.

Please prepare a summary of the status of the State's or Region's actions taken in response to each of the open recommendations from previous IMPEP reviews.

2016 IMPEP Recommendation: The review team recommends that the Division perform an evaluation to determine the causes for the low staff retention rate and implement corrective actions to mitigate the causes.

During the periodic review, we addressed this recommendation. We conducted interviews and evaluated the statewide salary structure in consultation with human resources to determine the causes for the low staff retention rate. Although we did not produce a written report of their evaluation; ultimately, we reported that the main cause for the low staff retention rate was the staff was overworked and underpaid. We are working to mitigate both aspects of the main cause by trying to increase salaries and reduce workload. The review of the statewide salary structure indicated that we had not taken advantage of the current salary structure such that it benefitted our technical staff. As a result, our staff received a pay raises in January 2018, July 2018, July 2019 and July 2020. We also modified the career ladder by creating two Environmental Scientist 4 (ES-4) positions. Previously, the highest Environmental Scientist position was an ES-3. Two ES-3 staff members were promoted into ES-4 positions. We believe this provides more opportunities for staff to advance and receive higher salaries.

We have decreased workload by reducing the number of internal metrics applied to the licensing and inspection programs. Also, we continued offering workplace flexibilities like telecommuting/work-at-home for one or two days a week to help alleviate the stress of traveling to work every day and allowing staff to focus on the work products without the distractions of the workplace, as well as, helping us attract and retain staff.

Since the periodic review, we have continued to look for ways to reduce unnecessary workload.

Checklists, in place of narratives, have been implemented for several types of inspections. These checklists reduce the time spent on post-inspection workload. Also, peer reviews of licenses and inspections have been eliminated and replaced with manager review, which tremendously cut down on workload. We also funded and filled a Senior Staff Scientist position, which will ensure there is an opportunity for continued advancement for Technical Staff in the future.

2016 IMPEP Recommendation: The review team recommends that the Division implement a procedure that addresses at a minimum, the means for controlling access to documents that contain sensitive information, within the limits of Louisiana regulations.

To address the recommendation, we initially blocke everyones access to license fill except for a few qualified licensing staff immediately after the 2016 IMPEP. Subsequently, the online access to all of the licensing files are blocked. After further discussions with records management and legal staff, access to non-sensitive licensing information was restored to additional Radiation staff. The licensing staff was working with the Departments records management staff to develop a procedure to better control and monitor access to licensee information. Access will be granted to members of the public, as allowed by law, with specific limitations and controls, which includes detailed contact information about the requester.

Sensitive information is not released. Radiation management staff monitors what is released.

Since the periodic review, no Radiation Records are accessible to the public or non-radiation LDEQ employees. The Emergency & Radiological Services Division Administrator, in conjunction with the Agency Records Management Director, maintains a list of approved Agency Staff that have a need for Radiation records access. This list is periodically reviewed for accuracy and modified for permissions as appropriate. The Manager or Licensing Supervisor manages all radiation public records requests. Each record is reviewed and sensitive information, such has inventory, site radioactive materials map, etc. is redacted from the files. For Physical Protection of Category 1 and Category 2 Quantities of Radioactive Material (PPQRM) files, we have created an

electronic filing system called On-Base. On-Base is not available to the public or non-radiation employees within Louisiana Department of Environmental Quality (LDEQ) and therefore cannot have a public records request.

2016 IMPEP Recommendation: The review team recommends that the Division develops and implements a comprehensive incident and allegation procedure, provides incident and allegations training to the staff, and ensures adequate management supervision in the incident and allegation program.

During the periodic review, to address the recommendation, a senior staff scientist reviewed and updated the standard operating procedures (SOPs) for complaints, allegations, and incidents (CAIs). Training was provided to all staff on the SOPs and the expectations for responding to CAIs. In general, when a CAI comes in, it is reviewed for significance by a supervisor, manager, or staff scientist and then dispatched or assigned to an inspector for follow-up and investigation, as appropriate. Once the inspector has completed the investigation, a report is generated and reviewed by our supervisors and management, as well as, the senior staff scientist responsible for closing out the event in NMED. To ensure adequate management oversight of CAIs, ongoing investigations are routinely discussed during inspector huddles to ensure that any issues identified during an investigation are communicated to management, supervisors, and senior staff scientists in a timely manner.

Since the periodic review, the SOP for CAIs has been revised on November 6, 2019, and every two years after, to make it easier for staff to receive and respond to CAIs. Training has been given and continues to be given to staff on updated SOPs. An Online reporting form has been created for anyone that receives a CAIs. Once the on-line form is completed, it is automatically sent to Senior Staff, Manager, Licensing Supervisor, Inspections Supervisor, and LDEQs Single Point of Contact. Senior Staff and Manager review for NRC reporting requirements and Supervisors assign to inspector for investigation.

B.

COMMON PERFORMANCE INDICATORS I.

Technical Staffing and Training

2.

Please provide the following organization charts, including names and positions:

(a)

A chart showing positions from the Governor down to the Radiation Control Program Director; (b)

A chart showing positions of the radiation control program, including management; and (c)

Equivalent charts for sealed source and device evaluation, low-level radioactive waste and uranium recovery programs, if applicable.

See attached organization charts.

Our SSD writers are Jim Pate, Gilberto Cuadra, and Ziad Fahd.

1.)

Jim Pate - can write and review sources and devices.

2.)

Gilberto - he has not been signed off for SSDs. His work is reviewed by Jim Pate and Ziad Fahd.

3.)

Ziad Fahd - he can write and review sources and devices.

3.

Please provide a staffing plan, or complete a listing using the suggested format below, of the professional (technical) full-time equivalents (FTE) applied to the radioactive materials program by individual. Include the name, position, and, for Agreement States, the fraction of time spent in the following areas: administration, materials licensing &

compliance, emergency response, low-level radioactive waste, uranium recovery, other.

If these regulatory responsibilities are divided between offices, the table should be consolidated to include all personnel contributing to the radioactive materials program.

If consultants were used to carry out the program's radioactive materials responsibilities, include their efforts. The table heading should be:

Name Position Area of Effort FTE%

Adminstration:

Jeff Dauzat Administrator 100%

Administration Karen Burgard Manager 75% Admin,20%

Compl, 5% REPR Judy Schuerman Environmental Scientist Senior Regulation Development, Special Projects 80% Regs, 15%

Special Projects, 5% REPR James Pate Environmental Scientist Staff 50%Compl, 20%

Admin, 25%

Hazwpr, 5% REPR Ashley Menard Environmental Scientist Staff 70%Compl,20%

MQSA, 5%Admin, 5% REPR Richard Scott Blackwell Supervisor Licensing &

Registrations, Surveillance, LLW 40% Admin, 20%

Lic & Reg, 20%

Compl, 10% MQSA, 5% REPR, 5% LLW Dwayne Stepter Supervisor Surveillance 50% Compl, 45%

Admin, 5% REPR Licensing &

Registration:

Tiffany White Environmental Scientist 4 Licensing &

Registrations 95% Lic & Reg, 5%

REPR Melanie Bauder Environmental Scientist 3 Licensing &

Registrations 95% Lic & Reg, 5%

REPR Gilberto Cuadra Environmental Scientist 3 Licensing &

Registrations 95% Lic & Reg, 5%

REPR Ziad Fahd Environmental Scientist 3 Licensing &

Registrations 95% Lic & Reg, 5%

REPR Macy Blanchard Environmental Scientist 3 Licensing &

Registrations 95% Lic & Reg, 5%

REPR Surveillance:

Jennifer Elee Environmental Scientist 4 Surveillance 75% Compl, 20%

MQSA, 5% REPR Paula Lang Environmental Scientist 3 Surveillance 95% Compl, 5%

REPR John Fontenot Environmental Scientist 3 Surveillance 95% Compl, 5%

REPR Russell Clark Environmental Scientist 3 Surveillance 95% Compl, 5%

REPR Angela Jackson Environmental Scientist 3 Surveillance 95% Compl, 5%

REPR Clayton Smith Environmental Scientist 2 Surveillance X-ray 95% Compl, 5%

REPR Sal Ange Environmental Scientist 3 Surveillance 90% X-ray, 10%

RAM (NGauges) 95% Compl, 5%

REPR Jonathan Crain Environmental Scientist 1 Surveillance 95% Compl, 5%

REPR Hannah Jones Environmental Scientist 1 Surveillance X-ray 95% Compl, 5%

REPR Sarah Trahan Environmental Scientist 1 Surveillance X-ray 95% Compl, 5%

REPR Enforcement:

Kelly ONeal Environmental Scientist 3 Enforcement 95% Enforcement, 5% REPR Emergency Planning &

Response (REPR):

Jerry Lang Manager 25% Admin, 40%

ER, 15% REPR, 15% CAPP, 5%

SPOC Brad Schexnayder Supervisor REPR 50% REPR, 25%

CAPP, 25% SPOC

Jessica Walker ES3 REPR 100% REPR Cliff Acosta ES3 REPR 100% REPR Jamie Dismukes ES3 REPR 100% REPR 1Estimated burden per response to comply with this voluntary collection request: 53 hours6.134259e-4 days <br />0.0147 hours <br />8.763227e-5 weeks <br />2.01665e-5 months <br />. Forward comments regarding burden estimate to the Records Management Branch (T-5 F52), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, and to the Paperwork Reduction Project (3150-0183), Office of Management and Budget, Washington, DC 20503. If an information collection does not display a currently valid OMB control number, NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

4.

Please provide a listing of all new professional personnel hired into your radioactive materials program since the last review, indicate the date of hire; the degree(s) they received, if applicable; additional training; and years of experience in health physics or other disciplines, as appropriate.

New Personnel Date of Hire Degrees, addl training, years experience in health physics or other disciplines Jeff Dauzat Hired on with DEQ-5/30/1989, ERSD Administrator-10/23/2017 B.S. in Wildlife Conservation, M.S. in Industrial Hygiene Sal Ange January 14, 2019 B.S. in Animal Science, FEMA Incident Command Courses 100, 200, 700, 800, 40-HR HAZWOPER, NRC Courses: Inspection Procedures, Indus Radiography H-305, Intro to Health Physics H-117S, Fund HP H-122S, Nuclear Medicine H-304 Macy Blanchard February 11, 2019 BS in Natural Resource Ecology & Management, FEMA Incident Command Courses 100, 200, 700, 800, 40-HR HAZWOPER, NRC Courses: Licensing Procedures, Intro to HP, Nuclear Medicine H-304, Internal Dos H-312, Jonathan Crain June 6, 2016 BS in Biology, FEMA Incident Command Courses 100, 200, 300, 400, 700, 800, 40-HR HAZWOPER & Refreshers, RERO, NRC Courses:

Inspection Procedures, Licensing Procedures, Root Cause, Environmental Monitoring, Intro to HP, Air Sampling, MARSSIM H-121, 80-Hr Fund HP I&II H-122, Advanced HP H-201, Nuclear Medicine H-304, Indus Radiography H-305, Transp of RAM H-308, Brachyth/Gamma H-313, Well Logging H-314, Materials Control S-201, Angela Jackson September 12, 2016 B.S. in Biology, FEMA Incident Command Courses 100, 200, 300, 400, 700, 800, 40-HR HAZWOPER & Refreshers, RERO, NRC Courses:

Inspection Procedures, Licensing Procedures, Root Cause, Environmental Monitoring, Intro to HP, Nuclear Medicine H-304, Indus Radiography H-305, Transp of RAM H-308, Brachyth/Gamma H-313, Well Logging H-314, Materials Control S-201,,

Hannah Jones November 4, 2019 B.S. in Biological Sciences

- Radiological Accident Assessment Concepts (RAAC) Course, HazMat 40-hr, FEMA 100, 200, 700, 800, 300, NRC Courses: H-117 Intro to Health Physics, DEQ X-Ray Inspection Training Elizabeth Levy July 2, 2018 Moved to remediation in July 2020 B.S. in Earth and Environmental Sciences, dual focus in Coastal Studies and Geology, MSc Graduate Certificate in Geology and Applied Depositional Basin Analysis, Trained independent user and researcher at the LSU Synchrotron facility (Center for Advanced Microstructures and Devices).

Published an x-ray technique using the Synchrotron, a spectrometer, and a partial least squared regression to quantify Fe 2+/3+ ratios in minerals. FEMA Incident Command Courses 100, 200, 700, 800, 40-HR HAZWOPER & Refreshers, RERO, NRC Courses:

Inspection Procedures, Root Cause, Intro to HP, Nuclear Medicine H-304, Indus Radiography H-305, Well Logging H-314 Clayton Smith August 12, 2019 B. S. in Physics, FEMA Incident Command Courses 100, 200, 300, 400, 700, 800, 40-HR HazMat Technician, Radiological Emergency Preparedness Program and Planning, Radiological Accident Assessment Concepts, Radiological Emergency Response Operations, Ludlum Measurements Calibration and Repair of Instruments, DOE TEPP Modular Emergency Response Radiological Transportation Training-Train the Trainer, DOE TEPP Radiation Specialist, Domestic Nuclear Detection Office

Quick Start-Train the Trainer, Introduction to Radiographic Imaging &

Radiologic Physics (MQSA), Fundamentals of MQSA Inspections, NRC Courses: Inspection Procedures G-108, Introductory Health Physics H-117, Fundamental Health Physics H-122S, Diagnostic and Therapeutic Nuclear Medicine (H-304),

Transportation of Radioactive Materials H-308S, Internal Dosimetry H-312S Charles Strawn August 27, 2016 Resigned November 2020 B.S. in Biology with a concentration in natural science, FEMA Incident Command Courses 100, 200, 300, 400, 700, 800, 40-HR HAZWOPER &

Refreshers, RERO, NRC Courses: Inspection Procedures, Root Cause, Environmental Monitoring, Intro to HP, MARSSIM H-121, 80-Hr Fund HP I&II H-122, Nuclear Medicine H-304, Indus Radiography H-305, Transp of RAM H-308, Brachyth/Gamma H-313, Well Logging H-314, Materials Control S-201, Sarah Trahan December 16, 2019 Bachelor of Science in Radiologic Technology licensed and registered with ARRT and LSRT.

13.5 years as an x-ray technologist, FEMA Incident Command Courses 100, 200, 300, 400, 700, 800, 40-HR HAZWOPER

5.

Please list all professional staff who have not yet met the qualification requirements for a radioactive materials license reviewer or inspector. For each, list the courses or equivalent training/experience they need and a tentative schedule for completion of these requirements.

Radiation Training Procedure has additional information and will be available to the IMPEP Review Team. Training for license reviewers and inspectors not qualified or partially qualified is pursued on an as available/needed basis to allow current and future needs. We progress most license reviewers and inspectors through the full range of qualifications.

SURVEILLANCE

6.

Identify any changes to your qualification and training procedure that occurred during the review period.

We have updated our training policies for license reviewer and inspectors. Changes include a more thorough explanation of the training progression. This describes what the license writer/inspector responsibility is with documentation, sign-offs, and etc. The Training Policy for License Writers within the Radiation Section and Training Policy of Surveillance Personnel within the Radiation Surveillance Section will be made available to the IMPEP Review Team

7.

Please identify the technical staff that left your radioactive materials program during the review period and indicate the date they left.

Departures:

Date:

Bryan Riche 10/13/2017 -Resigned Joseph Noble 9/1/2019 - Retired Mark Chrisman 12/31/2019-Retired Tiffany Rushing 10/31/2018-Texas DHH Kristen Bonds 5/12/2018 -Private Industry David Day 7/8/2017-USCOE Jamie Dismukes 9/8/2019 - transfer to LDEQ REPR Tim Butler 7/23/2016-Utah State DEQ Radiation Daniel Phan 6/29/2019-NASA Elizabeth Levy 7/25/2020- Transfer to LDEQ Remediation Charles Strawn 11/13/2020 - Teaching

8.

List any vacant positions in your radioactive materials program, the length of time each position has been vacant, and a brief summary of efforts to fill the vacancy.

We currently have two vacancies. SERO (Elizabeth Levy) position has been vacant since July 25, 2020. Due to COVID-19, we are unable to fill this position at this time. NWRO (Charles Strawn) has been vacant since November 13, 2020. We are in the process of filling this position.

9.

For Agreement States, does your program have an oversight board or committee which provides direction to the program and is composed of licensees and/or members of the public? If so, please describe the procedures used to avoid any potential conflict of interest.

We do not have an oversight board or committee. Physicists and RSOs are contacted as needed.

II.

Status of Materials Inspection Program

10.

Please identify individual licensees or categories of licensees the State is inspecting less frequently than called for in NRCs Inspection Manual Chapter (IMC) 2800 and explain the reason for the difference. The list only needs to include the following information:

license category or licensee name and license number, your inspection interval, and rationale for the difference.

All inspections are being conducted in accordance with the IMC 2800 inspection frequency.

11.

Please provide the number of routine inspections of Priority 1, 2, and 3 licensees, as defined in IMC 2800 and the number of initial inspections that were completed during each year of the review period.

12.

Please submit a table, or a computer printout, that identifies inspections of Priority 1, 2, and 3 licensees and initial inspections that were conducted overdue.

At a minimum, the list should include the following information for each inspection that was conducted overdue during the review period:

(1) Licensee Name (2) License Number (3) Priority (IMC 2800)

(4) Last inspection date or license issuance date, if initial inspection (5) Date Due (6) Date Performed (7) Amount of Time Overdue (8) Date inspection findings issued Premier Geotech and Testing LLC was performed a month late due to SWRO Inspector was unqualified to perform RAM inspections (mainly Industrial Radiography inspections) at the time. CRO was performing Cat 1 and 2 inspections in SWRO, which was pulling them from CRO area.

Belle Quality Testing LLC is late due to COVID-19 and Hurricane Laura. It has been scheduled several times within the last few months and canceled due to Hurricane Laura and Belle Quality Testing employees testing positive for COVID-19.

13.

Please submit a table or computer printout that identifies any Priority 1, 2, and 3 licensees and initial inspections that are currently overdue, per IMC 2800. At a minimum, the list should include the same information for each overdue inspection provided for Question 12 plus your action plan for completing the inspection. Also, include your plan for completing the overdue inspections.

The following inspections are currently past their due dates. Six of the included inspections are currently overdue, according to IMC 2800. These inspections are overdue because of the COVID-19 pandemic. Charles Strawn, the inspector in the NWRO has resigned. The inspections that were assigned to him have been reassigned to new inspectors and moved to the top of their priority list to be completed ASAP.

14.

Please provide the number of reciprocity licensees that were candidates for inspection per year as described in IMC 1220 and indicate the number of reciprocity inspections of candidate licensees that were completed each year during the review period.

YEAR

  1. of candidates
  1. of inspections Percentage 2016 45 12 26 2017 62 18 29 2018 63 24 38 2019 73 17 23 2020 57 14 25 III.

Technical Quality of Inspections

15.

What, if any, changes were made to your written inspection procedures during the reporting period?

We developed checklists to replace some of our narratives for better efficiency and consistency. We updated reciprocity procedures and revised 17 standard operating procedures (similar to IMC 2800; not Inspection Procedures). These procedures will be made available to the IMPEP Review Team.

16.

Prepare a table showing the number and types of supervisory accompaniments made during the review period. Include:

Inspector Supervisor License Category Date Start Date of Employ ment End Date of Employme nt Tim Butler Dwayne Stepter IR 6/6/2016 7/2011 7/23/2016 Kristen Bonds James Pate Nuclear Medicine 11/5/2016 8/2014 5/12/18 Kristen Bonds Dwayne Stepter Nuclear Medicine 4/18/2017 8/2014 5/12/18 Kristen Bonds Jeff Dauzat Nuclear Medicine 12/15/201 7

8/2014 5/12/18 Kristen Bonds Scott Blackwell Therapy/HDR/Brach y

4/10/2018 8/2014 5/12/18 Daniel Phan James Pate Portable Gauge 2/27/2018 3/2017 6/29/19 Daniel Phan Jeff Dauzat Portable Gauge 6/1/2018 3/2017 6/29/19 Daniel Phan Scott Blackwell Nuclear Medicine 6/12/2018 3/2017 6/29/19 Daniel Phan James Pate Nuclear Pharm 11/7/2018 3/2017 6/29/19 Daniel Phan James Pate IR 12/4/2018 3/2017 6/29/19

Daniel Phan James Pate M&D 6/11/2019 3/2017 6/29/19 Angela Jackson James Pate Nuclear Medicine 10/26/201 7

9/2016 Angela Jackson Jeff Dauzat Nuclear Medicine 6/6/2018 9/2016 Angela Jackson James Pate Nuclear Pharm 6/19/2019 9/2016 Angela Jackson Karen Burgard Nuclear Medicine 10/22/201 9

9/2016 Angela Jackson James Pate I.R. &PPQRM 5/29/2020 9/2016 Elizabeth Levy James Pate IR 5/16/2019 7/2018 7/25/2020 Elizabeth Levy James Pate Well Logging 5/21/2019 7/2018 7/25/2020 Elizabeth Levy James Pate Fixed Gauge 7/23/2019 7/2018 7/25/2020 Elizabeth Levy James Pate Portable Gauge 10/1/2019 7/2018 7/25/2020 Russell Clark Joe Noble Commercial PET 2/8/2016 9/1993 Russell Clark Judy Schuerman Fixed Gauge 6/16/2016 9/1993 Russell Clark Judy Schuerman IR 3/1/2017 9/1993 Russell Clark Dwayne Stepter Fixed Gauge 8/10/2017 9/1993 Russell Clark Jeff Dauzat IR 4/20/2018 9/1993 Russell Clark Judy Schuerman IR 5/2/2018 9/1993 Russell Clark Scott Blackwell IR 10/3/2019 9/1993 Russell Clark Scott Blackwell IR 12/11/201 9

9/1993 Paula Lang James Pate Nuclear Medicine 11/9/2016 7/2015 Paula Lang Judy Schuerman Nuclear Medicine 4/6/2017 7/2015 Paula Lang D. Stepter Nuclear Medicine 8/24/2017 7/2015 Paula Lang Scott Blackwell Nuclear Pharm 2/7/2018 7/2015 Paula Lang Jeff Dauzat Nuclear Med-Broadscope 3/5/2018 7/2015 Paula Lang Karen Burgard Nuclear Medicine 8/27/2019 7/2015 Paula Lang Karen Burgard Nuclear Medicine 11/5/2019 7/2015 Paula Lang Ashley Menard HDR 1/16/2020 7/2015 Paula Lang Scott Blackwell IR 2/12/2020 7/2015 Jamie Dismukes James Pate Portable Gauges 12/28/201 6

4/2016 9/8/2019 Jamie Dismukes Judy Schuerman Portable Gauges 8/4/2017 4/2016 9/8/2019 Jamie Dismukes Judy Schuerman Portable Gauges 10/13/201 7

4/2016 9/8/2019 Jamie Dismukes Jeff Dauzat Portable Gauges 2/26/2018 4/2016 9/8/2019 Jamie Dismukes James Pate IR 5/18/2018 4/2016 9/8/2019 Jamie Dismukes James Pate Nuclear Medicine 5/31/2018 4/2016 9/8/2019 Jamie Dismukes Karen Burgard Portable Gauges 8/22/2019 4/2016 9/8/2019 Ziad Fahd Judy Schuerman Recp-IR 11/21/201 7

1/1992 Ziad Fahd Judy Schuerman Recp-Fixed Gauges 2/21/2018 1/1992 Ziad Fahd Jeff Dauzat Recp-HDR source exchange 8/7/2018 1/1992 Ziad Fahd Karen Burgard Recp-HDR source exchange 9/25/2019 1/1992 Ziad Fahd Judy Recp-Port. Gauge 10/31/201 1/1992

Schuerman 9

Ziad Fahd Judy Schuerman Recp-IR 2/20/2020 1/1992 Jonathan Crain James Pate Portable Gauge 6/21/2018 6/2016 Jonathan Crain Jeff Dauzat Portable Gauge 10/8/2018 6/2016 Jonathan Crain James Pate Fixed Gauge 10/10/201 8

6/2016 Jonathan Crain Scott Blackwell Nuclear Medicine 1/30/2019 6/2016 Jonathan Crain Karen Burgard Portable Gauge 6/17/2019 6/2016 John Fontenot Bryan Riche IR 7/8/2016 5/2003 John Fontenot Bryan Riche Well Logging 11/28/201 6

5/2003 John Fontenot Dwayne Stepter IR & PPQRM 4/5/2017 5/2003 John Fontenot James Pate Manufacturer 11/8/2017 5/2003 John Fontenot Judy Schuerman Well Logging 3/22/2018 5/2003 John Fontenot Jeff Dauzat IR 5/9/2018 5/2003 John Fontenot Karen Burgard IR 5/22/2019 5/2003 John Fontenot Dwayne Stepter IR 9/26/2019 5/2003 John Fontenot Karen Burgard Well Logging 3/10/2020 5/2003 Ashley Menard Bryan Riche Nuclear Medicine 7/15/2016 8/2008 Ashley Menard Bryan Riche Nuclear Pharm 12/1/2016 8/2008 Ashley Menard Bryan Riche Nuclear Medicine 4/24/2017 8/2008 Ashley Menard Dwayne Stepter Nuclear Medicine 8/1/2017 8/2008 Ashley Menard Judy Schuerman Broadscope Academic 3/22/2018 8/2008 Ashley Menard Jeff Dauzat Nuclear Medicine 5/1/2018 8/2008 Ashley Menard Dwayne Stepter Nuclear Medicine 4/11/2019 8/2008 Ashley Menard Karen Burgard HDR,Therapy, Nuc Med 4/24/2019 8/2008 Ashley Menard Karen Burgard I-131 Therapy 11/2/2020 8/2008 Tiffany Rushing James Pate Nuclear Medicine 3/15/2017 12/201 5

10/31/18 Tiffany Rushing James Pate Fixed Gauge 9/21/2017 12/201 5

10/31/18 Tiffany Rushing James Pate IR 11/7/2017 12/201 5

10/31/18 Tiffany Rushing Dwayne Stepter Nuclear Medicine 4/12/2018 12/201 5

10/31/18 Sal Ange James Pate Portable Gauge 12/3/2019 1/14/19 Sal Ange James Pate IR & PPQRM 6/4/2020 1/14/19 Mark Chrisman James Pate Nuclear Medicine 4/5/2016 4/1996 12/31/19 Mark Chrisman James Pate Portable Gauge 9/20/2016 4/1996 12/31/19 Mark Chrisman James Pate Blood Irradiator 4/18/2017 4/1996 12/31/19 Mark Chrisman James Pate Portable Gauge 9/19/2017 4/1996 12/31/19 Mark Chrisman James Pate Portable Gauge 4/3/2018 4/1996 12/31/19 Mark Chrisman Jeff Dauzat IR 7/27/2018 4/1996 12/31/19 Mark Chrisman James Pate IR 4/16/2019 4/1996 12/31/19 Mark Chrisman James Pate Portable Gauge 9/10/2019 4/1996 12/31/19 Charles Strawn James Pate Portable Gauge 4/18/2017 8/2016 11/13/20 Charles Strawn James Pate Fixed Gauge 7/30/2017 8/2016 Charles Strawn James Pate Nuclear Medicine 9/19/2017 8/2016 Charles Strawn James Pate Nuc Med w/ Therapy 4/3/2018 8/2016 Charles Strawn James Pate IR 4/5/2018 8/2016

Charles Strawn Jeff Dauzat Nuclear Medicine 7/30/2018 8/2016 Charles Strawn James Pate HDR-Brachy 8/21/2018 8/2016 Charles Strawn Karen Burgard IR 4/30/2019 8/2016 Charles Strawn James Pate Nuclear Medicine 9/10/2019 8/2016 Charles Strawn Karen Burgard Nuclear Medicine 3/3/2020 8/2016 11/13/20 Jennifer Elee James Pate Nuclear Medicine 3/29/2016 7/1993 Jennifer Elee James Pate Portable Gauge 9/29/2016 7/1993 Jennifer Elee Bryan Riche Nuclear Pharm 2/10/2017 7/1993 Jennifer Elee Dwayne Stepter Portable Gauge 9/28/2017 7/1993 Jennifer Elee Dwayne Stepter Nuclear Pharm 6/28/2018 7/1993 Jennifer Elee Jeff Dauzat Consulting Service 6/29/2018 7/1993 Jennifer Elee Karen Burgard IR 4/29/2019 7/1993 Jennifer Elee Dwayne Stepter Nuclear Medicine 10/29/201 9

7/1993 Jennifer Elee Karen Burgard Portable Gauge 3/4/2020 7/1993

17.

Describe or provide an update on your instrumentation, methods of calibration, and laboratory capabilities. Are all instruments properly calibrated at the present time? Were there sufficient calibrated instruments available throughout the review period?

All radiation protection hardware we rely on for measurements are sent to a certified calibration facility (LSU Nuclear Science Center, Gulf Engineering, and KLS Physics Group) for calibration. All instruments used are properly calibrated at the present time.

Instrument calibrations records will be available for the IMPEP team members to review.

All radiation inspectors possess/maintain a sufficient amount of calibrated instruments throughout the review period in order to conduct his or her inspections.

IV.

Technical Quality of Licensing Actions

18.

How many specific radioactive material licenses does your program regulate at this time?

434 (10/30/2020)

19.

Please identify any major, unusual, or complex licenses which were issued, received a major amendment, were terminated, decommissioned, submitted a bankruptcy notification or renewed in this period.

ISOFLEX, LA-13526-L01

20.

Discuss any variances in licensing policies and procedures or exemptions from the regulations granted during the review period.

None

21.

What, if any, changes were made in your written licensing procedures (new procedures, updates, policy memoranda, etc.) during the reporting period?

Changes to licensing conditions are the only changes made to licensing procedures. I have contacted Michelle Beardsley on the licensing conditions. We are in the process of submitting all of these license conditions for approval or using already approved standard conditions.

GAUGES-Online internet training from an Agreement State or NRC approved course for portable nuclear gauge safety training must be followed by hands on training from the Radiation Safety Officer or Manufacturer prior to the use of the gauge. A written record of the hands on training shall be maintained for inspection by the Department.

MEDICAL 1--Old condition listed as:

For patients who have received therapeutic amounts of radionuclides, the provisions of NCRP Report No.

37, "Precautions in the Management of Patients Who Have Received Therapeutic Amounts of Radionuclides," shall govern:

A. hospital and nursing care; and B. release from the hospital, which may be authorized only by those physicians named in Condition 2 for the specified therapy procedures.

New condition updated to reflect NUREG now listed as:

For patients who have received therapeutic amounts of radionuclides, the provisions of US NRC Regulatory Guide 8.39 shall govern:

A. hospital and nursing care; and B. release from the hospital, which may be authorized only by individuals listed in Condition 2 above for the mentioned therapy procedures.

INDUSTRIAL RADIOGRAPHY 1--Old condition listed as:

Pursuant to LAC 33:XV.575.A., the licensee may permit an individual to act as a radiographer provided:

A.

Verification of satisfactory completion has been received from a person approved by the Department, an Agreement State, or the Nuclear Regulatory Commission to conduct a radiography training program which meets the requirements equivalent to LAC 33:XV.575.A.1. If verification cannot be received, then the licensee may accept verification from the holder of a license issued by the Department, an Agreement State or the Nuclear Regulatory Commission that the individual has been employed as a radiographer as defined by LAC 33:XV.503; and B. The individual has received instruction and training which meets the requirements of LAC 33:XV.575.A.2 and 3 as specified in the licensee's Operating and Emergency Procedures; and C.

Appropriate records are maintained which demonstrate the individual has met the above requirements, and Form DRC-20 has been filed with the Department.

D. The individual has successfully completed within the past five (5) years a radiation safety examination administered by the Department or its agent. The examination must be successfully completed at least once every five (5) years.

E. On-the-job training at temporary jobsites shall be under the direct personal supervision of the instructors listed in Attachment 1.

New condition with regulations directly referencing Chapter 5 removed now listed as:

On-the-job training received to act as a radiographer shall be under the direct personal supervision of the instructors listed in Attachment 1 of this license.

2--Old condition for licenses that teach 40-hour rad safety course listed as:

A. Pursuant to LAC 33:XV.575, the licensee is specifically authorized to train and qualify individuals as radiographers. Notification announcing the dates of the class must be submitted to the Department at least two (2) weeks in advance.

B. The licensee shall instruct individuals in the subjects outlined in Appendix A of Chapter 5 of the Louisiana Radiation Regulations in accordance with the course outline dated insert date. Instruction shall be given by insert instructor.

C. On-the job training shall be under the direct personal supervision of the instructors listed in Attachment 1.

D. Form DRC-20 shall be filed with the Department for each individual qualified under this license to act as a radiographer.

E. The individual has successfully completed within the last five years a radiation safety examination administered by the Department or its agent.

New condition with regulations directly referencing Chapter 5 removed now listed as:

A. Pursuant to LAC 33:XV.575, the licensee is specifically authorized to train and qualify individuals as radiographers. Notification announcing the dates of the class must be submitted to the Department at least two (2) weeks in advance.

B. The licensee shall instruct individuals in the subjects outlined in Appendix A of Chapter 5 of the Louisiana Radiation Regulations in accordance with the course outline dated insert date. Instruction shall be given by insert instructor.

3--Old condition listed as:

Tests for leakage and/or contamination of sealed sources listed in the schedule shall be performed in accordance with LAC 33:XV.544.

New condition updated to address items not referenced in 544 now listed as:

Tests for leakage and/or contamination of sealed sources listed in the schedule for industrial radiography shall be performed in accordance with LAC 33:XV.544 using approved leak test kits and procedures specified in the Licensee's application.

4--Old condition listed as:

The licensee is authorized to receive, possess and transfer depleted uranium for use as shielding material in amounts not greater than 999 kilograms.

New condition now reflects actual amount of depleted uranium + 500 kg.

    • addl 500 kg in order to account for any device additions made to the license but du amount accidentally not updated at that time in an effort to keep licensee in compliance

5--Old conditions listed separately as:

Each licensee or registrant shall conduct a program of internal inspections to ensure that the Louisiana Radiation Regulations, Louisiana Radioactive Material License Conditions, and the licensee's or registrant's operation and emergency procedures are followed by each radiographer. Each radiographer will be inspected at least quarterly.

-and-The licensee shall conduct a quarterly inventory and inspection of all devices containing radioactive material which determines the general physical condition of all devices. Records shall be maintained for inspection by the Department for three years and shall include, but not be limited to, the date of the inventory, the location and identification of the devices, the quantity and kinds of radioactive material, the sealed source identity, the findings of the physical inspection, and name of individual(s) performing the inspection and inventory.

New condition combined and now listed as:

Any irregularities or equipment malfunction observed during the quarterly inventory or inspection of all devices containing radioactive material shall be reported to the Department in accordance with LAC 33:XV.341.

6--Old condition listed as:

The Licensee shall perform a misconnect test in accordance with the manufacturers recommendations.

Records shall be maintained for inspection by the Department for three years and shall include, but not be limited to, the date, the name of the person who performed the test and the device serial number.

New condition to address third party equipment now listed as:

The Licensee shall perform a misconnect test in accordance with the manufacturers recommendations. If third party equipment is utilized, then a daily misconnect test shall be performed. Records shall be maintained for inspection by the Department for three years and shall include, but not be limited to, the date, the name of the person who performed the test and the device serial number.

    • The following conditions were removed because directly referenced in Chapter 5:

Each radioactive exposure device, sealed source storage container, and source changer shall be locked in accordance with LAC 33:XV.541 and 542.

Each licensee shall maintain a utilization log per LAC 33:XV.546.

Radioactive material shall only be used by employees of this license, who have received specific instruction in the use of the devices and in radiation protection by the manufacturer or by persons approved by the Department, an Agreement State, or the U. S. Nuclear Regulatory Commission, and have been designated by the Radiation Safety Officer of this license.

    • The following condition was removed because no longer accurate:

The licensee is authorized to receive, possess, and use sealed sources of Cobalt-60 and Iridium-192 where the radioactivity exceeds the amount of radioactivity specified in this license provided:

A.

Such sources do not exceed the quantity specified per source by more than 10% for Cobalt-60 or 20% for Iridium-192;

B.

Records of the licensee show that no more than the maximum amount of radioactivity specified per source above was ordered from the supplier or transferor of the radioactive material; and B.

Levels of radiation for radiographic source containers and storage containers do not exceed those specified in LAC 33:XV.540.

22.

Identify by licensee name and license number any renewal applications that have been pending for one year or more. Please indicate why these reviews have been delayed and describe your action plan to reduce the backlog.

1) Louisiana Department of Health OPH Laboratory LA-1320-L01B Expired: 11/30/2018 Renewal Finalized: 4/27/2020 Reasons for delay: lab relocation, multiple source updates, and personnel changes Notice of Deficiency Issued
2) Pioneer Wireline Services, LLC LA-12304-L01 Expired: 3/31/2019 Renewal Finalized: 4/27/2020 Reasons for delay: initial request to terminate then requested to renew; relocation and close out, multiple source updates, and personnel changes Four 90 day letter extensions issued V.

Technical Quality of Incident and Allegation Activities

23.

For Agreement States, please provide a list of any reportable incidents not previously submitted to NRC (See Procedure SA-300, Reporting Material Events, for additional guidance, OMB clearance number 3150-0178). The list should be in the following format:

Licensee Name License #

Date of Incident/Report Type of Incident None

24.

Identify any changes to your procedures for responding to incidents and allegations that occurred during the period of this review.

No changes to the responding procedures in Incidents and Allegations SOP have been made during this IMPEP time period. These procedures will be made available to the IMPEP Review Team.

C.

NON-COMMON PERFORMANCE INDICATORS I.

Legislation, Regulations and Other Program Elements Requirements

25.

Please list all currently effective legislation that affects the radiation control program. Denote any legislation that was enacted or amended during the review period.

R.S 30.2001 et.seq. LR 29:2053 (October 2003), amended by the Office of the Secretary, Legal Division, LR 43:952 (May 2017). It authorized a 10% increase in fees collected by the Department.

26.

Are your regulations subject to a "Sunset" or equivalent law? If so, explain and include the next expiration date for your regulations.

LDEQ is subject to a sunset law. Act 25 of the 2018 Legislative Session became effective on June 30, 2018 and expires July 1, 2023.

27.

Please review and verify that the information in the enclosed State Regulation Status (SRS) sheet is correct. For those regulations that have not been adopted by the State, explain why they were not adopted, and discuss actions being taken to adopt them. If legally binding requirements were used in lieu of regulations and they have not been reviewed by NRC for compatibility, please describe their use.

The information in the enclosed SRS sheet is correct. All recently required regulations have been adopted by Louisiana before the stated deadlines. Louisiana has updated some conditions, see question 21 above. We have contacted Michelle Beardsley with the NRC and working on submitting these changes for NRC approval.

28.

If you have not adopted all amendments within three years from the date of NRC rule promulgation, briefly describe your State's procedures for amending regulations in order to maintain compatibility with the NRC, showing the normal length of time anticipated to complete each step.

Since the 2016 IMPEP review, Louisiana has met all regulatory adoption deadlines. Louisiana typically adopts all amendments before the three-year deadline. RATS IDs 2018-1, 2018-3, 2019-1, 2019-2, 2020-1, 2020-2, and 2020-3 should all be adopted into Part XV of Title 33 of the Louisiana Administrative Code before each of these deadlines occurs.

The two NRC comments from RATS ID 2015-3, as well as the 10 comments from 10 CFR 34, will all be addressed in the next rulemaking package that is sent to the NRC in 2021. The main focus of this rulemaking package is to maintain equivalency with NRC regulations promulgated in RATS ID 2018-1.

With regard to comments #2, 4, and 10 from the NRC letter dated March 2, 2020 relating to 10 CFR 34 and LAC 33:XV.Chapter 5:

  1. 2. Definition: Independent Certifying Agency. Louisiana omits a definition of Independent certifying agency 10 CFR 34.3 does not have a definition for Independent certifying agency either. There are definitions for Independent certifying organization and Certifying entity in both 10 CFR 34.3 and LAC 33:XV.503 that are identical to each other. Michelle Beardsley has been contacted on how to proceed with this discrepancy.
  1. 4. Labeling, storage, and transportation. Louisianas regulations contain the following additional requirement which is not included in 10 CFR 34.35, and is more restrictive than NRC regulationsLouisiana will remove this additional requirement.
  1. 10. Radiographer certification. Louisiana regulations contain equivalent provisions to 10 CFR Part 34, Appendix A, in their definition of Certifying Entity... Louisiana will reference our equivalent regulations, i.e., Appendices A, B, and C in our definition of Certifying Entity.

II.

Sealed Source and Device (SS&D) Evaluation Program

29.

Prepare a table listing new and amended (including transfers to inactive status) SS&D registrations of sources and devices issued during the review period. The table heading should be:

SS&D Manufacturer, Registry Distributor or Product Type Date Type of Number Custom User or Use Issued Action

30.

Please include information on the following questions in Section A, as they apply to the SS&D Program:

Technical Staffing and Training - Questions 2-9 The SS&D Training procedure will be provided to the IMPEP Review Team.

Technical Quality of Licensing Actions - Questions 18-22 4 SS&Ds completed for this IMPEP. Nothing major, unusual, or complex. No variances or exemptions requested or granted. No changes to the written procedure.

Nothing-pending one year or more.

Technical Quality of Incident and Allegation Activities - Questions 23-24 None III.

Low-level Radioactive Waste Disposal Program

31.

Please include information on the following questions in Section A, as they apply to the Low-Level Radioactive Waste Disposal Program:

Louisiana is a member state of the Central Interstate Low-Level Radioactive Waste Commission. Participation includes attending the annual meeting and keeping up with any changes that occur in our and other programs. The Louisiana representative for this program is Richard S. Blackwell.

The department is involved in NORM waste disposal. Further information can be provided, if required.

IV.

Uranium Recovery Program

32.

Please include information on the following questions in Section A, as they apply to the Uranium Recovery Program:

Louisiana is not involved in the uranium mill program.

MATERIALS REQUESTED TO BE AVAILABLE FOR THE ON-SITE PORTION OF AN IMPEP REVIEW Please have the following information available for use by the IMPEP review team when they arrive at your office:

List of open license cases, with date of original request, and dates of follow-up actions. Will provide this when IMPEP begins.

List of licenses terminated during review period. Termination LicensesTermination Licenses.xlsx Copy of current log or other document used to track licensing actions. We have changed the way we track. Prior to this October they were done on paper tracking mail log (these can be provided upon request) and our database tracking list (see Radiation - Licenses Issued). Now Scott tracks them in excel from start to finish (also can be provided).

List of all licensing actions completed during the review period (sorted by license reviewer, if possible). Radiation - Licenses Issued Radiation - Licenses Issued.xlsx Copy of current log or other document used to track inspections. This is a continuous live worksheet. We have provided a glimpse of what we have now. RAM Due List IMPEP.xlsx List of all inspections completed during the review period (sorted by inspector, if possible).

Radiation - Inspections Radiation - Inspections.xlsx List of inspection frequencies by license type. List of Inspection frequencies by type List of Inspection frequencies by type.docx List of all allegations occurring during the review period. Show whether the allegation is open or closed and whether it was referred by NRC. Allegation Log 2016 Allegation Log 2016.pdf, Allegation Log 2017Allegation Log 2017.pdf, Allegation Log 2018Allegation Log 2018.pdf, ALLE Log 2019ALLE LOG 2019(1).xlsx, Allegation Log 2020 Allegation Log 2020.xlsx List of all licenses that your agency has imposed additional security requirements upon.PPQRM-Security Licenses List.xlsx

PLEASE HAVE THE FOLLOWING DOCUMENTS AVAILABLE All State regulations Statutes affecting the regulatory authority of the State program Standard license conditions Technical procedures for licensing, model licenses, review guides SS&D review procedures, guides, and standards Instrument calibration records Inspection procedures and guides Inspection report forms Documented training plan, if applicable Records of results of supervisory accompaniments of inspectors Emergency plan and communications list Procedures for investigating allegations Procedures for investigating incidents Enforcement procedures, including procedures for escalated enforcement, severity levels, civil penalties (as applicable)

Job descriptions