ML22027A594
| ML22027A594 | |
| Person / Time | |
|---|---|
| Issue date: | 01/25/2022 |
| From: | Office of Nuclear Security and Incident Response |
| To: | |
| Cecere B | |
| References | |
| Download: ML22027A594 (2) | |
Text
NRC FORM 361 (MM-YYYY)
U.S. NUCLEAR REGULATORY COMMISSION OPERATIONS CENTER Estimated burden per response to comply with this voluntary collection request: 30 minutes. The information provided will be used for evaluation of licensee event description, facility status and for input to the public website. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0238), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e-mail: oira_submission@omb.eop.gov. The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid OMB control number.
EXPIRES: (MM/DD/YYYY)
APPROVED BY OMB: NO. 3150-0238 REACTOR PLANT EVENT NOTIFICATION WORKSHEET NRC FORM 361 (MM-YYYY)
Page of Continued on next page EN #
NRC OPERATIONS TELEPHONE NUMBERS: PRIMARY - 301-816-5100 or 800-532-3469, BACKUPS - [1st ] 301-951-0550 or 800-449-3694,
[2nd] 301-415-0550 and [3rd] 301-415-0553. Licensees who maintain their own ETS are provided these telephone numbers.
FAX - 301-816-5151, EMAIL - hoo.hoc@nrc.gov Notification Time Name of Caller/Title Unit Facility or Organization Call Back #
Event Date Event Time & Zone Power/Mode (At Time of Event)
Power/Mode (At Time of Notification)
EVENT CLASSIFICATION 1-HR. NON-EMERGENCY 10 CFR 50.72(b)(1)
GENERAL EMERGENCY SITE AREA EMERGENCY ALERT UNUSUAL EVENT 50.72 NON-EMERGENCY PHYSICAL SECURITY (73.71)
MATERIAL/EXPOSURE FITNESS FOR DUTY GEN/AAEC SIT/AAEC ALE/AAEC UNU/AAEC (see next columns)
DDDD B????
HFIT TS Deviation (i) TS Required S/D (iv)(A) ECCS Discharge to RCS (iv)(B) RPS Actuation (scram)
(xi) Offsite Notification (ii)(A) Degraded Condition (ii)(B) Unanalyzed Condition (iv)(A) Specified System Actuation (v)(A) Safe S/D Capability (v)(B) RHR Capability (v)(C) Control of Rad Release (v)(D) Accident Mitigation (xii) Offsite Medical (xiii) Loss Comm/Asmt/Response Invalid Specified System Actuation ADEV 4-HR. NON-EMERGENCY 10 CFR 50.72(b)(2)
ASHU ACCS ARPS APRE 8-HR. NON-EMERGENCY 10 CFR 50.72(b)(3)
ADEG AUNA AESF AINA AINB AINC AIND AMED ACOM AINV 60-DAY OPTIONAL 10 CFR 50.73(a)(1)
OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)
NONR NONR Event Description (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continue on Page 2)
OTHER UNSPECIFIED REQMT.
(see last column)
INFORMATION ONLY NNF NOTIFICATIONS NRC RESIDENT YES NO WILL BE STATE(s)
LOCAL OTHER GOV AGENCIES MEDIA/PRESS RELEASE Anything Unusual or not understood?
Did all systems function as required?
Mode of operations until corrected (if applicable)
Yes (Explain above)
No Yes No (Explain above)
Additional Information continued on next page?
Yes No
NRC FORM 361 (MM-YYYY)
U.S. NUCLEAR REGULATORY COMMISSION OPERATIONS CENTER REACTOR PLANT EVENT NOTIFICATION WORKSHEET (Continued)
NRC FORM 361 (MM-YYYY)
Page of EN #
Liquid Release Gaseous Release Unplanned Release Planned Release Ongoing Terminated Monitored Unmonitored Offsite Release T.S. Exceeded RM Alarms Areas Evacuated Personnel Exposed or Contaminated Offsite Protection Actions Recommended
- State release path in description Release Rate (Ci/sec)
% T.S. Limit HOO Guide Total Activity (Ci)
% T.S. Limit HOO Guide Noble Gas 0.1 Ci/sec 1000 Ci Iodine 10 Ci/sec 0.01 Ci Particulate 1 Ci/sec 1 mCi Liquid (excluding tritium and dissolved noble gas) 10 Ci/min 0.1 Ci Liquid (tritium) 0.2 Ci/min 5 Ci TOTAL Plant Stack Condenser/Air Ejector Main Steam Line SG Blowdown Other RAD Monitor Readings Alarm Setpoints
% T.S. Limit (If applicable)
RCS OR SG TUBE LEAKS: CHECK OR FILL IN APPLICABLE ITEMS: (specific details/explanations should be covered in event description)
Location of the Leak (e.g., SG #, valve, pipe, etc.)
Leak Rate Units: gpm/gpd T. S. Limits Sudden or Long-Term Development Leak Start Date Time Coolant Activity and Units:
Primary Secondary List of Safety Related Equipment not Operational RADIOLOGICAL RELEASES: CHECK OR FILL IN APPLICABLE ITEMS (specific details/explanations should be covered in event description)
Event Description (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continued from Page 1)