ML22104A050
| ML22104A050 | |
| Person / Time | |
|---|---|
| Issue date: | 04/14/2022 |
| From: | Office of Nuclear Security and Incident Response, NRC/OGC |
| To: | |
| Cecere B | |
| Shared Package | |
| ML22005A062 | List: |
| References | |
| Download: ML22104A050 (6) | |
Text
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Home Even: No:ific.ation Form 361 Form 361 APPROVED BY OMS: NO. 3150-0238 EXPIRE S: 10/31/2022 Estimated burden per response lo 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 A 10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to lnfocollects.Resource@nrc.gov, and the 0MB reviewer at 0MB 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_submis.sion@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 0MB control number.
Create Draft Form 361 Review Ora.ft Form 351 i inaJ Form 351 Form 361 EN Number Notification Date And Time "
ii Facility or Organization "
Select ?bnt V
Unit" Name of Caner/Title "'
Call Back Number "
Provide a telephone number Event Time A nd Zone "
Event Date "'
ii Power Mode At Time Of Event "'
- a.
Power Mode At Time Of Notification "'
- a.
Event Classification General Emergency
@No O ves Unusual Event
@No O Yes Material Exposure
@No O Yes Information Only
@No O ves 1-HR Non-Emergency 10 CFR 50 72(b)(1)
TS Deviation
@No O ves 4-HR Non-Emergency 10 CFR 50 72(b)(2)
TS Required SD
@No O ves Offsite Notification
@No O ves 8-HR Non-Emergency 10 CFR 50 72(b)(3)
Degraded Condition
@No O ves Safe SD Capability
@No O Yes Accident Witigation
@No O Yes 60-Day Optional 10 CFR 50.73(a)(1)
Invalid Specified System Actuation
@No O Yes Other Unspecified Requirement (Identify)
NONR
@No O Yes Site Area Emergency
@ No 0 Yes 50,72 Non 4Emergency
@ No O Yes Fitness For Duty
@ No O Yes ECCS Discharge to RCS
@ No 0 Yes Unanalyzed Condition
@ No 0 Yes RHR Capability
@ No O Yes Offsite Medical
@ No O Yes NONR
@ No O Yes A lert
@ No 0 Yes Physical Security
@ No O Yes Other Unspecified Requirement
@ No O Yes RPS Actuation
@ No 0 Yes Specified System Actuation
@ No 0 Yes Control of Rad Release
@ No O Yes Loss CommfAsmt/Response
@ No O Yes
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)
Event Description Notifications NRC Resident State Local Other Gov Agencies Media Press Release V
V V
V V
Anything Unusual Or Not Understood
@No O ves Did All Systems Function As Required
@No O Yes Mode Of Operations Until Corrected Additional Information
@No O ves fi
Radiological Releases Check Or Fill In Applicable Items (specific details/explanations should be covered in event description)
Liquid Release
@ No O ves Planned Release
@ No O Yes Monitored
@ No O Yes T, S. Exceeded
@ No O ves Personnel Exposed or Contaminated
@ No O ves Noble Gas (Release Rate (Ci/sec))
Iodine (Release Rate (Ci/sec))
Particulate (Release Rate (Ci/sec})
Liquid (excluding tritium and dissolved noble gas) (Release Rate (Ci/sec))
Liquid (tritium) (Release Rate (Ci/sec))
Total (Release Rate (Ci/sec))
1 Gaseous Release
@ No O ves Ongoing
@ No O Yes Unmonitored
@ No O Yes RM Alarms
@ No O ves Unplanned Release
@ No O ves Terminated
@ No O Yes Offsite Release
@ No O Yes Areas Evacuated
@ No O ves Off site Protection Actions Recommended
@ No O ves Noble Gas(% T,S, Limit)
Iodine(% T,S, Limit)
Particulate(% T.S. Limit}
Liquid {excluding tritium and dissolved noble gas}(% T,S, Limit)
Liquid (tritium}% T.S. limit Total (% T.S. Limit)
Noble Gas (Total Activity (Ci))
Iodine (Total Activity (Ci))
Particulate (Total Activity (Ci))
Liquid (excluding tritium and dissolved noble gas) (Total Activity (Ci))
Liquid (tritium) (Total Activity (Ci))
Total Activity (Total Activity (Ci))
1 Noble Gas(% T,S, Limit 2}
Iodine(% T,S, Limit 2}
Particulate(% T.S. Limit 2}
Liquid {excluding tritium and dissolved noble gas}(% T,S, Limit
- 2)
Liquid (tritium) (% T. S. Limit 2)
Total {% T.S. Limit 2)
RAD Monitor Readings (Plant Stack)
Alarm Setpoi nts (Plant Stack)
% T. S. Limit (Plant Stack)
RAD Monitor Readings (Other)
Alarm Setpoi nts (Other)
% T, S. Limit (Other}
1 RAD Monitor Readings (Condenser/Air Ejector}
Alarm Setpoints (Condenser/Air Ejector)
% T.S. limit (Condenser!Air Ejector) i RAD Monitor Readings (Main Stream Line}
Alarm Setpoints (Main Stream line)
% T, S. Limit (Main Stream Line}
RAD Monitor Readings (SG Slowdown)
Alarm Setpoints (SG Slowdown)
% T.S. Umit (SG Slowdown}
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,1 SG #, valve 1 pipe, etc.)
Leak Rate Units: gpm/gpd Leak Start Date Leak Start Time ii T,S, limits Coolant Activity and Units (Primary)
Sudden Or Long Term Development Coolant Activity and Units
( Secondary)
List Of Safety Related Equipment Not Operational Event Description Ill HOME NEWS RELEASES ABOUT US STRATEGIC PLAN POPULAR DOCUMENTS INFO DIGEST fi STAY CONNECTED 11:1 11:1 11:1 r.l Ir.II Ir.II