ML22104A052
| ML22104A052 | |
| 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 | |
| OMB 3150-0238 | |
| Download: ML22104A052 (4) | |
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Home Even: No:ific.ation Form 361 N Form 361 N APPROVED BV 0MB: ND. 3150-0ilg EXPIRES: 10/3112022 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 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.
Form 361 N EN Number Notification Date And Time Facility or Organization "
V Name of Caller "
Call Back Number
- Provide a telephone number Event Time And Zone "
Event Date "
ii Power Mode Before L
Power Mode After Reactor Type Max Power Max Pulse Pulse Inserted During Event?
Event Classification (i)
General Emergency No O Yes Unusual Event
@ No O Yes Information Only No O Yes Reportable Condition (Varies by facility TS)
TS Deviation No O Yes Offsite Notification No O Yes Specified System Actuation
@ No O Yes Accident Mitigation
@ No O Yes Inval id Specified System Actuation
@ No O Yes Other Unspecified Requirement (Identify)
NONR
@ No O Yes NONR
@ No O Yes Site Area Emergency No O Yes Safeguards Event (73 App G)
@ No O Yes Other Unspecified Requirement (see Other Unspecified Requirement Section)
No O Yes TS Required SJ0 No O Yes Degraded Condition No O Yes Safe SID Capability
@ No O Yes Offsite Medical
@ No O Yes Suspicious Activity
@ No O Yes i
Alert No O Yes Material Exposure
@ No O Yes RPS Actuation (scram)
No O Yes Unanalyzed Condition
@ No O Yes Control of Rad Release
@ No O Yes Loss Comm/AsmtfResp,onse
@ No O Yes Security Event
@ No O Yes Identify Unspecified Requirement Identify Unspecified Requirement 1
Description (Include: System affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.)
Event Description Notifications HQ NPR Staff State(s)
Loca.l Other Gov Agencies Media/Press Release V
V V
V V
Anything Unusua.l Or Not Understood?
No OYes Did A ll System s Func tion A s Required?
No OYes Mode Of Operations Until Corrected (if applicable)
Estimate f0<r Restart Date Radiological Releases: Check Or Fill In Applicable Items (specific details/explanations should be covered in event description)
Liquid Release No O Yes Planned Release No O Yes Monitored
@ No O Yes Off site Protection Actions Recommended No O Yes Areas Evacuated
@ No O Yes Gaseous Release No O Yes Ongoing No O Yes Unmonitored
@ No O Yes T.S. E.xceeded No O Yes Personnel E.xpose<I or Contaminated
@ No O Yes Unplanned Release No O Yes Terminated No O Yes Offsite Release
@ No O Yes RM A larms No O Yes fi ii
L Noble Gas (Release Rate (Cil se-c))
Iodine (Release Rate (Ci/sec)J Particulate (Release Rate (Ci/sec))
Liquid (excluding tritium and di ssolved noble gas) (Release Rate (Ci/sec)J Liquid (tritium) (Release Rate (Ci/sec))
Total (Release Rate (Ci/sec))
Noble Gas (% T. S. Limit)
Iodine (% T.S. Limit)
Particulate (% T.S. Limit)
Liquid (excluding tlitium and dissolved noble gas)(% T. S.
Limit)
Liquid (tritium)(% T.S. Limit)
Total (% T.S. Limit) list Of Safety Retated Equipment Not Operational 1
Noble Gas (Total Activity (Ci))
Iodine (Total Activity (Ci))
Particulate (Tot.al Activity (Ci))
Liquid (excluding tritium and dissolved noble gasJ (Total Activity (Ci))
Liquid (tritium) (Total Activity (Ci))
Total Activity (Tota.I Activity (Ci))
Noble Gas (% T.S. Limit 2)
Iodine (% T.S. Limit 2)
Particulate (% T. S. Limit 2)
Liqu.id (excluding tritium a.nd dissolved noble gas)(% T.S. Limit
- 2)
Liqu.id (tritium)(% T. S. l imit 2)
Total (% T.S. Limit 2)