ML22105A002

CW-2022-02-Public Forms

ML22105A002
Person / Time
Site:	Callaway
Issue date:	02/23/2022
From:	Heather Gepford NRC/RGN-IV/DORS/OB
To:	Ameren Missouri
References
Download: ML22105A002 (19)

Text

EXAM ASSIGNMENT TICKLER Chief:

John Kirkland Facility:

CW 2/23/2022 U/I:

Start of Op Test:

2/14/2022 2/18/2022 Due Date Date Complete Initials 6/14/2021 3/4/2021 7/19/2021 3/4/2021 7/19/2021 3/4/2021 7/19/2021 9/13/2021 7/19/2021 3/8/2021 8/2/2021 3/4/2021 9/13/2021 9/13/2021 9/27/2021 9/28/2021 11/29/2021 11/22/2021 12/6/2021 12/7/2021 12/27/2021 12/7/2021 1/10/2022 12/7/2021 1/10/2022 1/13/2022 1/17/2022 1/17/2022 1/10/2022 1/10/2022 1/24/2022 1/17/2022 1/31/2022 1/31/2022 2/7/2022 2/1/2022 2/7/2022 N/A N/A 2/7/2022 2/7/2022 2/7/2022 1/10/2022 2/7/2022 2/7/2022 2/14/2022 2/14/2022 2/25/2022 2/25/2022 3/15/2022 3/8/2022 3/23/2022 3/15/2022 3/23/2022 3/15/2022 3/30/2022 3/15/2022 4/6/2022 3/23/2022 4/13/2022 N/A N/A 4/13/2022 4/4/2022 4/13/2022 4/4/2022 5/4/2022 N/A N/A 5/11/2022 4/14/2022 Rev. 9 Post exam comments and graded exams received ES-403-1 to BC Final Denial Letters mailed (if no request for informal review)

Replaces NUREG-1021, Revision 11, Forms ES-201-1 and ES-501-1 Post exam operating test comments reviewed and ES-303-1 updated Signed ES 303's to BC produced by CE License/Proposed Denial letters mailed; Facility notified of results Examination Report Issued RPS/IP number of examinees updated print Report-21 Waivers/deferrals reviewed for impact on licensing decision Post exam written comments reviewed and incorporated and NRC grading completed Approved scenarios and JPMs distributed to examiners Examiner's document op test results on ES 303's Final applications reviewed and audited; exam approval and waiver/excusal letters sent LA produces / BC signs Exam Approval Letter (ES-201 Att-5)

Chief examiner review of operating test and/or written exam grading completed Branch Chief review of exam results completed On-site validation & 10% audit of license applications Final license applications & waiver/excusal requests due ES-201-4 prepared by LA Proctoring/written exam administration guidelines reviewed with facility licensee Document review on ES-401-9 Preliminary license applications & waiver/excusal requests due NRC Forms 398/396 Feedback approved by Branch Chief Examination review results discussed between NRC and facility licensee Date of Written Exam:

Description Notes Examination administration date confirmed For NRC prepared exams, arrangements made for the facility to submit reference materials End of Op Test:

Written Exam Developed By: NRC / Facility Operating Test Developed By: NRC / Facility NRC examiners and facility contact assigned Facility contact briefed on security and other requirements Operating test outline(s) and other checklists due ES-201-2, 201-3, 301-1, 301-2, 301-5, D-1 Reference material due for NRC prepared exams ES-201 Att-3 Corporate Notification Letter sent ES-201 Att-4 produced by CE NRC developed written examination outline sent to facility contact ES-401-1/2 and ES-401-3 21 days after proposed denial letters mailed.

Preliminary license applications and waivers reviewed Request facility licensee management feedback on the exam Operating test outline(s) reviewed by NRC and feedback provided to facility licensee ES-201-2 signed by CE & BC Peer review of written exam complete Document review on ES-401-9 Proposed exams, outlines, supporting documentation, and reference materials due.

Exams prepared by the NRC are approved by BC and forwarded for facility licensee review Written exam and operating test reviews completed Written exams and operating tests approved by Branch Chief Administer Operating Test

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ES-201 Examination Outline Quality Checklist Form ES-201-2 Facility:

Callaway Date of Examination: 2/14/2022 Initials Item Task Description a

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1.

a. Verify that the outline(s) fit(s) the appropriate model in accordance with ES-401 or ES-401N.

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b. Assess whether the outline was systematically and randomly prepared in accordance with

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Section D.1 of ES-401 or ES-401 N and whether all KIA categories are appropriately sampled.

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c. Assess whether the outline overemphasizes any systems, evolutions, or generic topics.

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d. Assess whether the justifications for deselected or rejected KIA statements are appropriate.

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2.

a.

Using Form ES-301-5, verify that the proposed scenario sets cover the required number of

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normal evolutions, instrument and component failures, technical specifications, and major

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s transients.

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b. Assess whether there are enough scenario sets (and spares) to test the projected number and u

mix of applicants in accordance with the expected crew composition and rotation schedule

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without compromising exam integrity, and ensure that each applicant can be tested using at f'L-A least one new or significantly modified scenario, that no scenarios are duplicated from the T

applicants' audit test(s), and that scenarios will not be repeated on subsequent days.

0 To the extent possible, assess whether the outline(s) conforms with the qualitative and R

c.

IU quantitative criteria specified on Form ES-301-4 and described in Appendix D and in

~ 'fJL Section D.5, "Specific Instructions for the 'Simulator Operating Test,'" of ES-301 (including overlap).

3.

a. Verify that the systems walkthrough outline meets the criteria specified on Form ES-301-2:

(1) The outline(s) contains the required number of control room and in-plant tasks distributed w

among the safety functions as specified on the form.

A (2) Task repetition from the last two NRC examinations is within the limits specified on the form.

L (3) No tasks are duplicated from the applicant's audit test(s).

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K (4) The number of new or modified tasks meets or exceeds the minimums specified on the form.

T (5) The number of alternate-path, low-power, emergency, and radiologically controlled area H

tasks meets the criteria on the form.

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b. Verify that the administrative outline meets the criteria specified on Form ES-301-1 :

u (1) The tasks are distributed among the topics as specified on the form.

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H (3)

No more than one task is repeated from the last two NRC licensing examinations.

c.

Determine whether there are enough different outlines to test the projected number and mix of &-Tl; '{-<.-

applicants and ensure that no items are duplicated on subsequent days.

4.

a. Assess whether plant-specific priorities (including probabilistic risk assessment and individual

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~ 'fL-plant examination insights) are covered in the appropriate exam sections.

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b. Assess whether the 10 CFR 55.41, 55.43, and 55.45 sampling is appropriate.

N Ensure that KIA importance ratings (except for plant-specific priorities) are at least 2.5.

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d. Check for duplication and overlap among exam sections and the last two NRC exams.

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e. Check the entire exam for balance of coverage.

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Assess whether the exam fits the appropriate job level (RO or SRO).

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Date

a.

Author et.t-, [c.l

b.

Facility Reviewer(*)

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NRC Chief Examiner (#)

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d.

NRC Supervisor J..'t ;>.Hit'r C:r e,b -fcx-1'.'.1 /

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• Not applicable for NRG-prepared examination outlines.

1. The independent NRC reviewer initials items in column "c"; the chief examiner's concurrence is required.

SIGN

ES-401 Written Examination Quality Checklist Form ES-401-6 Facility: Callaway Date of Exam: 02/23/2022 Exam Level:

RO/ SRO Item Description

1.

Questions and answers are technically.accurate and applicable to the facility.

2.

3.

4

5.

6.

7.

8.

9.

10.

11.

a.

NRC K/As are referenced for all questions.

b.

Facility learning objectives are referenced as available.

c.

Correct answer explanation and dlstractor analysis provided (E8-401, 0.2.g)

SRO questions are appropriate In accordance with Section 0.2.d of ES-401 The sampling process was random and systematic. (If more than four RO or two SRO questions were repeated from the last two NRC licensing exams, consult the NRR/NRO OL program office).

Question duplication from the licensee screenln!J'audlt exam was controlled as Indicated below (check the item that applies) and appears appropriate.

_ The audit exam was systematically and randomly developed, or

_ the audit exam was completed before the license exam was started, or

_ the examinations were developed Independently, or

_ the licensee certifies that there is no duplication, or

_ other (explain).

Bank use meets limits (no more than 75% from the bank, at least 10% new, and the rest new or modified); enter the actual RO/SRO-only question dlstrlbulion(s) at right.

Bank Modified New 28/s f} m4 1f*11&

Between 38 and 45 questions of the questions on the RO exam and at least 13 questions of the questions on the SRO-only portion of the exam are written at the comprehension/analysis level (see ES-401, 0.2.c); enter the actual RO/SRO-only question dislributlon(s) at right.

Memory References/handouts provided do not give away answers or aid In the elimination of distractors.

CIA Question content conforms lo specific KIA statements In the previously approved examination outline and is appropriate for the tier to which they are assigned; deviations are justified.

Question psychometric quality and formal meet the guidelines In Appendix B, The exam contains the requlrecl number of one-point, multiple-choice Items; the total is correct and agrees with the value on the cover sheet.

Printed Name/Signature

a.

Author

b.

Facility Reviewer (*)

c.

NRC Chief Examiner(#)

d.

NRC Regional Supervisor Note:

The facility reviewer's initials or signature are not applicable for NRG-developed examinations.

Independent NRC reviewer initials Items in Column *c*; chief examiner concurrence is required, Initial

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ES-301 Operating Test Quality Checklist Form ES-301-3 Facil' : Callawa Date of Examination: Week of 2/14/2022 0 eratln Test Number: 2022-1

a.

b.

c.

d.

e.

1. General Criteria The operating test confonns to the previQusly approved outline; changes are consistent with sam lin re uirements e *., 10 CFR 55.45, function distribution There is no day-to-day repetition between this and other operating tests to be administered durin this examination.

Theo eratin test shall not du icate Items from the a licants' audit test s see Section D.1.a.*

Overlap with the written examination and between different parts of the operating test Is within acce table limits.

It appears that the operating testwlll differentiate between competentand less-than-competent a licants at the desi nated license level.

2. Walk1hrou h Criteria

a.

Each JPM Includes the following, as applicable:

b.

initial conditions initiating cues references and tools, including associated procedures reasonable and validated time limits (average time allowed for completion) and specific designation If deemed to be time critical by the facility licensee operationally Important specific performance criteria that lnclud&-

detailed expected actions with exact criteria and nomenclature system response and other examiner cues statements describing important observations to be made by the applicant criteria for successful completion of the task identlfication of critical steps and their associated performance standards restrictions on the s uence of ste s, if a licable Ensure that any changes from the previously approved systems and administrative walkthrough outlines (Forms ES-301-1 and ES-301-2) have not caused the test to deviate from any of the acceptance criteria (e.g., Item distribution, bank use, repetition from the last two NRC examinations s eclfled on those forms and Form ES-201 *2.

3. Simulator Criteria The associated simulator operating tests (scenario sets) have been reviewed In accordance with Form ES-301-4, and a co is attached.

a.

Author

b.

Facility Reviewer (*)

C.

NRC Chief Examiner(#)

d.

NRC Supervisor

• The facility licensee signature is not applicable for NRC-developed tests.

1. The inde endent NRC reviewer initials items in column "c"; the chief examiner concurrence is r ulred.

Initials a

b*

Date

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ES-301 Simulator Scenario Quality Checklist Form ES-301-4 Facility: Callaway Date of Exam: Week of 2/14/2022 Scenario Numbers: 1/2/3/4 OperatingTest No.: 2022-1 QUALITATIVE ATTRIBUTES Initials a

b*

c'

1.

The initial conditions are realistic in that some equipment and/or instrumentation may be out of service,

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2.

The scenarios consist mostly of related events.

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3.

Each event description consists of the followlng:

the point in the scenario when it is to be initiated the malfunction(s) or conditions that are entered to Initiate the event the symptoms/cues that will be visible to the crew the expected operator actions (by shift position) ftrl the event termination point (if applicable) i'jJ

4.

The events are valid with regard to physics and thermodynamics.

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5.

Sequencing and timing of events is reasonable and allows lhe examination team to obtain complete f&

f,t-evaluation results commensurate with the scenario objectives.

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If time compression techniques are used, the scenario summary clearly so Indicates.

Operators have sufficient time to carry out expected activities without undue time constraints.

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Cues are given.

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The simulator modeling Is not altered.

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The scenarios have been validated. Pursuant to 10 CFR 55.46(d), any open simulator performance deficiencies or deviations from the refel"Elnced plant have been evaluated to ensure that functional

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fidelity ls maintained while running the planned scenarios.

9.

Scenarios are new or significantly modified in accordance with Section D.5 of ES-301.

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10. All individual operator competencies can be evaluated, as verified using Form ES-301-6 (submit the

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form along with the simulator scenarios).

11. The scenario set provides the opportunity for each applicant to be evaluated in each of the appllcable lfQ.- ~.p-rating factor.;. (Competency rating factors as described on Forms ES-303-1 and ES-303-3.)

12. Each applicant wlll be significantly Involved in the minimum nwnber of transients and events specified,~ r!A.p:

on Form ES-301-5 (submit the form with the simulator scenarios).

13. Applicants are evaluated on a similar number of preldentified critical tasks across scenarios, wl'len

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g 1Z-possible.

14. The level of difficulty Is appropriate to support licensing decisions for each crew position.

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Target Quantitative Attributes per Scenario (See Section D.5.d)

Actual Attributes Scenarios 1/2/3/4

1.

Malfunctions after EOP entry (1-2) 1/2/2/2

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Abnormal events (2-4) 3/3/4/4 RkJ AA.. ~

3.

Major transients (1-2) 1/1/1/1

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4.

EOPs entered/requiring substantive actions (1-2) 1/1/1/2

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5.

Entry into a contingency EOP with substantive actions ~ 1 per scenario 2/1/1/0 ffl2-

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Preidentilied critical tasks ~ 2) 2/4/2/3 f&, ~.,/IX-

• The facility licensee signature is not applicable*for NRG-developed tests.

1. An independent NRC reviewer Initials Items in column "c": chief examiner concurrence is required.

ES-403 Written Examination Grading Quality Checklist Form ES-403-1 Facility: Callaway Station Date of Exam: 2/23/2022 Exam Level:

RO 0 SRO u2f Item Description Initials a

b

1.

Clean answer sheets copied before grading

2.

Proposed answer key changes and question deletions justified and documented (facility reviewer initials not required

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(N/R) if NO post-examination comments are submitted)

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3.

4.

Applicants' scores checked for addition errors (reviewers spot check> 25% of examinations)

Grading for all borderline cases (80% ::t:2% overall and 70% or 80%, as applicable, +/-4% on the SRO-only exam) reviewed in l1l/"J

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5.

6.

All other failing examinations checked to ensure that grades are justified Performance on missed questions checked for training deficiencies and wording problems; evaluate validity of questions missed by one-half or more of the applicants Printed Name/Signature

a. Grader 1\\-.:\\ \\c(' ~ S........ / ~

b. Facility Reviewer(*)

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c. NRC Chief Examiner (*)

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d. NRC Supervisor (*)

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(*)

The facility reviewer's signature is not applicable for examinations graded by the NRC; two independent NRC reviews are required.

ES-301 Transient and Event Checklist Form ES-301-5 Facility:

Callaway Date of Exam: 2/14/2022 Operating Test No. 2022-1 A

P P

L I

C A

N T

E V

E N

T T

Y P

E Scenarios - Team 1: I1, I2, R1 1 (Spare) 2 (Monday 2/14) 3 (Tuesday 2/15) 4 (Wednesday 2/16)

T O

T A

L M

I N

I M

U M(*)

CREW POSITION CREW POSITION CREW POSITION CREW POSITION S

R O

A T

C B

O P

S R

O I1 A

T C

I2 B

O P

R1 S

R O

I2 A

T C

R1 B

O P

I1 S

R O

I2 A

T C

I1 B

O P

R1 R

I U

I1 RX 2

1 1

1 0 NOR 1

1 1

1 1 I/C 2,3,4

,6,7 2,4,5

,6 5,7,8 12 4

4 2 MAJ 5

7 6

3 2

2 1 TS 2,4 2

0 2 2 I2 RX 2

1 1

1 0 NOR 1

1 2

1 1 1 I/C 2,4, 6

2,3,4

,5,6 3,4,5

,7,8 13 4

4 2 MAJ 5

7 6

3 2

2 1 TS 2,4 2,5 4

0 2 2 R1 RX

(*)

1 1 0 NOR 1

1 1

3 1

1 1 I/C 2,3,4, 6,7 3,4,5

,6 2,3,4, 7

13 4

4 2 MAJ 5

7 6

3 2

2 1 TS 0

2 2

ES-301 Transient and Event Checklist Form ES-301-5 Facility:

Callaway Date of Exam: 2/14/2022 Operating Test No. 2022-1 A

P P

L I

C A

N T

E V

E N

T T

Y P

E Scenarios - Team 2 &(3): I3, R2, R3 & (I4, R4, R5) + Surrogate(S1) 1 (Spare) 2 (Monday 2/14) 3 (Tuesday 2/15) 4 (Wednesday 2/16)

T O

T A

L M

I N

I M

U M(*)

CREW POSITION CREW POSITION CREW POSITION CREW POSITION S

R O

A T

C B

O P

S R

O I3 (I4)

A T

C R2 (R4)

B O

P R3 (R5)

S R

O S1 A

T C

I3 (I4)

B O

P R2 (R4)

S R

O I3 (I4)

A T

C R3 (R5)

B O

P R2 (R4)

R I

U I3 (I4)

RX 2

1 1

1 0 NOR 1

1 1

3 1

1 1 I/C 2,3,4

,6,7 3,4,5, 6

3,4,5

,7,8 14 4

4 2 MAJ 5

7 6

3 2

2 1 TS 2,4 2,5 4

0 2 2 R2 (R4)

RX

(*)

1 1 0 NOR 1

1 1

1 1 I/C 2,4, 6

2,4, 5,6 2,3,4, 7

11 4

4 2 MAJ 5

7 6

3 2

2 1 TS 0

2 2 R3 (R5)

RX 2

1 1

1 0 NOR 1

1 1

1 1 I/C 2,3,4, 6,7 5,7,8 8

4 4 2 MAJ 5

6 2

2 2 1 TS 0

2 2

ES-301 Transient and Event Checklist Form ES-301-5 Facility:

Callaway Date of Exam: 2/14/2022 Operating Test No. 2022-1 A

P P

L I

C A

N T

E V

E N

T T

Y P

E Scenarios - Team 4: I5, R6, Surrogate(S1) 1 (Spare) 2 (Monday 2/14) 3 (Tuesday 2/15) 4 (Wednesday 2/16)

T O

T A

L M

I N

I M

U M(*)

CREW POSITION CREW POSITION CREW POSITION CREW POSITION S

R O

A T

C B

O P

S R

O I5 A

T C

R6 B

O P

S1 S

R O

S1 A

T C

I5 B

O P

R6 S

R O

A T

C B

O P

R I

U I5 RX

(*)

1 1 0 NOR 1

1 2

1 1 1 I/C 2,3,4

,6,7 3,4,5

,6 9

4 4 2 MAJ 5

7 2

2 2 1 TS 2,4 2

0 2 2 R6 RX

(*)

1 1 0 NOR

(*)

1 1 1 I/C 2,4, 6

2,4,5

,6 7

4 4 2 MAJ 5

7 2

2 2 1 TS 0

2 2

ES-301 Transient and Event Checklist Form ES-301-5 Instructions:

1.

Check the applicant level and enter the operating test number and Form ES-D-1 event numbers for each event type; TS are not applicable for RO applicants. ROs must serve in both the at-the-controls (ATC) and balance-of-plant (BOP) positions. Instant SROs (SRO-I) must serve in both the SRO and the ATC positions, including at least two instrument or component (I/C) malfunctions and one major transient, in the ATC position. If an SRO-I additionally serves in the BOP position, one I/C malfunction can be credited toward the two I/C malfunctions required for the ATC position.

2.

Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.5.d) but must be significant per Section C.2.a of Appendix D. (*) Reactivity and normal evolutions may be replaced with additional I/C malfunctions on a one-for-one basis.

3.

Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicants competence count toward the minimum requirements specified for the applicants license level in the right-hand columns.

4.

For new reactor facility licensees that use the ATC operator primarily for monitoring plant parameters, the chief examiner may place SRO-I applicants in either the ATC or BOP position to best evaluate the SRO-I in manipulating plant controls.

NOTES:

ES-301 Competencies Checklist Form ES-301-6 Instructions:

Check the applicants license type and enter one or more event numbers that will allow the examiners to evaluate every applicable competency for every applicant. (This includes all rating factors for each competency.) (Forms ES 303 1 and ES 303 3 describe the competency rating factors.)

Facility: Callaway Date of Examination: Week of 2/14/2022 Operating Test No.: 2022-1 APPLICANTS RO SRO-I Competencies SCENARIO#

SCENARIO#

1 (Spare) 2 3

4 1

(Spare) 2 3

4 Interpret/Diagnose Events and Conditions 2,3,4,5, 6,7 2,3,4,5, 6,7 2,3,4,5

,6,7 2,3,4,5, 6,7,8 2,3,4,5, 6,7 2,3,4,5

,6,7 2,3,4,5

,6,7 2,3,4,5, 6,7,8 Comply with and Use Procedures (1) 1,2,3,4, 5,6,7 1,2,3,4, 5,6,7 1,2,3,4

,5,6,7 1,2,3,4, 5,6,7,8 1,2,3,4, 5,6,7 1,2,3,4

,5,6,7 1,2,3,4

,5,6,7 1,2,3,4, 5,6,7,8 Operate Control Boards (2) 1,2,3,4, 5,6,7 1,2,3,4, 5,6,7 1,2,3,4

,5,6,7 1,2,3,4, 5,6,7,8 1,2,3,4, 5,6,7 1,2,3,4

,5,6,7 1,2,3,4

,5,6,7 1,2,3,4, 5,6,7,8 Communicate and Interact 1,2,3,4, 5,6,7 1,2,3,4, 5,6,7 1,2,3,4

,5,6,7 1,2,3,4, 5,6,7,8 1,2,3,4, 5,6,7 1,2,3,4

,5,6,7 1,2,3,4

,5,6,7 1,2,3,4, 5,6,7,8 Demonstrate Supervisory Ability (3)

Note 3 1,2,3,4, 5,6,7 1,2,3,4

,5,6,7 1,2,3,4

,5,6,7 1,2,3,4, 5,6,7,8 Comply with and Use TS (3) 3,4 2,4 2,4 2,5 Notes:

(1)

Includes TS compliance for an RO.

(2)

Optional for an SRO-U.

(3)

Only applicable to SROs.

• See RO competencies if SRO-I is in the ATC or BOP position for that scenario

1. Candidates Exam Week Site / Docket # / Insp Rpt #

RO LSRO SROI SROU Type Exam Author Chief Examiner Examiners Assigned 02/13/2022 Callaway / 05000483 / 2022301 CAC #: 000500 6

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0 FB-OR-INITIAL LICENSE EXAM ADMINIS TRATION (EXAD)

NFF Kirkland, John Farina,Thomas Hayes,Mahdi Kirkland,John You,David Page 1 of 4 2/1/2022 1:53:06 PM Orgs: ALL Sites: CALL Exam Author: ALL Activity Codes: EXAD IP 21 Operator Licensing Exam Schedule Phase Code: 2 - Construction, 5 - Operational Region: 4 From 02/01/2022 to 02/28/2022

Summary by Date RO SROI SROU LSRO Total 02/2022 6

5 0

0 11 Page 2 of 4 2/1/2022 1:53:06 PM Orgs: ALL Sites: CALL Exam Author: ALL Activity Codes: EXAD IP 21 Operator Licensing Exam Schedule Phase Code: 2 - Construction, 5 - Operational Region: 4 From 02/01/2022 to 02/28/2022

Summary by Site RO SROI SROU LSRO Total Callaway 6

5 0

0 11 Page 3 of 4 2/1/2022 1:53:06 PM Orgs: ALL Sites: CALL Exam Author: ALL Activity Codes: EXAD IP 21 Operator Licensing Exam Schedule Phase Code: 2 - Construction, 5 - Operational Region: 4 From 02/01/2022 to 02/28/2022

Summary by Region RO SROI SROU LSRO Total Region 4 6

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0 11 Page 4 of 4 2/1/2022 1:53:06 PM Orgs: ALL Sites: CALL Exam Author: ALL Activity Codes: EXAD IP 21 Operator Licensing Exam Schedule Phase Code: 2 - Construction, 5 - Operational Region: 4 From 02/01/2022 to 02/28/2022

ES-201 Examination Security Agreement Form ES-201-3

1.

Pre-Examination I acknowledge that I have acquired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of 7./~<?m:)_...,u,_~~~ the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who h e not bee authorized by the NRC's chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC's chief examiner any indications or suggestions that examination security may have been compromised.

2.

Post-Examination rn To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered N during the week(s) of -z/ 1-tf\\-,-~ 1~?i"'"l,ifrom the date that I entered into this security agreement until the completion of examination administration, I did

~ not instruct, evaluate, or provide pe o mance feedback to those applicants who were administered these licensing examinations, except as specifically

-u noted below and authorized by the NRC.

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~

PRINTED NAME JOB TITLE/RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2)

DATE NOTE

(,)

ES-201, Page 31 of 32

ES-201 Examination Security Agreement Form ES-201-3

1.

Pre-Examination I acknowledge that I have acquired specialized knowledge about the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of '1/ J ';i.,,, _..., y,~,__l-as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who h e not bee authorized by the NRC's chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures} and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC's chief examiner any indications or suggestions that examination security may have been compromised.

2.

Post-Examination 8J To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered

~ during the week(s) of 11/ 1~/'1? -?2(,p/,i!L.From the date that I entered into this security agreement until the completion of examination administration, I did

~ not instruct, evaluate, or povide perf6rmance feedback to those applicants who were administered these licensing examinations, except as specifically

-u noted below and authorized by the NRC.

n>

co Cl)

JOB TITLE/RESPONSIBILITY SIGNATURE (1)

ES-201, Page 31 of 32 DATE NOTE

ES-201 Examination Security Agreement Form ES-201-3

1.

Pre-Examination I acknowledge that I have acquired specialized knowledge about-the U.S. Nuclear Regulatory Commission (NRC) licensing examinations scheduled for the week(s) of *:d\\:::tl:n ~7;t_o/1'"\\..as of the date of my signature.

I agree that I will not knowingly divulge any information about these examinations to any persons who ha"lie not b e authorized by the NRC's chief examiner.

I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC (e.g., acting as a simulator booth operator or communicator is acceptable if the individual does not select the training content or provide direct or indirect feedback). Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee.

I will immediately report to facility management or the NRC's chief examiner any indications or suggestions that examination security may have been compromised.

2.

Post-Examination ill To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered

~ during the week(s) of n 4 "1From the date that I entered into this security agreement until the completion of examination administration, I did

~ not instruct, evaluate, or rovide pe o mance feedback to those applicants who were administered these licensing examinations, except as specifically

-u noted below and authorized by the NRC.

Ill

<C CD PRINTED NAME s: 1. ('td~ t"" btid=::s:

w 2. TfM,4~ -,re&f.lo,J

....,. 3. CWN ~W

4. _______ _

5. _______ _

6. _______ _

?. _______ _

8. _______ _

9. _______ _

10. _______ _

11. _______ _

12. _______ _

13. _______ _

14. _______ _

15~. -------

NOTES:

JOB TITLE/RESPONSIBILITY SIGNATURE (1)

DATE DATE NOTE ES-201, Page 31 of 32