ML22195A189
| ML22195A189 | |
| Person / Time | |
|---|---|
| Issue date: | 08/30/2022 |
| From: | Bezakulu Alemu Policy and Oversight Branch |
| To: | |
| Alemu B | |
| Shared Package | |
| ML22189A141 | List: |
| References | |
| Download: ML22195A189 (2) | |
Text
Page of NRC FORM 361A (07-13-2022)
U.S. NUCLEAR REGULATORY COMMISSION OPERATIONS CENTER FUEL CYCLE AND MATERIALS EVENT NOTIFICATION WORKSHEET APPROVED BY OMB: NO. 3150-0238 EXPIRES: 10/31/2022 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.
NRC FORM 361A (07-13-2022)
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 Facility or Organization License #
Name of Caller/Title Call Back #
Event Time & Zone Event Date Location of Event (Include County and State)
Portion of Plant Affected (If applicable)
EVENT CLASSIFICATIONS GENERAL EMERGENCY*
SITE AREA EMERGENCY ALERT NOTIFICATION OF UNUSUAL EVENT*
INCIDENT REPORT TRANSPORATION EVENT INFORMATION ONLY EVENT TYPES FUEL CYCLE MEDICAL / ACADEMIC TRANSPORTATION WASTE MANAGEMENT INDUSTRIAL/ COMMERCIAL FOREIGN EVENT OTHER (Specify)
OTHER (Specify)
INCIDENT REPORTS (30.50, 40.60, 70.50) 20.2201 LOSS / THEFT 20.2202 ACTUAL / THREATENED OVEREXPOSURE 20.2202 ACTUAL / THREATENED RELEASE 21.21 DEFECT / NONCOMPLIANCE 26.791 FITNESS FOR DUTY 35.3045 MEDICAL EVENT 36.83 IRRADIATOR EVENT 39.77 RUPTURED WELL LOGGING SOURCE 39.77 IRRETRIEVABLE WELL LOGGING SOURCE 40.26 TAILINGS / WASTE DAM FAILURE (a) PROTECTIVE ACTION PREVENTED (b)(1) UNPLANNED CONTAMINATION (b)(2) SAFETY EQUIPMENT FAILURE (b)(3) MEDICAL TREATMENT WITH CONTAMINATION (b)(4) FIRE / EXPLOSION 70.52 ACTUAL / ATTEMPTED THEFT APPENDIX A, 1-Hour APPENDIX A, 24-Hour CONCURRENT REPORT 70.52 CRITICALITY / SNM LOST
- ONLY UNDER OLD 1981 ORDER NOTIFICATIONS NRC REGION YES NO WILL BE STATE(s)
LOCAL OTHER GOVERNMENT AGENCIES PRESS RELEASE Anything Unusual or not understood?
Yes (Explain below)
No Did all systems function as required?
Yes No (Explain below)
Additional Information on page 2?
Yes No 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)
PHYSICAL SECURITY
Page of NRC FORM 361A (07-13-2022)
FUEL CYCLE AND MATERIALS EVENT NOTIFICATION WORKSHEET (Continued)
U.S. NUCLEAR REGULATORY COMMISSION OPERATIONS CENTER NRC FORM 361A (07-13-2022)
EN #
RADIOLOGICAL / CHEMICAL RELEASES: CHECK OR FILL IN APPLICABLE ITEMS Isotope Activity Physical Form Chemical Form Stack Liquid Effluent Other (Specify)
Monitor Reading Alarm Setpoint Event Description (Continued) (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.)
ONGOING RELEASE TERMINATED RELEASE OFFSITE RELEASE ONSITE AREAS EVACUATED OFFSITE PROTECTIVE ACTION RECOMMENDED PERSONNEL EXPOSURE / CONTAMINATION DATA Number of Personnel Exposed Maximum External Dose Maximum Internal Dose Critical Organ (if known)
Critical Organ (if known)
Maximum Internal Level Maximum External Level Number of Personnel Contaminated Number and Types of controls necessary under normal operating conditions Number and Types of controls which functioned properly under upset conditions Number and Types of controls necessary to restore a safe situation Safety Significance of Events Safety Equipment Status Status of Corrective Actions