PLA-2829, Rev 3 to Emergency Plan Implementing Procedure EP-IP-032, General Ofc Activation & Rev 5 to EP-IP-033, Dose Assessment & Protective Actions. W/Revised Lists of Effective Pages &

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Rev 3 to Emergency Plan Implementing Procedure EP-IP-032, General Ofc Activation & Rev 5 to EP-IP-033, Dose Assessment & Protective Actions. W/Revised Lists of Effective Pages &
ML20205R888
Person / Time
Site: Susquehanna  Talen Energy icon.png
Issue date: 03/24/1987
From: Hagan D, Keiser H
PENNSYLVANIA POWER & LIGHT CO.
To:
NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I)
References
PLA-2829, PROC-870324, NUDOCS 8704060471
Download: ML20205R888 (42)
v • d • e


Text

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Q Pennsylvania Power & Light Company Two North Ninth Street

  • Allentown, PA 18101 = 215 / 7705151 Harold W. Keiser Vice President-Nuclear Operations 215/770-7502 March 24, 1987 Administrator - Region I U. S. Nuclear Regulatory Comission 631 Park Avenue King of Prussia, PA 19406 q 3g(

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SUSQUEHANNA STEAM ELECTRIC STATION -

EP IMPLEMENTING PROCEDURE REVISIONS CCN 741328 FILE AIS PLA- 2829 R41-2A

  • Gentlemen:

In accordance with the requirements of 10CFR50 Appendix E, attached are copies of the latest approved Susquehnna steam Electric Station Emergency Plan Implementing Procedure Change Approval Forms, (PCAF's), and/or permanent test revisions to the Emergency Plan Implementing Procedures.

, Very truly yours,

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uW1 Harold W.k eiser Vice President - Nuclear Ooerations JSR:sr Attachments cc: Administrator - Region I (2)

U.S. Juclear Regulatory Commission 631 Park Avenue King of Prussia, PA 19406 Document Control Desk (1)

U. S. Nuclear Regulatory Comission Washington, D.C. 20555 NRC Resident Inspector Susquehanna SES S&A Building 8704060471 870324 DR ADOCK 05000387 {

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' ' ',. ., i. .,,,*J . *.,..3. . ... .  : ." e Revision 120, Effect. Date 03/24/87 Page 1 of 2 TABLE OF CONTENTS EMERGENCY PLAN IMPLEMENTATI0t,4 PROCEDURE MANUAL PROCEDURE EFFECTIVE UUdBEB___ __________IIILE_________________________ BEVISIQU DoIE_____

EP-IP-001 Emergency Classification 5 03/06/87 EP-IP-002 Emergency Management Not i fica t ions 2 7 10/02/86 EP-IP-006 Search / Rescue /First Aid i 8/26/86 EP-IP-007 Personnel Assembly and Accountability 9 12/02/86 and Site Evacuation EP-IP-009 Emergency Of f-Si te Dose Ca lcu la t ions 7 09/26/86

(]P-IP-011 V

Security Contingency and Emergency. 2 12/10/86 Access EP-IP-012 On-Site Emergency Monitoring 5 01/16/87 EP-IP-013 Nearsite and Offsite Emergency Monitoring 5 10/27/86 Teams EP-IP-016 In-Plant (INDIA) Team Management 1 07/20/04 EP-IP'Oi7 Hazardous Material Release Response 2 04/22/85 During an Emergency EP-IP-019 Management of Nearsite and Offsite 5 03/23/87 Emergency Monitoring Teams EP-IP-022 Shift Turnover During an Emergency 0 12/20/83 EP-IP-027 Activation of Restoration Organization 1 05/31/84 EP-IP-029 Activation of TSC 2 04/15/86 EP-IP-030 Activation and Functional Operation  ; 8 03/16/87 of Emergency Operations Facilit'y and Transfer of Control From the Technical Support Center Public Information Emergency Procedures 2 09/23/86

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ZP-IP-032 General Office Activation ,- g 3 03/24/87 Yi -

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Page'2 of 2 PROCEDURE -

EFFECTIVE NUMBE8___ __________ IIILE_________________________ REVISION DeIE_____

EP-IP-033 Dose Assesstaent and Protective Actions 5 03/24/87 EP-IP-034 Reactor Building Sampte Station 5 01/13/87 Emergency Sampling EP-IP-035 Emergency Vent Monitor Sampling 5 . 04/14/86 EP-IP-038 Reconstruction and Accident Close Out 2 05/19/86 EP-IP-042 In-Plant and EOF Chemistry Lab 4 02/27/87 Emergency Preparati,on EP-IP-043 Pass Staa L L Vo Lume Liquid Samp te 5 04/07/86 EP-IP-044 Emergency Environmental Sampling 5 03/03/86 EP-IP-045 Pass 14.7/ML Gas Sample 8 04/07/86 (jP-IP-046

_ Pass Iodine / Particulate Sample 6 03/21/86 EP-IP-047 Pass Large Liquid / Dissolved Gas Samp Le 4 04/22/85 EP-IP-048 Est i saa t i on of Core Datoage Dur i ng an 3 12/12/86 Emergency EP-IP-051 Radioactive Sample Transport 1 09/19/84 During an Emergency EP-IP-052 Backup EOF Activation 1 04/24/86 EP-IP-053 Emergency Liquid Release Samp ling 3 03/23/87 and Ca lc u la t i ons EP-IP-054 Offsite Monitoring Vehicle CaLLout i 12/02/86

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FORMS INDEX EMERGENCY PLAN IMPLEMENTATION PROCEDURE MANUAL EFFECT.

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EP-IP-002-1 Incident Form 3 09/03/86 EP-IP'002-2 Radiological Assessment Form 5 10/02/86.

EP-IP-006-1 Susquehanna Steam Electric Station 0 08/26/86 First Aid Data Sheet (Print)

EP-IP-006-2 Ambulance / Hosp i ta L Med ica L Emergency 0 08/26/06 Data Sheet EP-IP-009-1 Of fsi te Dose Ca lcula t ion 2 10/14/83 Worksheet EP-IP-009-2 Overlay Ca'Lculation Worksheet 2 07/02/86

- P-IP-009-3 Population Dose Worksheet 0 10/14/83 EP-IP-009-4 Back Calculation Worksheet O 10/14/83 EP-IP-Oi2-1 On-Site Monitoring Team Data Sheet 2 01/16/87 EP-IP-012-2 HP Radio Oscar Log 0 05/01/86 EP-IP-013-3 Air Sample Dat'a Sheet - Nearsite Monitoring i 10/27/86 EP-IP-013-4 Radiation Survey and SRD Data 2 10/27/86 l l

EP-IP-013-6 Air Sampte Data Sheet - Offsite Monitoring 0 10/27/86 EP-IP-016-1 In-Plant (INDIA) Team Log 0 07/20/84 EP-IP-Oi9-1 Emergency Monitoring Team i 12/12/86 Exposure Tracking Form EP-IP-019-2 Emergency Monitoring Team Status i 12/12/86 and Data Tracking Form EP-IP-Oi9-3 Emergency Monitoring Tean i 12/12/06 Briefing Sheet Radiation Survey - SRD - Air Sample Data 0 12/12/86

( M-IP-019-4 EP-IP-022-1 Nuclear Emergency Repsonse Organization 0 12/20/83

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Shift Turnover Checklist EP-IP-030-v E.O.F. Access / Egress Log 0 03/09/84 EP-IP-030-3 E.O.F. Message Sheet 0 03/09/84 EP-IP-030-4 Technical Problems Priority List 0 03/16/87 EP-IP-030-5 In-Plant Rad Data 0 03/16/87 EP-IP-031-1 PIEP Change 0 09/23/86 EP-IP-033-1 Emergency Exposure Extension 3 03/24/87 Request EP-IP-033-2 Issuance of Potassium Iodide 1 03/24/87 EP-IP-034-1 Reactor Building Sampte Station i 01/06/84

. Emergency Samp l i ng Data Sheet

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2P- I P-035-1 Vent Monitor Data Sheet 2 01/06/86 EP-IP-035-2 Vent Monitor Sample Data Sheet 0 06/i6/82 EP-IP-035-3 PAVSS Data Sheet 0 01/06/86 EP-IP-043-1 Pass Small Volume Liquid Sample 4 04/07/86 Data Sheet EP-IP-043-2 Valve Positions O 04/07/86 l

EP-IP-043-3 Hand Switch Positions O 04/07/86 EP-IP-045-1 Pass 14.7-ML Gas Sampte Data Sheet 4 04/07/86 EP-IP-045-2 Valve Positions 0 04/07/86 EP-IP-045-3 Hand Switch Positions 0 04/07/86 EP-IP-046-1 Pass Iodine / Particulate 2 04/22/85 Sampte Data Sheet EP-IP-047-1 Dissolved Gas Sampte Data Sheet . 3 04/22/G5 EP-IP-048-1 Basic Data Needed to Compute Isotope 1 12/12/86 l O Correction Factors I

' s' EP-IP-048-2 Computation of the Corrected Fission i 12/12/86

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Product Concentrations EP-IP-048-3 Cornputat ion of Inventory Correction i 12/12/86 Factor for Intertned i a te and Long-L i ved Fission Products EP-IP-048-4 S urntna r y of Core Darnage Est iraates 2 12/12/86 EP-IP-048-5 Data Forrn 1 04/22/85 EP-IP-048-6 Inventory Estimate of Short i 12/12/86 Lived Isotope EP-IP-048-7 Computat ion of the Actua L Fission 0 11/21/84 Product Inventory EP-IP-048-8 NRC Core Darnage Index i 04/22/05 EP-IP-048-9 Pre L iin i nar y Core Darnage Est i rna te 0 12/12/86 -

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SUSQUEHANNA STEAM ELECTRIC STATION EP-IP-032 Revision 3 GENERAL OFFICE ACTIVATION Page 1 of 6 EFFECTIVE DATE ,3, cWfK7 EXPIRATION DATE 3 2t/!f 9 ,

REVISED EXPIRATION DATE PROCEDURE TYPE: (Check only one) PORC NON-PORC REVIEW TYPE: (Check only one) PORC ALTERNATE EXPEDITED PORC MTG. NO. Ol- OO ,

I (N/A 1f NON-PORC or ALTERN. REV)

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-. . Page 2 of 6 1-j TABLE OF CONTENTS SECTION . PAGE 1.0 PURPOSE 3 t'

2.0 SCOPE 3 l

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3.0 REFERENCES

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! 4'.0 RESPONSIBILITIES 3 1

. 5.0 DEFINITIONS 3 j 6.0 INSTR'JCTIONS 4 i

ATTACHMENTS I

ATTACHMENT PAGE

! A ACTION STEP - General Office Support Manager 5 l .

General 0ffice Support Coordinator t

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B ACTION STEP - G.O. Engeneering Support Leader 6 ESL Caller l

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EP-IP-032 Revision 3 '

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- Page 3 of 6 I.0 PURPOSE .

To describe the method of activating the ALLENTOWN GENERAL OFFICE in support of an emergency at the SUSQUEHANNA STEAM ELECTRIC STATION.

2.0 SCOPE The scope of this instruction pertains to the activation of GENERAL' 0FFICE facilities and personnel in the event of an emergency condition at the SUSQUEHANNA STEAM ELECTRIC STATION.

3.0 REFERENCES

Susquehanna Steam Electric Station Emergency Plan 4.0 RESPONSIBILITIES 4.1 It is the responsibility of the GENERAL OFFICE SUPPORT MANAGER (GOSM) to report to the GENERAL OFFICE NUCLEAR EMERGENCY SUPPORT CENTER (GONESC) in Allentown and place the facility in service. -

4.2 It 1.s the responsibility of the GENERAL OFFICE SUPPORT COORDINATORS (GOSC) to contact ADMINISTRATIVE SUPPORT PERSONNEL for the General Office. In addition, the GOSC will assume the duties of the GOSM until relieved by the GOSM.

4.3 It is the responsibility of the GENERAL OFFICE ENGINEERING SUPPORT LEADER (GOESL) to report to the GENERAL OFFICE ENGINEERING SUPPORT CENTER (GOESC) in Allentown and place the facility in service.

4.4 It is the responsibility of the GENERAL OFFICE ENGINEERING SUPPORT LEADER CALLER (ESL CALLER) to contact the staff and key technical "on-the-floor" resources for the GOESC.

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4.5 It is the responsibility of the SECURITY CONTROL CENTER CONTROLLER to contact the CENTRAL, LEHIGH, and SUSQUEHANNA DIVISION SERVICE DISPATCHERS to page the on-call General Office Nuclear Emergency Response Organization.

5.0 DEFINITIONS ,

5.1 GENERAL OFFICE NUCLEAR EMERGENCY SUPPORT CENTER (GONESC) - the focal point for communication and data transfer between the Susquehanna Site, i PP&L corporate management and employees, and certain outside agencies  ;

and contractors (i.e., INPO, Bechtel, GE).

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_O Page 4 of 6 5.2 GENERAL OFFICE ENGINEERING SUPPORT CENTER (GOESC) - the focal point for activation of Nuclear Plant Engineering resources in support of technical problem resolution. -

6.0 INSTRUCTIONS 6.1 The GOSM and/or GOSC will follow the instructions in Attachment A, GENERAL OFFICE NUCLEAR EMERGENCY SUPPORT CENTER (GONESC) ACTIVATION.

6.2 The GOESL or ESL CALLER will follow the instructions in Attachment B, GENERAL OFFICE ENGINEERING SUPPORT CENTER (GOESC) ACTIVATION.

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ACTION STEP EP-IP-032 (m-}/ ' GENERAL OFFICE SUPPORT MANAGER Revision 3 .

GENERAL 0FFICE SUPPORT COORDINATOR Page 5 of 6 CHECK .

A.1.0 .Upon notification to activate the G0NESC, the GENERAL OFFICE SUPPORT MANAGER and the GENERAL OFFICE SUPPORT COORDINATORS will:

A.1.1 Notify appropriate CORPORATE, SECURITY, and BUILDING DEPARTMENT personnel of the emergency.

A.1.2 Verify that communications equipment are operable.

A.1.3 Establish communications with INPO and other outside

organizations as appropriate.

A.1.4 Verify that call-out system of on-call personnel has been completed, that appropriate personnel have been notified, and that the designated personnel are enroute to the EMERGENCY OPERATIONS FACILITY (EOF). (If not, identify best qualified replacement).

A.I.5 Ensure liaison with the GENERAL OFFICE ENGINEERING SUPPORT 4 LEADER (GOESL). .

'- A.1.6. Notify SYSTEMS AND COMPUTER SERVICES that STAIRS, TSO and DDMS SYSTEMS will be required for'the duration of the EMERGENCY. INSTRUCT them to notify you if STAIRS, TSO or DDMS are unavailable or become unavailable for any reason.

A.1.7 Keep CORPORATE MANAGEMENT personnel informed of developments.

A.1.8 Establish and maintain liaison with the EOF and TECHNICAL SUPPORT CENTER (TSC).

A.1.9 Verify that clerical support function is in place.

A.1.10 Establish and maintain log books.

A.1.11 Direct SUSQUEHANNA RECORDS MANAGEMENT SYSTEM to have personnel available for records retrieval as required. H A.1.12 Maintain current status of technical information received.

A.1.13 Arrange for and coordinate assistance from GENERAL OFFICE and outside urganizations as requested by the EMERGENCY DIRECTOR or the RECOVERY MANAGER.

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Attachment B EP-IP-032 A,O -

Revision 3 -

Page 6 of 6 ACTION STEP ENGINEERING SUPPORT-LEADER ESL CALLER CHECK B.1.0 Upon notification to activate the GOESC, the ENGINEERING SUPPORT -

LEADER via the ESL CALLER (who is notified automatically) will: ,

B.1.1 Notify-G0ESL staff to report.

B.1.2 Notify key technical "on-the-floor" resources. .

B.1.3 Verify that these functions are in place:

a. Data Link
b. Log Keeper
c. GOSM Liasion B.1.4 Notify GOSM when GOESL Group is functionally, operational.

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SUSQUEHANNA STEAM ELECTRIC STATION EP-IP-033 00SE ASSESSMENT AND PROTECTIVE ACTIONS Revision 5 Page 1 of 30 EFFECTIVE DATE 3 t/ 6? EXPIRATIONDATE3I7v!89 REVISED EXPIRATION DATE PROCEDU,RE TYPE: (Check only one) PORC NON-PORC REVIEW TYPE: (Check only one) PORC ALTERNATE EXPEDITED N 0 OR or AL ERN, REV) ',

l l CO NTR0Li_E) 9 Prepared by wI Date [b dA 87 Reviewed by  !/_/_Ierusm Date Sf&ff7 i Recommended'i / 6, . d,/ e, w m 0 ate R /e 7 3ectfori Read /Mina er ~/ /

Approved .

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EP-IP-033

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is Revision 5 Page 2 of 30 TABLE OF CONTENTS SECTION PAGE 1.0 PURPOSE 4 2.0 SCOPE 4

3.0 REFERENCES

4 4.0 RESPONSIBILITIES 4 5.0 DEFINITIONS 5 6.0 INSTRUCTIONS 6 l

ATTACHMENTS ATTACHMENT PAGE A Action Step - Emergency Director 8

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B Ac' tion Step - Recovery Manager 10 -

C Action Step - Radiation Protection Coordinator 11 0 Action Step - Radiation Support Manager 13 E Action Step - OSC/TSC Coordinator 15 F Public Dose Assessment and Protective Action -

16 Recommendation Guide Table F-1, Protective Action Guidelines 19 Table F-2, Evacuation Time Estimates 20 Table F-3, Flow Chart for Arriving at Protective 21 Action Decision 1

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ATTACHMENT PAGE G PP&L Emergency Personnel Dose Assessment and 22 Protective Action Recommendation Guide H Health Physics and ALARA Considerations 26 During Emergencies I Emergency Dose Extension Authorizations 28 J Emergency Exposure Extension Request, 29 Form EP-IP-033-1 K Issuance of Potassium Iodide, Form EP-IP-033-2 30 V

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- . EP-IP-033

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j 1.0 PURPOSE This procedure provides guidance in assessing radiation doses and determining appropriate protective actions.- .

2.0 SCOPE ,

This procedure applies only to radiation exposures of the public and i

emergency response personnel of PP&L resulting from emergency conditions at 1 SSES. ,

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3.0 REFERENCES

i 3.1 ICRP Publication 28, The Principles and General Procedures for Handling Emergency and Accidental Exposures of Workers. International Commission on Radiation Protection, 1978.

j 3.2 NCRP Report 39, Basic Radiation protection Criteria, National Council j on Radiation Protection and Measurements, 1971. ,

3.3 NCRP Report 55, Protection of the Thyroid Gland in the Event of i

() Releases of Radiciodine, National Council on Radiation Protection and Measurements, 1977. .

3.4 SSES Emergency Plan . .

t 3.5 Environmental Protection Agency Manual of Protective Action Guides and i

Protective Actions for Nuclear Incidents, 1979.

3.6 NOI-6.4.2. ALARA Policy and Program 1

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3.7 NOI-6.4.3, Personnel Radiation Exposure Policy 3.8 EP-IP-030, Activation and Functional Operation of the Emergency Operations Facility and Transfer of Control from the Technical Support  !

Center. j 3.9 EP-IP-044, Emergency Environmental Sampling I 3.10 EP-IP-053, Emergency Liquid Release Sampling and Calculations 4.0 RESPONSIBILITIES i 4.1 It is the responsibility of the SHIFT SUPERVISOR / EMERGENCY DIRECTOR to

! make a recommendation to the Bureau of Radiation Protection for a l protective action to limit deses to the public following an accidental release of radioactive materials from SSES. This responsibility is j (]) maintained until relieved by the RECOVERY MANAGER.

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4.2 It is the responsibility of the SHIFT SUPERVISOR / EMERGENCY DIRECTOR to

! authorize emergency exposures for in plant emergency pers annel in j ,

combatting the EMERGENCY.

4.3 It is the responsibility of the OSC/TSC COORDINATOR to identify in- -

j plant efforts which have a significant potential for over-exposure and i to not'ify the SHIFT SUPERVISOR / EMERGENCY DIRECTOR for a decision on the urgency for carrying out such efforts and an emergency exposure '

authorization if required.

4.4 It is the responsibility of the RADIATION PROTECTION COORDINATOR ,to: )

3 4.4.1 Assess in plant radiological conditions and advise the' SHIFT -

SUPERVISOR / EMERGENCY DIRECTOR on emergency exposures and on '

l 1 methods to limit personnel doses to ALARA.

i j 4.4.2 Assess real and potential off-site radiological conditions

,1 and recommend to the SHIFT SUPERVISOR / EMERGENCY DIRECTOR a

PROTECTIVE ACTION to protect the public until relieved by the J EOF SUPPORT MANAGER or the RADIATION SUPPORT MANAGER.

4.5 It is the responsieiiity of aii emergency personnei to monitor their -

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exposures and notify health physics personnel or their appropriate COORDINATOR / MANAGER.

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.i 4.6 It is the responsibility of the EOF SUPPORT MANAGER to assess real and i- potential off-site radiological conditions and recommend a PROTECTIVE i ACTION and alternatives to the EMERGENCY DIRECTOR to protect the i public, EOF personnel and EMERGENCY MONITORING TEAMS. This l ' responsibility is maintained until the EOF SUPPORT MANAGER is relieved j by the RADIATION SUPPORT MANAGER.

4.7 It is the responsibility of the RECOVERY MANAGER to:

l 4.7.1 Relieve the EMERGENCY DIRECTOR and assume the responsibility

! to make a recommendation to the Department of Environmental j Resources / Bureau of Radiation Protection (DER /BRP) for a i PROTECTIVE ACTION to limit doses to the public following an j accidental release of radioactive materials from SSES.

i 4.7.2 Authorize actions to reduce exposure for off-site emergency

! personnel employed by PP&L in combatting the EMERGENCY.

4.8 It is the responsibility of the RADIATION SUPPORT MANAGER to assess i real and potential off-site radiological conditions and reenmmend a 1

PROTECTIVE ACTION and alternatives to the RECOVERY MANAGER to protect j the public, EOF personnel and EMERGENCY MONITORING TEAMS.

EP-IP-033

, p Revision 5 l v Page 6 of 30 5.0 DEFINITIONS 5.1 ALARA - As Low As Reaso'nably Achievable 5.2 OER/BRP - Department of Environmental Resources / Bureau of Radiation P,rotection 5.3 Emergency Actions - actions required to protect or save lives, eliminate or control effluent releases, or protect or' repair vital equipment.

5.4 Emergency Exposure planned or voluntary exposures of personnel to doses exceeding 2500 mrem per quarter.

5.5 Emergency Planning Boundary (EPB) - corresponds to PP&L legal site boundary with the exception of sectors bordering on Route 11. With

  • respect to these sectors, Route 11 is used as the perimeter of the EPB.

The EPB locations will be use'd when projecting dose to the public and thus for public protective action recommendations.

5.6 Emergency Platining Zone (EPZ) - There are two Emergency Planning Zones.

O The first is an area, approximately ten (10) miles in radius around the Susquehanna SES for which emergency planning consideration of the plume exposure pathway has been given in order to ensure that prompt and effective actions can be taken to protect the -public in the event of an accident. The second is an area approximately 50 miles in radius around SSES, for which emergency planning consideration of the

! ingestion exposure pathway has been given.

5.7 KI - potassium Iodide j

I 5.8 Legal Site Boundary - the outermost perimeter of all PP&L* owned I property surrounding the Susquehanna Steam Electric Station.

5.9 OSCAR Monitoring Locations predesignated locations in each sector where plant health physics personnel perform boundary monitoring.

5.10 PAG - Protective Action Guide.

5.11 PING - Particulate, Icdine, Noble Gas 6.0 INSTRUCTIONS 1

l 6.1 When EMERGENCY conditions warrant, the SHIFT SUPERVISOR / EMERGENCY I DIRECTOR will follow the instructions provided in Attachment A, Action Step - SHIFT SUPERVISOR / EMERGENCY DIRECTOR.

6.2 When EMERGENCY conditions warrant, the RECOVERY MANAGER will follow the

O instructions provided in Attachment B, Action Step - RECOVERY MANAGER.

EP-IP-033

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Revision 5 Page 7 of 30 6.3 The RADIATION PROTECTION COORDINATOR will follow the instructions provided in Attachment C, Action Step - RADIATION PROTECTION COORDINATOR.

6,4 The RADIATION SUPPORT MANAGER will follow the instructions provided in*

Attachment 0, Action Step - RADIATION SUPPORT MANAGER.

6.5 When in plant EMERGENCY teams are needed, the OSC/TSC COORDINATOR will follow the instructions provided in Attachment E, Action Step - OSC/TSC COORDINATOR. .

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(_) EP-IP-033 Revision 5 '

Page 8 of 30 ACTION STEP SHIFT SUPERVISOR / EMERGENCY DIRECTOR CHECK A.1.0 Upon identification of real or potential 0FF-SITE doses, the SHIFT SUPERVISOR / EMERGENCY DIRECTOR will:

A.1.1 Consult with the HP SUPERVISOR / RADIATION PROTECTION COORDINATOR to arrive at a PROTECTIVE ACTION recommendation to protect the PUBLIC using the guide presented in Attachment F.

A.1.2 Notify DER /BRP of PROTECTIVE ACTION recommendation.

A.1.3 Periodically review applicability of the recommendation.

A .1. '4 Renotification of DER /BRP is required:

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a. Following any subsequent reclassification of the EMERGENCY.

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b. Following any change in PROTECTIVE ACTION recommendation,
c. Every 30 minutes or af ter any significant event other than A.1.4 a or b.

A.1.5 Upon signific2nt change in emergency conditions affecting 0FF-SITE doses, reassess protective action recommendation.

A.2.0 Upon identification of a .ituation where IN-PLANT exposures are anticipated to be greater than the administrative exposure objectives in Attachment I, the SHIFT SUPERVISOR / EMERGENCY DIRECTOR will:

A.2.1 Examine and determine with the appropriate COORDINATORS the necessity to exceed the administrative exposure objectives.

A.2.2 Consult with the HP SUPERVISOR / RADIATION PROTECTION COORDINATOR.

A.2.3 Provide written authorization of extension and document on Form EP-IP-033-1.

A.2.4 If the doses are expected to exceed 2500 mrem, apply EMERGENCY exposure considerations (see Attachment G).

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Attachment A

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EP-IP-033 Revision 5 Page 9 of 30 A.3.0 Upon identification of a situation where IN-PLANT potential EMERGENCY exposures (>2500 mrem / quarter) are anticipated, the SHIFT SUPERVISOR / EMERGENCY DIRECTOR will: .

A.3.1 Examine and determine with the appropriate COORDINATORS the necessity for EMERGENCY exposure.

A.3.2 ' Direct the HP SUPERVISOR / RADIATION PROTECTION COORDINATOR to determine the consequences of anticipated actions and methods of minimizing exposure using Attachment G.

A.3.3 Provide written authorization with an upper limit established and document on Form EP-IP-033-1.

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- Attachment B O. .

EP-IP-033 Revision 5 Page 10 of 30 l

ACTION STEP EOF SUPPORT MANAGER i

RECOVERY MANAGER CHECK

. B.1.0 Upon identification of real or potential 0FF-SITE doses, the EOF i SUPPORT MANAGER or RECQVERY MANAGER will:

)

B.1.1 Consult with the EMERGENCY DIRECTOR / RADIATION SUPPORT MANAGER

to arrive at a PROTECTIVE ACTION. recommendation to protect the public using the guide pr'esented in Attachment F.

1 i B.1.2 Notify DER /BRP of PROTECTIVE ACTION recommendation.

B.1.3 Periodically review applicability of the recommendation.

B.1.4 Renotification of DER /BRP is required:

i l a. Following any subsequent reclassification of the-l EMERGENCY. .

l

~

b. Following any change in PROTECTIVE ACTION

,i recommendation.

I c. Every 30 minutes or after any significant event other 1 i than B.1.4 a or b.

B.1.5 Upon significant change in emergency conditions affecting i 0FF-SITE doses, reassess protective action recommendation.

I B.2.0 Upon id'entification'of the potential for unessential exposure of 0FF-SITE emergency personnel, the EOF SUPPORT MANAGER or RECOVERY MANAGER i will:

5 B.2.1 Consult with the EMERGENCY DIRECTOR / RADIATION SUPPORT l MANAGER.

1

B.2.2 Authorize and implement appropriate protective actions per 3

Attachment G.

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i

~s Attachment C EP-IP-033 k-)

s Revision 5 Page 11 of 30 ACTION STEP RADIATION PROTECTION COORDINATOR CHECK C.1.0 Upon identification of real or potential 0FF-SITE doses the RADIATION PROTECTION COORDINATOR will:

C.1.1 Assemble all pertinent data needed to assess the magnitude

. and anticipated duration of 0FF-SITE releases.

C.1.2 Evaluate data for 0FF-SITE dose assessment. ,

C.1.3 Determine a recommended PROTECTIVE ACTION following th'e criteria and guidance in Attachment F.

1: .1. 4 Advise EMERGENCY DIRECTOR of recommendation.

C.2.0 In situations where a real or potential IN-PLANT or ON-SITE individual exposure may occur, the RADIATION PROTECTION COORDINATOR will ensure that survey and radiological review is performed by appropriate -

O

  • COORDINATOR or TEAM LEtDER.

C.3.0 In situations where a real or potential IN-PLANT or OH-SITE exposure may exceed the site individual administrative exposure objectives in Attachment I, the RADIATION PROTECTION COORDINATOR will:

C.3.1 Examine and determine with the appropriate COORDINATORS the necessity to exceed the administrative exposure objectives.

C.3.2 Perform an ALARA review per Attachment H.

C.3.3 Provide written authorization of extension and document on Form EP-IP-033-1.

C.3.4 Advise the EMERGENCY DIRECTOR when he is responsible for approval of extensions.

C.4.0 When EMERGENCY exposures are anticipated, the RADIATION PROTECTION COORDINATOR will:

C 4.1 Evaluate the consequences of anticipated actions and methods of minimizing exposure per Attachments G and H and advise EMERGENCY DIRECTOR.

Page 1 of 2

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- Attachment C

\ EP-IP-033 Revision 5 Page 12 of 30

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i C.4.2 If necesary, obtain the advice of CONSULTING RADIOLOGICAL PHYSICIAN by notifying Radiation Management Corp. (215) 243-2990, i

C.4.3 Establish a eaximum permissible emergency exposure.

C.4.4 Obtain written authorization from the EMERGENCY DIRECTOR and document on Foro EP-IP-033-1.

! C.5.0 Following any EMERGENCY exposure or accidental over-exposure, the l RADIATION PROTECTION COORDINATOR will provide guidance on the

! administrative and medical actions required and any protective actions deemed necessary as specified in Attachment G.

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E Attachment D- '

s .EP-IP-033 Revision 5 Page 13 of 30  !

ACTION STEP RADIATION SUPPORT-MANAGER.

CHECK D.1.0 Upon identification of real or potential 0FF-SITE doses, the RADIATION _

SUPPORT MANAGER will:

D.1.1- . Assemble all pertinent data needed to assess the magnitude ,

. and anticipated duration of 0FF-SITE releases.

D.1.2 Evaluate data for 0FF-SITE dose asse,ssment.

D.1.3 Determine a recommended PROTsCTIVE ACTION following the criteria and guidance in Attachment F.

D.1.4 Advise RECOVERY MANAGER of recommendation.

D.2.0 The RADIATION SUPPORT MANAGER will evaluate exposures to 0FF-SITE l EMERGENCY personnel per Attachment G and advise RECOVERY MANAGER of the need for PROTECTIVE ACTIONS. l O D.3.0 The RADIATION SUPPORT MANAGER will:

[

D.3.1 If EMERGENCY MONITORING TEAM doses may exceed 500 mrem: l

a. Rotate TEAM locations.

i

b. Provide written authorization of extension and document on Form EP-IP-033-1.
c. Consider callout of BACK-UP MONITORING TEAMS.

D.3.2 If EMERGENCY MONITORING TEAM doses may exceed 1000, 1500, or 2000 mrem per quarter:

a. Continue rotating and/or pulling back TEAM locations and advise RECOVERY MANAGER.
b. Provide written authorization of extension, obtain approval from the RECOVERY MANAGER, and document on Form  ;

EP-IP-033 or - consider immediate de-activation of team.

c. Call out BACKUP TEAMS ,

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E

Attachment D '

( ,s) EP-IP-033 Revision 5 Page 1.4 of 30 j 0.3.3 If an EMERGENCY exposure is anticipated or an accidental over-exposure occurs (>2500 mrem /qtr):

a. De-activate TEAM
b. Replace with BACKUP TEAM, when available
c. Advise RECOVERY MANAGER- .
d. Provide guidance on the administrative and medical actions required and any other protective actions deemed necessary as specified in Attachment G.

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Attachment E r-EP-IP-033

(_I. - Revision 5 Page 15 of 30 ACTION STEP OSC/TSC COORDINATOR CHECK E.1.0 Prior to dispatching any in plant teams into the Controlled Zone, the OSC/TSC COORDINATOR will:

E.1.1 Consult with the RADIATION PROTECTION COORDINATOR.

E.2.0 For the administrative exposure objectives in Attachment I, the OSC/TSC COORDINATOR will perform the following when it appears that an IN-PLANT individual may, exceed'any one of these limits:

E.2.1 Consult with the appropriate approval authorities per Attachment I.

E.2.2 Perform ALARA review per Attachment H.

E.2.3 Obtain written authorization on Form EP-IP-033-1.

() E.3.0 The OSC/TSC COORDINATOR will identify situations where EMERGENCY exposures may occur, he will then:

E.3.1 Consult with EMERGENCY DIRECTOR and RADIATION PROTECTION COORDINATOR.

E.3.2 Evaluate the consequences of anticipated actions and methods of minimizing exposures per Attachment G and H.

E.3.3 Obtain written authorization with an upper limit established and record on Form EP-IP-033-1.

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Attachment F (3

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EP-IP-033 Revision 5 -

Page 16 of 30 PUBLIC. DOSE ASSESSMENT AND PROTECTIVE ACTION RECOMMENDATION GUIDE PROTECTIVE ACTION DECISION PROCESS OBJECTIVE: PROTECTIVE ACTIONS are taken to limit the exposure to the general public. PROTECTIVE ACTION decisions must weigh all risks to the public. Evaluate the risk of the exposure versus the risk of implementing the PROTECTIVE ACTION. The risks of the PROTECTIVE ACTION include the psychological effects and the risks associated with an evacuation. See Table F.3.

Check F.1.0 Determine the need for PROTECTIVE ACTIONS based on:

F.1.1 Plant Status - technical assessment of conditions in the plant which may present the potential for an off-site release. . -

() F.1.2 Off-site Doses - combined evaluation and correlation of field '

monitoring data and dose calculations when both are available,

a. Field Monitoring Data - actual field dose readings by EMERGENCY MONITORING TEAMS,
b. Dose Calculations
1. Current Dose Rate
2. Integrated Dose - total accumulated dose from the beginning of the release to the present time. ,
3. Projected Dose - future projected accumulated dose
over the entire course of the release. It incorporates the integrated dose and assumes the current release rate to project a dose over a future specified time period. Table F.1 gives the guidelines for PROTECTIVE ACTIONS based on projected doses.

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Attachment F .

- EP-IP-033 Revision 5 Page 17 of 30; 4

l F.1.3 Environmental Sampling - assessment of environmental sampling analyses data indicating need for public protective actions.

a. Environmental TLDs
b. River Water, Milk, and Vegetation Sampling 4,

F.2.0 ,De.termine which PROTECTIVE ACTION:

I F.2.1 Consider the following optio~ns:

I a. No action, sheltering, or evacuation NOTE: By Pennsylvania state directive, evacuation

! will be of the entire 10 mile EPZ. However, PP&L may make.a recommendation to DER /ERP consisting of option (s) which apply to a i reduced radius (2 or 5 miles) 360 degrees I around, and/or affected d.ownwind sector (s) out

  • i to 10 miles.

i'

b. Environmental Protective Actions (refer to EP-IP-044 & EP-IP-053).

I

! 1. Control of Agricultural Products

- PP&L may make recommendations to DER /BRP.

! 2. Isolation of Downstream Water Users

- PP&L makes recommendations to DER /BRP

  • based on calculations performed in EP-IP-053.

The state will notify the Danville Water Authority.

I F.2.2 Consider time available to Implement the Action -

determination of this time constraint may come from three ,

possible time inputs.

l i a. Estimated duration of release - technical assessment of j plant conditions causing release and known or.

anticipated time of release initiation and termination.

When there is no definite release duration known, a l default time of six (6) hours may be used. This is the i maximum fair weather evacuation time estimate. (See l

Table F.2). .

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5 . Attachment F I

_, )  ! EP-IP-033 Revision 5 Page 18 of 30 l 0

b. Time until_ allowable dose is exceeded - time until '

integrated doses reach or exceed protective action levels. I

c. Time required to complete PROTECTIVE ACTION i
1. Obtain an estimate of time required to initiate PROTECTIVE ACTION on the state and county level /

from DER /BRP.

2. Consult evacuation time estimates (Table F.2) to determine if release termination justifies evacuation. g F.2.3 Consider Non-Ouantitative Factors Affecting Prognosis -

evaluation of the following factors which may affect PROTECTIVE ACTION decisions:

a. Plant Status potential for release n ~

U b. Weather Changes .or Con'ditions

c. Time of Day F.3.0 Insure Confidence in' Data Utilized for Decision Process - careful e evaluation of the following: o ,

F.3.1 Age of Information - most current information utilized available for proper dose assessment.

F.3.2 Scope of Available Information - sufficient information ,

available for proper dose assessment.- -

F.3.3 Information Source

a. Consistency of data points with trend analysis.

IMPORTANT: Deci siota i s not-based on a single data point.

b. Reasonable correlation between all available information Sources.
c. Lim'itations and capabilities of methodology utilized.

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' Attachment F

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EP-IP-033 Revision 5 -

Page 19 of 30 TABLE F.1 PROTECTIVE ACTION GUIDELINES 1

Projected Dose to Population

  • Recommended Responses Comments-Whole body 0 to i #

No protective action required. If. sheltering is-0.5 rem Sheltering may be suggested, chosen, evaluate Monitor off-site radiation levels. potential exposure to people who choose to Thyroid 0 to 2.5 rem voluntarily leave.

Whole body 0.5 to Shelter May be recommended 1 rem ,

Monitor off-site radiation while considering levels the advisability Control access to EPZ.

of an evacuation Thyroid 2.5 to 5 rem recommendation or for a

) short term release.

Whole body greater Evacuation of entire 10 mile EPZ** Seeking shelter.would than 1 rem Monitor off-site radiation levels be an alternative if time or other conditions Thyroid greater than do not permit an 5 rem evacuation.

No provisions have been made to give public KI.

Based on doses at Emergency Planning Boundary.

    • By Pennsylvania state directive. However, PP&L may make a recommendation to DER /BRP consisting of option (s) which apply to a reduced radius (2 or 5 miles) 360 degrees around, and/or affected downwind sector (s) out to 10 miles.

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Attachment F' i

d EP-IP-033 Revision 5 Page 20 of 30 TABLE F.2 EVACUATI'ON TIME ESTIMATES 10 mile EPZ 360*

TIME (minutes)

CASE DAY NIGHT WEEKENO FAIR WEATHER 365 260 300 ADVERSE WEATHER 515 365 430 Flooding 530 Icing 530 Winter Sterm 530 e g G

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  • FLOW CHART FOR ARRIVING AT PROTECTIVE ACTION DECISION os o Table F.3 m
  • as ypp Acttal esoTedTlvt Action orflows: gg, NEra roa .. No Actio.. , , , , , ^

reorecTIVE Tes s ,

b. SIelter EVAlUATitM c. Evacuattosi M EVActBATION
d. Environmental Prot. Actiosis s .

, ,, BWVIPoseentfAL .

ts a> W rearrscTavr ACTitWsS thian Factors That Confidence Time Avellable Calcielstione of Dectolog

"' To leptement Will Alter Date Fiel.1 Protect 8ve Actton l*rnsinos te Heamuremente e 6 y T I ,A

  • T T Weather Time Projected Plant Current Present Status chasiges of Ikome Initograted Dose Over Day soome Nest Few (TSc)

Wate Nace8ved esoura T

Nat f oetal Envi rewinent al Weatlicr 4 _ 5 eselIna y Service

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p.se a y

  • Time Avall-! Time sentil Fet tent e.l scope of leformattee Allowable Ter seistion Ase of ,

able to home is of Releana y,g,,,,gg,, y ,g ,,,,,,g ,, 3,,,,,

Complete Protective Enceeded i .

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  • M DA ia T T T l

T T ~m HO OB T I T CAlfUt.-

NEAS- ESTINA- g 3

gfj T ouTh&TED cuttert pen $oet

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PLANT WEEEEND fuY WIQtT " w y STATUS lptrateHATifW o 5.0 Hre. 6.8 Nes. 4.4 IIRS.

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f-sg Attach' ment G

(/ EP-IP-033-Revision-5 Page 22 of 30 PP&L EMERGENCY PERSONNEL DOSE ASSESSMENT AND PROTECTIVE ACTION RECOMMENDATION GUIDE Check G.1.0 Dose Limits for EMERGENCY exposures G.1.1 Life-saving actions apply to those efforts involving the search and rescue of.known or allegeo injured persons and the correction of conditions that may seriously injure others.

, The maximum doses are:

1 a. Planned whole body deses shall not exceed 75 rem.

1 .

b. Planned extremity doses shall not exceed 300 rem.

G.1.2 Less urgent EMERGENCIES for which an EMERGENCY exposure-authorization may be granted are those circumstances to protect facilities and-equipment, those efforts designed to substantially limit the escape of radioactive effluents or

.O' control fires. The maximum pl-anned doses are:

a. Whole body dose shall not exceed 25 rem.
b. Extremity doses shall not exceed 100 rem.
c. Thyroid doses shall not exceed 125 rem.

G.2.0 The following factors should be considered prior to authorizing an individual to receive an EMERGENCY exposure.

G.2.1 Rescue' personnel should be volunteers or professional

, rescuers.

G.2.2 Other considerations being equal (e.g., skill, potential need for person on another mission) personnel _ above the age of 45 are preferred.

G.2.3 Rescue personnel should be familiar and briefed with the consequences of exposure.

Women capable of reproduction shall not take part in an G.2.4 effort requiring EMERGENCY exposure.

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vr = -- ,%~, - -* --m . r -r -

Attachment G p/

.s.

EP-IP-033 Revision 5

'Page 23 of 30 G.2.5 Internal exposure shall be. minimized by the use of the best available respiratory protection, and contamination shall be controlled by the'use of protective clothing. .

G.2.6 Exposure under these conditions shall be limited to once in a lifetime.

G.3.0 For any EMERGENCY exposure or accidental over-exposure, the following assessment actions must be performed.

G.3.1 Collect, process and evaluate personnel dosimetry devices when technically appropriate.

G.3.2 Investigate the circumstances of all emergency exposures and confirm the dose received.

NOTE: Notification of the NRC within 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> is required for:

s

1. Exposure of the whole body of greater than 5

$ rems; or i

2. Exposure of the skin of the whole body of greater than 30 rems; or
3. Exposure of the extremities of greater than 75 rems.

,G.3.3 Assess the health consequences of all emergency exposures.

Consult with a physician to determine tbe need for and extent of physical and biochemical examinations.

G.3.4 Whole body greater than 25 rem should result in an examination of the exposed person by a physician.

NOTE: Immediate notification of the NRC is required for:

1. Exposure of the whole body of greater than 25 rems; or
2. Exposure of the skin of the whole body of greater than 150 rems; or
3. Exposure of the extremities of' greater than 375 rems.

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f-c Attachment G

-(_) EP-IP-033

- Revision 5 Page 24 of 30 G.3.5 If internal exposure is suspected, qualitative measurements should be made immediately. Bioassays required based on the following:

a. Nasal smear greater than 10,000 dpm.
b. Greater than 40 MPC-HRS over 7 consecutive days.
c. Entry by an individual into an area exceeding 100 times MPC.

G.4.0 Protective Actions l

G.4.1 Potassium Iodide I a. The CONSULTING RADIOLOGICAL PHYSICIAN should provide input concerning the administration and cessation of KI intake. The PHYSICIAN can be reached at Radiation Management Corp."(215)-243-2990.

O b. For thyroid exposures tnat are strongly expected to .

exceed 25 REM, KI doses of 130 mg (100 mg - iodine) per day should be administered.

Unless the EMERGENCY DIRECTOR or RECOVERY MANAGER instructs personnel to do otherwise, the KI tablets should generally be taken as soon as possible after thyroid exposure exceeding 25 REM is projected.

NOTE (1): KI has a four to six hour ingestion duration prior to becoming effective.

NOTE (2): Input from the PHYSICIAN should be factored into the timing of tablet administration relative to thyroid exposure.

c. On-site issuance of KI for iodine prophylaxis requires the approval of the EMERGENCY DIRECTOR. Issuance to EOF and FIELO EMERGENCY MONITORING TEAM personnel requires the approval of the RECOVERY MANAGER. These approvals must be documented on Form EP-IP-033-2.

G.4.2 Protective measures should be implemented for EOF personnel at the direction of the RADIOLOGICAL SUPPORT MANAGER in 1 accordance with EP-IP-030. j

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\--) Page 3 of 4 l

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Attachment G V EP-IP-033 I Revision 5 l Page 25 of 30 l G.4.3 Exposures to members of local offsite support groups, (ambulance workers, firefighters) shall not exceed 300 mrem for the performance of support duties on the site of the Susquehanna S.E.S.

O Page 4 of 4

Attachment H EP-IP-033

.(s)

-Revision 5 <

Page 26 of 30 HEALTH PHYSICS AND ALARA CONSIDERATIONS DURING EMERGENCIES CHECK H.1.0 Evaluate radiological conditions H.1.1 Obtain detail survey data to ascertain:

a. B-r radiation levels
b. Need for neutron measurements
c. Contamination levels and protective clothing requirements
d. Airborne radioactive materials
e. Variabilit'y of conditions over space and time H.1.2 Evaluate personnel status '

O a.. Determine available dose under normal. administrative dose objectives,

b. If essential, obtain approval from RADIATION PROTECTION COORDINATOR / EMERGENCY DIRECTOR for persons expected to exceed administrative objectives.
c. Follow criteria in Attachment G when emergency exposures are deemed appropriate by EMERGENCY DIRECTOR.
d. Assess individual's history of exposure to airborne materials.
e. Assess individual's skills in relation to proposed task.

H.1.3 Determine proper type and placement of dosimeters

a. Evaluate need for additional whole body dosimeters NOTE: For emergency exposures, the placement of l several dosimeters on an individual is . l recommended to determine special distribution  !

of dose to the~ individual, j

b. Evaluate need and placement of extremity dosimeters.

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- Attachment H n)

(' EP-IP.-033 Revision 5 Page 27 of 30

c. Evaluate need for additional dosimetry devices such as high range self-reading dosimeters, electronic dosimeters and neutron dosimeters. .
d. Evaluate need for time keeping.

.: H.1.4 Determine proper respiratory equipment required to perform task. .

NOTE: For tasks expected to 1,ast more than several hours, consider need for relief of team members.

H.1.5 Review the following ALARA items:

NOTE: The detail and scope of ALARA reviews are to be commensurate with the magnitude of doses expected, numbers of people involved and urgency of required task.

! a. Consider the use of remote handling devices or other

! (_-) special tools.

b. Consider the use of portable shielding.

i

c. Consider the need for mock-ups or other practice exercises.
d. Assess the number-of people requ' i red to assure all have 4

essential productive roles.

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e. Consider magnitude of doses received by team members in.

transit to work location.

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i p , Attachment I:

A. EP-IP-033 Revision 5 Page 28 of-30 1 EMERGENCY DOSE EXTENSION AUTHORIZATIONS REQ'O 4

EXPECTED APPROVAL' 00SE BY ACTION 1

0 - 500 mrem /qtr. OSC/TSC Coord. Normal HP Procedure

>500 mrem /qtr. RPC/RSM written authorization

>1000 mrem /qtr. RPC/RSM- ALARA review written authorization i

c

~

>1500 mrem /qtr. RPC and ED/RSM and RM ALARA review written authorization 1

>2000 mrem /qtr. RPC and ED/RSM and RM ALARA review written authorization

>2500 mrem /qtr. RPC and ED/RSM and RM ALARA review written authorization Emergency Exposure

! Considerations j i l

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Page 1 of 1

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Attachment J

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b-)x EP-IP-033 Revision 5 Page 29 of 30' 1 .

EMERGENCY EXPOSURE EXTENSION REQUEST DATE/ TIME / TEAM OESIGNATION (IF APPLICABLE)

~

REASON FOR EXTENSION:

PERSONNEL INFORMATION

NAME SOC SEC #

COMPANY EMERG. RESPONSE FUNCTION i ,

CURRENT EXPOSURE: ,

QUARTER TO DATE mrem mrem ' mrein YEAR TO DATE mrem mrem mrem TYPE OF EXTENSION:

4 ,

>500 mrem /qtr

>1000 mrem /qtr

>1500 mrem /qtr ,

4

>2000 mrem /qtr

>2500 mrem /qtr (EMERGENCY EXPOSURE)

MAXIMUM ALLOWABLE . mrem mrem mrem APPROVAL: '

1

RPC/RSM ED/RM lO FORM EP-IP-033-1, Rev. 3, Page 1 of 1

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. dttachmentK-1 l(-),

EP-IP-033 Revision 5 Page 30 of 30 ISSUANCE OF PDTASSIUM IODIDE _(KI)

(Recommended dose: 1 tablet / day = 130 mg) u KI Issued Soc. Sec. # Est. Date/ Time KI Intake = Dosage To: (Name) of Exposure Start Stop _ (Tablets)

-Date/ Time- Date/ Time i- .

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I Approved by: .

i Date Emergency Director - or - Recovery Manager t

, FORM EP-IP-033-2,_Rev. 1, Page 1 of 1

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