ML18081A423

Draft NRC Form 361, Reactor Plant Event Notification Worksheet

ML18081A423
Person / Time
Issue date:	09/27/2018
From:	NRC/OCIO
To:
References
Download: ML18081A423 (1)

Text

Page of NRC FORM 361 U.S. NUCLEAR REGULATORY COMMISSION APPROVED BY OMB: NO. 3150-XXXX EXPIRES: (MM/DD/YYYY)

(MM-YYYY) OPERATIONS CENTER 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 Information Services Branch (T-2 F43), U.S. Nuclear Regulatory REACTOR PLANT EVENT Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-10202, (3150-XXXX), Office of Management and Budget, NOTIFICATION WORKSHEET Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

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 Unit Name of Caller/Title Call Back #

Event Time & Zone Event Date Power/Mode (At Time of Event) Power/Mode (At Time of Notification)

EVENT CLASSIFICATION 1-HR. NON-EMERGENCY 10 CFR 50.72(b)(1) (v)(A) Safe S/D Capability AINA GENERAL EMERGENCY GEN/AAEC TS Deviation ADEV (v)(B) RHR Capability AINB SITE AREA EMERGENCY SIT/AAEC 4-HR. NON-EMERGENCY 10 CFR 50.72(b)(2) (v)(C) Control of Rad Release AINC ALERT ALE/AAEC (i) TS Required S/D ASHU (v)(D) Accident Mitigation AIND UNUSUAL EVENT UNU/AAEC (iv)(A) ECCS Discharge to RCS ACCS (xii) Offsite Medical AMED 50.72 NON-EMERGENCY (see next columns) (iv)(B) RPS Actuation (scram) ARPS (xiii) Loss Comm/Asmt/Response ACOM PHYSICAL SECURITY (73.71) DDDD (xi) Offsite Notification APRE 60-DAY OPTIONAL 10 CFR 50.73(a)(1)

MATERIAL/EXPOSURE B???? 8-HR. NON-EMERGENCY 10 CFR 50.72(b)(3) Invalid Specified System Actuation AINV FITNESS FOR DUTY HFIT (ii)(A) Degraded Condition ADEG OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)

OTHER UNSPECIFIED REQMT. (see last column) (ii)(B) Unanalyzed Condition AUNA NONR INFORMATION ONLY HFIT (iv)(A) Specified System Actuation AESF NONR 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)

WILL NOTIFICATIONS YES NO BE Anything Unusual or not understood? Yes (Explain above) No NRC RESIDENT STATE(s)

Did all systems function as required? Yes No (Explain above)

LOCAL OTHER GOV AGENCIES Mode of operations until corrected (if applicable)

MEDIA/PRESS RELEASE Additional Information continued on next page? Yes No NRC FORM 361 (MM-YYYY) Continued on next page

Page of NRC FORM 361 U.S. NUCLEAR REGULATORY COMMISSION (MM-YYYY) OPERATIONS CENTER REACTOR PLANT EVENT NOTIFICATION WORKSHEET (Continued)

EN #

RADIOLOGICAL RELEASES: CHECK OR FILL IN APPLICABLE ITEMS (specific details/explanations should be covered in event description)

Liquid Release Gaseous Release Unplanned Release Planned Release Ongoing Terminated Monitored Unmonitored Offsite Release T.S. Exceeded RM Alarms Areas Evacuated Personnel Exposed or Contaminated Offsite Protection Actions Recommended *State release path in description Release Rate (Ci/sec)  % T.S. Limit HOO Guide Total Activity (Ci)  % T.S. Limit HOO Guide Noble Gas 0.1 Ci/sec 1000 Ci Iodine 10 Ci/sec 0.01 Ci Particulate 1 Ci/sec 1 mCi Liquid (excluding tritium and dissolved 10 Ci/min 0.1 Ci noble gas)

Liquid (tritium) 0.2 Ci/min 5 Ci TOTAL Plant Stack Condenser/Air Ejector Main Steam Line SG Blowdown Other RAD Monitor Readings Alarm Setpoints

% T.S. Limit (If applicable)

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., SG #, valve, pipe, etc.)

Leak Rate Units: gpm/gpd T. S. Limits Sudden or Long-Term Development Leak Start Date Time Primary Secondary Coolant Activity and Units:

List of Safety Related Equipment not Operational Event Description (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continued from Page 1)

NRC FORM 361 (MM-YYYY)