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{{#Wiki_filter:Page of NRC FORM 361N U.S. NUCLEAR REGULATORY COMMISSION (MM-YYYY) OPERATIONS CENTER c'')R REGN
{{#Wiki_filter:Page                   of NRC FORM 361N           U.S. NUCLEAR REGULATORY COMMISSION                   APPROVED BY OMB: NO. 3150-XXXX                                                         EXPIRES: (MM/DD/YYYY)
% NON-POWER REACTOR (NPR) e-,. 5 EVENT NOTIFICATION WM 4°. VVORKSHEET
(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.
***** APPROVED BY OMB: NO. 3150-XXXX EXPIRES: (MM/DD/YYYY)
Send comments regarding burden estimate to the Information Services Branch (T-2 F43), U.S. Nuclear Regulatory e-c'')R REGN%
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.
NON-POWER REACTOR (NPR)                                    Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov and to the Desk Officer, 5                      EVENT NOTIFICATION                                    Office of Information and Regulatory Affairs, NEOB-10202, (3150-XXXX), Office of Management and Budget, WM                                                                    Washington, DC 20503 lf a means used to impose an information collection does not display a currently valid OMB 4°.              VVORKSHEET                                    control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information
Send comments regarding burden estimate to the Information Services Branch (T-2 F43), U.S. Nuclear Regulatory 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, Washington, DC 20503 lf 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.
        *****                                                                  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.
EN #
FAX - 301-816-5151, EMAIL - hoo.hoc@nrc.gov Notification Time Facility or Organization Unit Name of Caller/Title Call Back #
NRC OPERATIONS TELEPHONE NUMBERS: PRIMARY - 301-816-5100 or 800-532-3469*, BACKUPS - [1st ] 301-951-0550 or 800-449-3694*,
Event Time & Zone Event Date Power/Mode (At Time of Event)
[2nd] 301-415-0550 and [3rd] 301-415-0553. *Licensees who maintain their own ETS are provided these telephone numbers.
Power/Mode (At Time of Notification)
FAX - 301-816-5151, EMAIL - hoo.hoc@nrc.gov Notification Time           Facility or Organization                 Unit           Name of Caller/Title                                                     Call Back #
Reactor Type Max Power Max Pulse Pulse Inserted During Event EVENT CLASSIFICATION REPORTABLE CONDITION (varies by facility TS)
Event Time & Zone           Event Date                               Power/Mode (At Time of Event)                                 Power/Mode (At Time of Notification)
Offsite Medical AMED GENERAL EMERGENCY GEN/AAEC TS Deviation ADEV Loss Comm/Asmt/Resp ACOM SITE AREA EMERGENCY SIT/AAEC TS Required S/D ASHU Invalid Specified System Act AINV ALERT ALE/AAEC RPS Actuation (scram) ARPS ]jjjjjjj Suspicious Activity UNUSUAL EVENT UNU/AAEC Offsite Notification APRE Security Event SAFEGUARDS EVENT (73 App G)
Reactor Type               Max Power                               Max Pulse                                                     Pulse Inserted During Event EVENT CLASSIFICATION                         REPORTABLE CONDITION (varies by facility TS)                                           Offsite Medical                             AMED GENERAL EMERGENCY                     GEN/AAEC                       TS Deviation                                 ADEV                     Loss Comm/Asmt/Resp                         ACOM SITE AREA EMERGENCY                     SIT/AAEC                     TS Required S/D                               ASHU                     Invalid Specified System Act                 AINV ALERT                                 ALE/AAEC                     RPS Actuation (scram)                         ARPS                     Suspicious Activity
Degraded Condition ADEG 111 MATERIAL/EXPOSURE B???? ]jjjjj Unanalyzed Condition AUNA INFORMATION ONLY NNF ]jjjjj Specified System Actuation AESF OTHER UNSPECIFIED REQMT (see last column)
                                                                                                                                  ]jjjjjjj UNUSUAL EVENT                         UNU/AAEC                       Offsite Notification                         APRE                     Security Event SAFEGUARDS EVENT (73 App G)                                         Degraded Condition                           ADEG 111     MATERIAL/EXPOSURE                         B????     ]jjjjj         Unanalyzed Condition                         AUNA INFORMATION ONLY                             NNF     ]jjjjj         Specified System Actuation                     AESF OTHER UNSPECIFIED REQMT         (see last column)                   Safe S/D Capability                           AINA     OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)
Safe S/D Capability AINA OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)
Control of Rad Release                         AINC                                                                 NONR 1111                                                                         Accident Mitigation                           AIND                                                                 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)
Control of Rad Release AINC NONR 1111 Accident Mitigation AIND 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 HQ NPR STAFF Did all systems function as required?                         Yes                                     No (Explain above)
NOTIFICATIONS YES NO WILL  BE Anything Unusual or not understood?   Yes (Explain above) No HQ NPR STAFF Did all systems function as required? Yes No (Explain above)
STATE(s)
STATE(s) LOCAL ]jj Mode of operation until corrected (if applicable)
LOCAL                                               ]jj           Mode of operation until corrected (if applicable)
OTHER GOV AGENCIES  
OTHER GOV AGENCIES                                 ]jj           Estimate for restart date:
]jj Estimate for restart date:
MEDIA/PRESS RELEASE                                   jjjji]       Additional Information continued on next page?                               Yes                       No NRC FORM 361N (MM-YYYY)                                                                                                                                                 Continued on next page
MEDIA/PRESS RELEASE jjjji] Additional Information continued on next page? Yes No NRC FORM 361N (MM-YYYY) Continued on next page Page of NRC FORM 361N U.S. NUCLEAR REGULATORY COMMISSION (MM-YYYY) OPERATIONS CENTER NON-POWER REACTOR (NPR)
 
EVENT NOTIFICATION WORKSHEET (Continued) EN # RADIOLOGICAL RELEASES: CHECK OR FILL IN APPLICABLE ITEMS (specific details/explanations should be covered in event description)
Page             of NRC FORM 361N                                                                                                                     U.S. NUCLEAR REGULATORY COMMISSION (MM-YYYY)                                                                                                                                     OPERATIONS CENTER NON-POWER REACTOR (NPR)
LJ Liquid Release LJ Gaseous Release I 1 Unplanned Release I I Planned Release LJ Ongoing Li Terminated I I Monitored Unmonitored H Offsite Release LI T.S. Exceeded LJ RM Alarms LI Areas Evacuated Personnel Exposed or Contaminated Offsite Protection Actions Recommended "State release path in description Release Rate (Ci/sec)  
EVENT NOTIFICATION WORKSHEET (Continued)                                                                       EN #
% T.S. Limit HOO Guide Total Activity (Ci)  
RADIOLOGICAL RELEASES: CHECK OR FILL IN APPLICABLE ITEMS (specific details/explanations should be covered in event description)
% T.S. Limit HOO Guide Noble Gas 0.1 Ci/sec 1000 Ci iodine 10 pCi/sec 0.01 Ci Particulate 1 pCi/sec 1 mCi Liquid (excluding tritium and dissolved noble gas) 10 pCi/min 0.1 Ci Liquid (tritium) 0.2 Ci/min 5 Ci Total Activity 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)
LJ     Liquid Release LJ   Gaseous Release         I   1 Unplanned Release             I   I   Planned Release LJ     Ongoing         Li     Terminated I I   Monitored                 Unmonitored             H       Offsite Release               LI     T.S. Exceeded LJ   RM Alarms       LI     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 pCi/sec                                                                     0.01 Ci Particulate                                                                             1 pCi/sec                                                                     1 mCi Liquid (excluding tritium and dissolved                                                                   10 pCi/min                                                                     0.1 Ci noble gas)
Liquid (tritium)                                                                       0.2 Ci/min                                                                       5 Ci Total Activity 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 361N (MM-YYYY)}}
NRC FORM 361N (MM-YYYY)}}

Latest revision as of 11:17, 2 February 2020

NRC Form 361N - Non-Power Reactor Event Notification Worksheet - (OMB Copy)
ML19057A169
Person / Time
Issue date: 03/26/2019
From:
NRC/OCIO, NRC/OGC
To:
ANNETTE STANG
Shared Package
ML19039A205 List:
References
Download: ML19057A169 (2)


Text

Page of NRC FORM 361N 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 e-c)R REGN%

NON-POWER REACTOR (NPR) Commission, Washington, DC 20555-0001, or by e-mail to Infocollects.Resource@nrc.gov and to the Desk Officer, 5 EVENT NOTIFICATION Office of Information and Regulatory Affairs, NEOB-10202, (3150-XXXX), Office of Management and Budget, WM Washington, DC 20503 lf a means used to impose an information collection does not display a currently valid OMB 4°. VVORKSHEET 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)

Reactor Type Max Power Max Pulse Pulse Inserted During Event EVENT CLASSIFICATION REPORTABLE CONDITION (varies by facility TS) Offsite Medical AMED GENERAL EMERGENCY GEN/AAEC TS Deviation ADEV Loss Comm/Asmt/Resp ACOM SITE AREA EMERGENCY SIT/AAEC TS Required S/D ASHU Invalid Specified System Act AINV ALERT ALE/AAEC RPS Actuation (scram) ARPS Suspicious Activity

]jjjjjjj UNUSUAL EVENT UNU/AAEC Offsite Notification APRE Security Event SAFEGUARDS EVENT (73 App G) Degraded Condition ADEG 111 MATERIAL/EXPOSURE B???? ]jjjjj Unanalyzed Condition AUNA INFORMATION ONLY NNF ]jjjjj Specified System Actuation AESF OTHER UNSPECIFIED REQMT (see last column) Safe S/D Capability AINA OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)

Control of Rad Release AINC NONR 1111 Accident Mitigation AIND 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 HQ NPR STAFF Did all systems function as required? Yes No (Explain above)

STATE(s)

LOCAL ]jj Mode of operation until corrected (if applicable)

OTHER GOV AGENCIES ]jj Estimate for restart date:

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

Page of NRC FORM 361N U.S. NUCLEAR REGULATORY COMMISSION (MM-YYYY) OPERATIONS CENTER NON-POWER REACTOR (NPR)

EVENT NOTIFICATION WORKSHEET (Continued) EN #

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

LJ Liquid Release LJ Gaseous Release I 1 Unplanned Release I I Planned Release LJ Ongoing Li Terminated I I Monitored Unmonitored H Offsite Release LI T.S. Exceeded LJ RM Alarms LI 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 pCi/sec 0.01 Ci Particulate 1 pCi/sec 1 mCi Liquid (excluding tritium and dissolved 10 pCi/min 0.1 Ci noble gas)

Liquid (tritium) 0.2 Ci/min 5 Ci Total Activity 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 361N (MM-YYYY)