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| issue date = 01/08/2009
| issue date = 01/08/2009
| title = PV-2009-11-Public Forms
| title = PV-2009-11-Public Forms
| author name = Lantz R E
| author name = Lantz R
| author affiliation = NRC/RGN-IV/DRP/RPB-D
| author affiliation = NRC/RGN-IV/DRP/RPB-D
| addressee name = Garchow S M
| addressee name = Garchow S
| addressee affiliation = NRC/RGN-IV/DRS/OB
| addressee affiliation = NRC/RGN-IV/DRS/OB
| docket = 05000528, 05000529, 05000530
| docket = 05000528, 05000529, 05000530
Line 15: Line 15:


=Text=
=Text=
{{#Wiki_filter:January 8, 2009 Ryan Lantz Chief, Operations Branch Division of Reactor Safety Steve Garchow Chief Examiner, Operations Branch INITIAL OPERATOR LICENSING EXAMINATION ASSIGNMENT You have been assigned as Chief Examiner of the Palo Verde, Units 1, 2, and 3, initial licensing examination.
{{#Wiki_filter:January 8, 2009 FROM:        Ryan Lantz Chief, Operations Branch Division of Reactor Safety TO:          Steve Garchow Chief Examiner, Operations Branch
The operating test has been scheduled to be completed by November 20, 2009. Thank you for contacting the Palo Verde facility to finalize the details of the examination.
You are reminded that the RPS/IP system must be maintained to ensure the examiners and numbers of candidates are accurate.
In addition, you are reminded that only qualified examiners are permitted to conduct any part of the examination.
ADAMS ACCESSION NO. TEMPLATE NO. S:\DRS\OB\OB-ONL Y\ADMIN\ASSIGNMENT SHEETS\CY'08\DEC08_RBS_ASSIGNMENT MEMO_MH.DOC GP5-APP-A
-ASSIGNMENT TICKLER ASSIGNMENT TICKLER .
Facility:  First Date of Chief: I, ',':;; *.... Written Exam Developed By: NRC ! Facility Operating Test Developed By: NRC ! Facility Due Date Description Date Complete Initials Notes 5/10/2009 Exam Administration Date Confirmed (C.1.a; C.2.a & b) '/7 ott  7/9/2009 NRC Staff & Facility Contact Assigned (C.1.d: C.2.e) '/"1 I fJ 'I  I 7/9/2009 Facility Contact Briefed on Security & Other Req's (C.2.c) 1('1 01 (j}1Ifr 7/9/2009 Corporate Notification letter (ES-201 Att-3) Sent (C.2.d)
J produced by Chief Examiner 8/8/2009 Reference Material Due (if NRC authored) (C.1.e; C.3.c) NPr 13mrr 8/23/2009 Integrated Exam Outlines Due (C.1.e & f; C.3.d) 7 23 DC( 8m{r 8/28/2009 Outlines Reviewed & Feedback Provided (c.2.h; C.3.e) ..., !2)//oc; Id 9/22/2009 Draft Exams wlReferences Due (C.1.e,f,g,h; C.3.d) 'l/2. 0'1 Iii'rJllf 10/7/2009
'Peer Reviewer Completes Review of Exam on ES-401-9 If) /S'dT IY:  lOnJ2009 'NRC BC Approves Feedback to Facility (C.2.h; C.3.f) lD /5 olif 1'2  101712009
'Exams Reviewed wI Fac. (C.1.h;C.2.f
& h; C.3.g) /0 ZOlo'J rJ.... " w.VItro 10/7/2009 Preliminary Applications Due (C.1.1;C.2.g; ES-202) /rJ I  1l1hJ tr I 10/12/2009 Preliminary Applications Reviewed (C.1.1:C.2.g)
/r) /' OCf  10/23/2009 Final Applications Due (C.1.I:C.2.i:ES-202) j  10/23/2009 On-Site Preparatory Week to Validate Operating Exam //)/2/0Q '-II A, fA "n 10/23/2009 On-Site Audit (10%) of License App's (ES-202 C.2.e) //)/z/t>9 r)'t V 10/30/2009 Final AppJ. OK'ed & Waiver letters Sent (ES-204; C.2.e) /0  fjnt' NRC Supervisor Approved Final Exams (C.2.i:C.3.h)
II A /L 10/30/2009 7/1'10 10/30/2009 Exam Approval letter (ES-201 Att-4) and List of Applicants produced by OlA (ES-201-4)
Prepared (C.2.i) 10/30/2009 Proctor Rules Review w/Fac. & Written Authorized (C.3.k) "Ii I Or JJrtr 10/30/2009 Exam Material to Exam Team (C.3.i) " 2-ocr .J.A 11/6/2009 Administer Operating Exam On-Site "/1'3/0,,/  11118/2009 Facility Graded Exam & Comments Received H It> 09  11/21/2009 NRC Written Exam Grading Completed "13 0 oct r;, A. tJrrfJ 11/21/2009 Examiners Document Exam Grades on ES Forms r2./l I t:>4 8Jrtr 12/112009 NRC Chief Examiner Grading Review Completed II (30{ bCf ,?trlr 12/2/2009 NRC BC Review Completed 12/2,-  12/6/2009 LicenselDenials Mailed; Facility Notified of Results z.. d1 '''.1 V., T 12/6/2009 RPS/IP Number of Examinees Updated 'fJ  1'f; print Report-21 r Examination Report Issued (zitS! 6'1 A produced by Chief Examiner 12/21/2009 TO 12/28/2009 Package Closed Out J.{ 'I t>'t 11r' Chief QA of ADAMS and SISP review complete 'I 04 12/28/2009 I 7J1Y1 rJ 1/5/2010 Ref Mat'I Returned after Final Res of Appeals N!+ I"""'IAJ U*U Examination Outline Quality Checklist Form ES-201-2 Date of Examination: Task Description a b* c# 1. Verify that the outline(s) fit(s) the appropriate model, in accordance with ES-401. W R b. Assess whether the outline was systematically and randomly prepared in accordance Section D.1 of ES-401 and whether all KIA cateaories are appropriately Assess whether the outline over-emphasizes any systems, evolutions, or generic topics. T E d. Assess whether the justifications for deselected or rejected KIA statements are appropriate.
N Using Form ES-301-5, verify that the proposed scenario sets cover the required of normal evolutions, instrument and component failures, technical
: 2. and major S b. Assess whether there are enough scenario sets (and spares) to test the projected and mix of applicants in accordance with the expected crew composition and rotation without compromising exam integrity, and ensure that each applicant can be tested using at least one new or significantly modified scenario, that no scenarios are duplicated A from the applicants' audit test(s), and that scenarios will not be repeated on subsequent days. T o To the extent possible, assess whether the outline(s) conform(s) with the qualitative R and quantitative criteria specified on Form ES-301-4 and described in Appendix D. Verify that the systems walk-through outline meets the criteria specified on Form ES-301-2:
: 3. the outline(s) contain(s) the required number of control room and in-plant tasks distributed among the safety functions as specified on the form W (2) task repetition from the last two NRC examinations is within the limits specified on the / no tasks are duplicated from the applicants' audit test(s) the number of new or modified tasks meets or exceeds the minimums specified on the form the number of alternate path, low-power, emergency, and RCA tasks meet the criteria on the form. Verify that the administrative outline meets the criteria specified on Form ES-301-1:  'I the tasks are distributed among the topics as specified on the form at least one task is new or significantly modified no more than one task is repeated from the last two NRC licensing examinations Determine if there are enough different outlines to test the projected number and of applicants and ensure that no items are duplicated on subsequent Assess whether plant-specific priorities (including PRA and IPE insights) are in the appropriate exam
: 4. G b. Assess whether the 10 CFR 55.41/43 and 55.45 sampling is appropriate.
E Ensure that KIA importance ratings (except for plant-specific priorities) are at least 2.5. N E Check for duplication and overlap among exam sections.
R A e. Check the entire exam for balance of Assess whether the exam fits the appropriate job level (RO or SRO). 7 Date ......o a. Author  b. Facility Reviewer (*)  '1>'1 c. NRC Chief Examiner (#)
JlJq C. M.
11M '"  1).1{ all d. NRC Supervisor C.\n..-h-.
1'oUIL I ()tl Note: # Independent NRC reviewer initial items in Column "c"; chief examiner concurrence required.
* Not applicable for NRC-prepared examination outlines ES-201, Page 26 of 28 Written Examination Quality Checklist Form ES-401-6 PALO VERDE Date 'of Exam: Nov 6, 2009 Exam Level: RO eli) SRO c.. Initial Item Description b" c'  f' IttY ,(  l\1V, ,1 W The sampling process was random and systematic (If more than 4 RO or 2 SRO questions r were repeated from the last 2 NRC licensing exams, consult the NRR OL orogram office). iWrf:' ?irt 3. SRO Questions are appropriate in accordance with Section O.2.d of ES-401 1. Questions and answers are technicallY accurate and applicable to the facility.
2 a. b. NRC KlAs are referenced for all questions.
Facility learning objectives are referenced as I Question duplication from the license screening/audit exam was as indicated below (check the item that applies) and appears the audit exam was systematically and randomly develpped; =the audit exam was completed before the license exam was started; .,F the examinations were developed independently; or A. the licensee certifies that there is no duplication; or I_ other (explain) f  Bank use meets limits (no more than 75 percent Bank Modified New *f. (, new or modified);
enter the actual RO ; SRO-only from the bank, at least 10 percent new, and the rest 14/ 19 11/ 15%-SO/ 66 question distribution(s) at riqht.  ;Between 50 and 60 percent of the questions on the RO Memory exam are written at the comprehension/
analysis level; the SRO exam may exceed 60 percent if the 32 /43% 43 selected KlAs support the higher cognitive levels; enter / 57% r.M the actual RO / SRO Question distributionfs) at richt. (  References/handouts provided do not give away answers  "'J' or aid in the elimination of  Question content conforms with specific KIA statements in the previously approved J '\ examination outline and is appropriate for the tier to which they are deviations are justified. ( tl lA\ Question psvchometric Quality and format meet the Quidellnes in ES Appendix B. \  1\The exam contains the required number of one-point.
multiple choice items; oJ . II' the total is correct and 3Qrees with the value on the cover sheet. t'-
.hIif Date a. 10/2/09 b. Facility Reviewer 10(2(2009
: c. NRC Chief Examiner (#) 3-, d. NRC Regional Supervisor U 1\ 'I Note: The facility reviewer's initials/signature are not applicable for NRC-developed
# Independent NRC reviewer initial items in Column "CO; dlief examiner concurrence ES-401, Page 29 of 33 Written Examination Quality Checklist Form ES-401-6 VERDE Facility: Date of Exam: Nov 6, 2009 Exam Level: RO Lc SRO  Initial b+ c'Item Description I \*,.M'\ ,\Questions and answers are technically accurate and applicable to the facility.
d a. NRC KlAs are referenced for all questions. Facility learning objectives are referenced as available.  ,. SRO questions are appropriate in accordance with Section D.2.d of ES-401 The sampling process was random and systematic (If mOle than 4 RO or 2 SRO were reoeated from the last 2 NRC licensina exams, cons!.!lt the NRR OL program  Question duplication from the license screening/audit exam was as indicated below (check the item that applies) and appears
_ the audit exam was systematically and randomly developed; _ the audit exam was completed before the license exam was started; _ the examinations were developed independently; i-the licensee certifies that there is no duplication; _ other (explain)
\' ,',1'( Jt,r ModifiedBank use meets limits (no more than 75 percent Bank New from the bank, at least 10 percent new, and the rest new or modified);
enter the actual RO I SRO-only 6 15/60':, 4 /16 / 24%
question distribution(s) at right. 1  Between 50 and 60 percent of the questions on the RO Memory CIA \ exam are written at the comprehension/
analysis level; , the SRO exam may exceed 60 percent if the randomly  16/9 64%I 36%selected KlAs support the higher cognitive levels; enter the actual RO I SRO question distribution(s) at riqht. References/handouts provided do not give away answers " i',\V, (jn1f or aid in the elimination of distractors.
C Question content conforms with specific KIA statements in the previously examination outline and is appropriate for the tier to which they are (  deviations are justified. M IA i\\I\'\Question psychometric Quality and format meet the guidelines in ES Appendix B. The exam contains the required number of one-point.
multiple choice items; ,...
Ithe total is correct and aarees with the value on the cover:sheet. Date Printed  Larry Burton 10/2/09Warren :0/2/09 b. Facility Reviewer !"r
.' . -c. NRC Chief Examiner (#)  W 71hI ..a )-iBNRC Regional Supervisor Ktil\J Clo.\I{oi\
*1IlIlIJD, I I7)b.....
let \ \+ The facility reviewer's initials/signature are not applicable for NRC*developed
# Independent NRC reviewer initial items in Column *c"; chief examiner concurrence ES-401. Page 29 of 33 
------Operating Test Quality Checklist Form ES-301-3 Facility:
fh\o Date of Examination: \ \ "0 I oq Operating Test Number: Initials 1. General Criteria il b* elf. The operating test conforms with the previously approved outline; changes are consistent with f 1/sampling requirements (e.(I., 10 CFR 55.45, operational importance, safety function distribution). IShlr JThere is no day-to-day repetition between this and other operating tests to be administered during this examination.
uNJ YJr6' The operatinQ test shall not duplicate items from the applicants' audit test(s). (see Section D.1.a.) wAf Overlap with the written examination and between different parts of the operating test is within acceptable limits. It appears that the operating test will differentiate between competent and less-than-competent
{applicants at the designated license level. WJJ  2. Walk-Throuah Criteria -Each JPM includes the following, as applicable:
*
* initial initiating
* 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 operationally important specific performance criteria that -detailed expected actions with exact criteria and
-system response and other examiner -statements describing important observations to be made by the
-criteria for successful completion of the -identification of critical steps and their associated performance
;  restrictions on the sequence of steps, if applicable Ensure that any changes from the previously approved systems and administrative walk-through outlines (Forms ES-301-1 and 2) have not caused the test to deviate from any of the acceptance criteria (e.g., item distribution, bank use, repetition from the last 2 NRC examinations) specified on those forms and Form ES-201-2. t#l  -.3. Simulator Criteria The associated simulator operating tests (scenario sets) have been reviewed in accordance with  I Form ES-301-4 and a COpy is attached. Printed Na  1\Date ---. Author Larry Burton -,\.. 09/02/09 AAWarren Potter 09/02/09Facility Reviewer(*) NRC Chief Examiner (#)
t; ,."  .....--0 I() /2If /0'1 1 NRC Supervisor


  '\1).  "]";h, 101 J.l\lqq l\ TJ A
==SUBJECT:==
* The facility signature is not applicable for NRC-developed tests. # Independent NRC reviewer initial items in Column "c"; chief examiner concurrence required.
INITIAL OPERATOR LICENSING EXAMINATION ASSIGNMENT You have been assigned as Chief Examiner of the Palo Verde, Units 1, 2, and 3, initial licensing examination. The operating test has been scheduled to be completed by November 20, 2009.
ES-301, Page 24 of 27 Facilitv:
Thank you for contacting the Palo Verde facility to finalize the details of the examination. You are reminded that the RPS/IP system must be maintained to ensure the examiners and numbers of candidates are accurate. In addition, you are reminded that only qualified examiners are permitted to conduct any part of the examination.
Palo Verde Date 0 fE xam: 11/10/09 S cenano. N um b ers: 1/3/40 Jperatlng T es t N 0.: QUALITATIVE ATIRIBUTES Initials b* elf. ) i&'\\t .k 1. The initial conditions are realistic, in that some equipment and/or instrumentation may be out C of service. but it does not cue the operators into expected events. 2. The scenarios consist mostlv of related events. (, ,J W 3. Each event description consists of
ADAMS ACCESSION NO.
* the point in the scenario when it is to be initiated
TEMPLATE NO.
* the malfunction(s) that are entered to initiate the event
S:\DRS\OB\OB-ONLY\ADMIN\ASSIGNMENT SHEETS\CY'08\DEC08_RBS_ASSIGNMENT MEMO_MH.DOC
* the symptoms/cues that will be visible to the crew rill
 
* the expected operator actions (by shift position)
GP5-APP-A - ASSIGNMENT TICKLER ASSIGNMENT TICKLER
          . ~~c~1 Chief: I,              ',':;;                *.. .        Facility: ~                        First Date of    Exam:~g09 Written Exam Developed By:          NRC ! Facility                        Operating Test Developed By:            NRC ! Facility Due Date                              Description                          Date Complete  Initials                  Notes 5/10/2009    Exam Administration Date Confirmed (C.1.a; C.2.a & b)
                                                                              '/7 ott          ~
7/9/2009  NRC Staff & Facility Contact Assigned (C.1.d: C.2.e)          '/"1 IfJ 'I      ~fr I              Facility Contact Briefed on Security & Other Req's (C.2.c)    1('1            (j}1Ifr 7/9/2009                                                                        01 7/9/2009  Corporate Notification letter (ES-201 Att-3) Sent (C.2.d)    2./~/lFf        J ~rr- produced by Chief Examiner 8/8/2009  Reference Material Due (if NRC authored) (C.1.e; C.3.c)              NPr    13mrr 8/23/2009    Integrated Exam Outlines Due (C.1.e & f; C.3.d)              7 23 DC(        8m{r 8/28/2009    Outlines Reviewed & Feedback Provided (c.2.h; C.3.e)        . ., !2)//oc; Id~lr 9/22/2009    Draft Exams wlReferences Due (C.1.e,f,g,h; C.3.d)            'l/2. 0'1 Iii'rJllf 10/7/2009    'Peer Reviewer Completes Review of Exam on ES-401-9          If) /S'dT IY: ~
lOnJ2009    'NRC BC Approves Feedback to Facility (C.2.h; C.3.f)          lD /5 olif 1'2 ~
101712009  'Exams Reviewed wI Fac. (C.1.h;C.2.f & h; C.3.g)              /0      ZOlo'J      rJ.... " w.
VItro 10/7/2009  Preliminary Applications Due (C.1.1;C.2.g; ES-202)          /rJ    I ~1    1l1hJ tr I
10/12/2009  Preliminary Applications Reviewed (C.1.1:C.2.g)
                                                                                /r) /' OCf  I~r 10/23/2009  Final Applications Due (C.1.I:C.2.i:ES-202)                  /I/2fJ/~CJ j ~
                                                                                              '-II  A, 10/23/2009  On-Site Preparatory Week to Validate Operating Exam            //)/2/0Q fA "n 10/23/2009  On-Site Audit (10%) of License App's (ES-202 C.2.e)            //)/z/t>9 r)'tV 10/30/2009  Final AppJ. OK'ed & Waiver letters Sent (ES-204; C.2.e)
                                                                              /0 ~/o~        fjnt' II 2,/~'l 7/1'10 A /L 10/30/2009  NRC Supervisor Approved Final Exams (C.2.i:C.3.h)
                                                                                              ~
Exam Approval letter (ES-201 Att-4) and List of Applicants
{(f2/~1 produced by OlA 10/30/2009 (ES-201-4) Prepared (C.2.i) 10/30/2009  Proctor Rules Review w/Fac. & Written Authorized (C.3.k)
                                                                            "IiIOr          JJrtr 10/30/2009  Exam Material to Exam Team (C.3.i)                                    ocr      .J.A 11/6/2009  Administer Operating Exam On-Site                            ""/1'3/0,,/
2-      l{j"~
I~
11118/2009  Facility Graded Exam & Comments Received                      H It>      09  ~
r;,    A.
11/21/2009  NRC Written Exam Grading Completed "13 0 oct      tJrrfJ 11/21/2009  Examiners Document Exam Grades on ES Forms                    r2./l It:>4    8Jrtr 12/112009  NRC Chief Examiner Grading Review Completed                      II (30{ bCf ,?trlr 12/2/2009  NRC BC Review Completed                                        12 / 2,- JO~        ~
12/6/2009  LicenselDenials Mailed; Facility Notified of Results 1'2- z.. d1 V., T  '''.1 12/6/2009  RPS/IP Number of Examinees Updated "II~'fJ ~ 1'f;r print Report-21 A
12/21/2009  Examination Report Issued                                    (zitS! 6'1            TO        produced by Chief Examiner 12/28/2009  Package Closed Out                                          J.{ 'I    t>'t      11r' 12/28/2009  Chief QA of ADAMS and SISP review complete                  'I I      04    7J1Y1rJ 1/5/2010  Ref Mat'I Returned after Final Res of Appeals                      N!+      I"""'IAJ U*U
 
ES-201                                Examination Outline Quality Checklist                                    Form ES-201-2 Facility:                                                                                    Date of Examination:
Initials Item                                                Task Description a    b*      c#
: 1. a. Verify that the outline(s) fit(s) the appropriate model, in accordance with ES-401.
W R      b. Assess whether the outline was systematically and randomly prepared in accordance with I        Section D.1 of ES-401 and whether all KIA cateaories are appropriately sampled.
T
: c. Assess whether the outline over-emphasizes any systems, evolutions, or generic topics.
T E
: d. Assess whether the justifications for deselected or rejected KIA statements are appropriate.
N
: 2. a. Using Form ES-301-5, verify that the proposed scenario sets cover the required number of normal evolutions, instrument and component failures, technical specifications, S        and major transients.
I M      b. Assess whether there are enough scenario sets (and spares) to test the projected number U        and mix of applicants in accordance with the expected crew composition and rotation schedule L        without compromising exam integrity, and ensure that each applicant can be tested using A        at least one new or significantly modified scenario, that no scenarios are duplicated T        from the applicants' audit test(s), and that scenarios will not be repeated on subsequent days.
o      c. To the extent possible, assess whether the outline(s) conform(s) with the qualitative R        and quantitative criteria specified on Form ES-301-4 and described in Appendix D.
: 3. a. Verify that the systems walk-through outline meets the criteria specified on Form ES-301-2:
(1) the outline(s) contain(s) the required number of control room and in-plant tasks W              distributed among the safety functions as specified on the form
    /        (2) task repetition from the last two NRC examinations is within the limits specified on the form T        (3) no tasks are duplicated from the applicants' audit test(s)
(4) the number of new or modified tasks meets or exceeds the minimums specified on the form (5) the number of alternate path, low-power, emergency, and RCA tasks meet the criteria on the form.
: b. Verify that the administrative outline meets the criteria specified on Form ES-301-1:                  'I (1) the tasks are distributed among the topics as specified on the form (2) at least one task is new or significantly modified (3) no more than one task is repeated from the last two NRC licensing examinations                  I~
: c. Determine if there are enough different outlines to test the projected number and mix of applicants and ensure that no items are duplicated on subsequent days.
: 4. a. Assess whether plant-specific priorities (including PRA and IPE insights) are covered in the appropriate exam sections.
G      b. Assess whether the 10 CFR 55.41/43 and 55.45 sampling is appropriate.
E N      c. Ensure that KIA importance ratings (except for plant-specific priorities) are at least 2.5.
E
: d. Check for duplication and overlap among exam sections.
R A      e. Check the entire exam for balance of coverage.
L
: f. Assess whether the exam fits the appropriate job level (RO or SRO).
Date
: a. Author                                                                                                                7 -~~    ......o
: b. Facility Reviewer (*)                                                                                                7A~ '1>'1
: c. NRC Chief Examiner (#)          C. M.        G1a.,..~                11M '"                                      I~/Z'i JlJq
: d. NRC Supervisor                  Kf\l~
I C.\n..-h-.
l 1'oUIL
()
                                                                                            ,~
tl
                                                                                                      -                10-1).1{ all Note:                # Independent NRC reviewer initial items in Column "c"; chief examiner concurrence required.
* Not applicable for NRC-prepared examination outlines ES-201, Page 26 of 28
 
ES-401                                    Written Examination Quality Checklist                                    Form ES-401-6 Facility'          PALO VERDE                                        Date 'of Exam: Nov 6,    2009    Exam Level: RO    eli) SRO c..
Initial Item Description                                                        b"            c'
: 1.          Questions and answers are technicallY accurate and applicable to the facility.                            l~\~
                                                                                                                          '~\1f'      IttY 2            a.          NRC KlAs are referenced for all questions.
                                                                                                                          ,(
: b.          Facility learning objectives are referenced as available.                                    t'~\ ~          ~
W
                                                                                                                              ,1
: 3.          SRO Questions are appropriate in accordance with Section O.2.d of ES-401                                  l\1V,
: 4.          The sampling process was random and systematic (If more than 4 RO or 2 SRO questions were repeated from the last 2 NRC licensing exams, consult the NRR OL orogram office).            I      iWrf:'        ?irt  r
: 5.          Question duplication from the license screening/audit exam was controlled as indicated below (check the item that applies) and appears appropriate:
            =    the audit exam was systematically and randomly develpped; or I
the audit exam was completed before the license exam was started; or                                  .,F the examinations were developed independently; or                                                    l'1I~\
A. the licensee certifies that there is no duplication; or
_ other (explain) f                      I~
: 6.          Bank use meets limits (no more than 75 percent                  Bank      Modified        New from the bank, at least 10 percent new, and the rest                                                              *
: f. (,
t,Nr~
                                                                                                                                        ~
new or modified); enter the actual RO ; SRO-only                14/ 19    11/ 15%-      SO/ 66    ~
question distribution(s) at riqht.
: 7.          Between 50 and 60 percent of the questions on the RO          ;    Memory            CiA exam are written at the comprehension/ analysis level; the SRO exam may exceed 60 percent if the randomly r.M
                                                                                                                                        ~
selected KlAs support the higher cognitive levels; enter          32 /43%          43  / 57%      (
the actual RO / SRO Question distributionfs) at richt.
: 8.          References/handouts provided do not give away answers or aid in the elimination of distractors.                                                        ~        "'J' ~
                                                                                                                        ~h
: 9.          Question content conforms with specific KIA statements in the previously approved                                '\
J examination outline and is appropriate for the tier to which they are assigned:
deviations are justified.                                                                        (        tllA\ ~
: 10.          Question psvchometric Quality and format meet the Quidellnes in ES Appendix B.                  \        ~J~r ~
1\
: 11.          The exam contains the required number of one-point. multiple choice items;                        oJ        . II' the total is correct and 3Qrees with the value on the cover sheet.                                  t'-  !Vr~\        .hIif Date
: a. Author                                                                                                                  10/2/09
: b. Facility Reviewer (')                                                                                                10(2(2009
                                                                                                                              ~
: c. NRC Chief Examiner (#)
: d. NRC Regional Supervisor                                                                                                        3-,
                                                                \                          U  1\
                                                                                                  'I Note:          The facility reviewer's initials/signature are not applicable for NRC-developed examinations.
              # Independent NRC reviewer initial items in Column "CO; dlief examiner concurrence required.
ES-401, Page 29 of 33
 
ES-401                                      Written Examination Quality Checklist                                        Form ES-401-6 Facility:    PALO VERDE                                                Date of Exam: Nov 6,      2009        Exam Level: RO Lc SRO ~
Initial Item Description                                                    I          b+          c'
: 1.          Questions and answers are technically accurate and applicable to the facility.                          d      \*,.M'\ rJ,/r
                                                                                                                              ,\
                                                                                                                                              ~
: 2.          a.            NRC KlAs are referenced for all questions.
: b.          Facility learning objectives are referenced as available.                                  ~      r'~~\1~,.
: 3.          SRO questions are appropriate in accordance with Section D.2.d of ES-401                                        [\I.\-!        ~
: 4.          The sampling process was random and systematic (If mOle than 4 RO or 2 SRO questions were reoeated from the last 2 NRC licensina exams, cons!.!lt the NRR OL program office).                ~      m~f"        ~
: 5.          Question duplication from the license screening/audit 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 i- the licensee certifies that there is no duplication; or
_ other (explain)                                                                                                    \' t'
                                                                                                                                ,',1'(      Jt,r 1
: 6.          Bank use meets limits (no more than 75 percent                    Bank      Modified            New from the bank, at least 10 percent new, and the rest new or modified); enter the actual RO I SRO-only question distribution(s) at right.
4  /16    6    / 24%      15/60':,          I'l'~'      ~
: 7.          Between 50 and 60 percent of the questions on the RO                  Memory              CIA          \
exam are written at the comprehension/ analysis level; I~
the SRO exam may exceed 60 percent if the randomly 9                  16/                          ~I selected KlAs support the higher cognitive levels; enter                I 36%                      64%          LI,~i';
the actual RO I SRO question distribution(s) at riqht.
: 8.          References/handouts provided do not give away answers or aid in the elimination of distractors.                                                                C        i',\V, (jn1f
: 9.          Question content conforms with specific KIA statements in the previously approved examination outline and is appropriate for the tier to which they are assigned:
deviations are justified.
( "~    ~If M
                                                                                                                                            ~
I A
: 10.          Question psychometric Quality and format meet the guidelines in ES Appendix B.                                    i\\I\'\
                                                                                                                        ,... 111\~I
                                                                                                                                            ~
: 11.          The exam contains the required number of one-point. multiple choice items;
                                                                                                                                  .~
the total is correct and aarees with the value on the cover :sheet.
Printed Nam~~                                                        Date Larry Burton                                                                10/2/09
: a. Author b.
c.
Facility Reviewer (0)
NRC Chief Examiner (#)
Warren Po~ter
                                                      ~~
                                                                                !"r ~f/::w W
71hI ..a    --        )
:0/2/09 iB
: d. NRC Regional Supervisor                            Ktil\J Clo.\I{oi\                *1IlIlIJD, I I7)b.....                    let d'\
                                                                \        \                        0 Note:        + The facility reviewer's initials/signature are not applicable for NRC*developed examinations.
              # Independent NRC reviewer initial items in Column *c"; chief examiner concurrence required.
ES-401. Page 29 of 33
 
ES-301                                            Operating Test Quality Checklist                                      Form ES-301-3 Facility: fh\o \ferJ.e                                                  Date of Examination: \ \  "0Ioq    Operating Test Number:
Initials
: 1. General Criteria il    b*      elf.
: a.          The operating test conforms with the previously approved outline; changes are consistent with sampling requirements (e.(I., 10 CFR 55.45, operational importance, safety function distribution).
f ~ IShlr 1/
: b.          There is no day-to-day repetition between this and other operating tests to be administered                    J during this examination.                                                                                          uNJ YJr6'
: c.          The operatinQ test shall not duplicate items from the applicants' audit test(s). (see Section D.1.a.)              wAf rnatr
(~ ~ ~
: d.            Overlap with the written examination and between different parts of the operating test is within acceptable limits.
{
                                                                                                                                          ~
: e.            It appears that the operating test will differentiate between competent and less-than-competent applicants at the designated license level.                                                                        WJJ
: 2. Walk-Throuah Criteria                                                --      -      --
: a.            Each JPM includes the following, as applicable:
              **    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 inclUde:
                                                                                                                          ;~ ~
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
                    -      identification of critical steps and their associated performance standards
                    -      restrictions on the sequence of steps, if applicable
                                                                                                                          ~ t#l ~
: b.            Ensure that any changes from the previously approved systems and administrative walk-through outlines (Forms ES-301-1 and 2) have not caused the test to deviate from any of the acceptance criteria (e.g., item distribution, bank use, repetition from the last 2 NRC examinations) specified 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 COpy is attached.                                                                                    I~    ~~
Printed Na  (~L 1\ ature              ---.
Date
: a. Author                            Larry Burton                  -,\..                ')                    09/02/09
: b. Facility Reviewer(*)              Warren Potter              AA~            ---=--                        09/02/09
: c. NRC Chief Examiner (#)            ~~~~~                                t; ,."    ~    .....--0            I() /2If   /0'1 K~llv QCl1I~~                        '\1). ~~I ~ "]";h, 1
: d. NRC Supervisor                                                                                              101 J.l\lqq l       \                         TJ A NOTE:
* The facility signature is not applicable for NRC-developed tests.
            #       Independent NRC reviewer initial items in Column "c"; chief examiner concurrence required.
ES-301, Page 24 of 27
 
Facilitv: Palo Verde                           Date 0 fExam: 11/10/09 S cenano . Numbers:   1 / 3 / 4 0Jperatlng Test N0.:
QUALITATIVE ATIRIBUTES                                                       Initials b*       elf.
                                                                                                                        )
: 1.         The initial conditions are realistic, in that some equipment and/or instrumentation may be out of service. but it does not cue the operators into expected events.                                     C  i &'\\t    .k
: 2.         The scenarios consist mostlv of related events.                                                       (,     ,J       W
: 3.         Each event description consists of
                                                                                                                      ~ rill ~
the point in the scenario when it is to be initiated the malfunction(s) that are entered to initiate the event
            **       the symptoms/cues that will be visible to the crew the expected operator actions (by shift position)
* the event termination ooint (if aoolicable)
* the event termination ooint (if aoolicable)
: 4. No more than one non-mechanistic failure (e.g., pipe break) is incorporated into the scenario without a credible precedillQ incident such as a seismic event. 5. The events are valid with regard to physics and thermodynamics. 6. Sequencing and timing of events is reasonable, and allows the examination team to obtain   complete evaluati.on results commensurate with the scenario obiectives.
: 4.         No more than one non-mechanistic failure (e.g., pipe break) is incorporated into the scenario without a credible precedillQ incident such as a seismic event.                                             I~ I/~
: 7. If time compression techniques are used. the scenario summary clearly so indicates.
: 5.         The events are valid with regard to physics and thermodynamics.                                       ~    I~ ~~
wAf" Operators have sufficient time to carry out expected activities without undue time constraints.
: 6.         Sequencing and timing of events is reasonable, and allows the examination team to obtain complete evaluati.on results commensurate with the scenario obiectives.                                     I~ 1~6'"
Cues are given. C' 8. The simulator modelinQ is not altered. A !lAW 9. The scenarios have been validated.
: 7.         If time compression techniques are used. the scenario summary clearly so indicates.
Pursuant to 10 CFR 55.46(d), any open simulator J performance deficiencies or deviations from the referenced plant have been evaluated 0 )J((to ensure that functional fidelity is maintained while running the planned scenarios.
Operators have sufficient time to carry out expected activities without undue time constraints.
: 10. Every operator will be evaluated using at least one new or significantly modified scenario. All other scenarios have been altered in accordance with Section 0.5 of ES-301. a i ! ti  11. All individual operator competencies can be evaluated, as verified using Form ES-301-6 (submit the form along with the simulator scenarios). ( 12. Each applicant will be significantly involved in the minimum number of transients and events 0'1 iNtI specified on Form ES-301-5 (submit the form with the simulator scenarios).
Cues are given.                                                                                       C'     wAf"
: 13. The level of difficulty is appropriate to support licensing decisions for each crew position.
: 8.         The simulator modelinQ is not altered.                                                                 A     !lAW ,~ ~
I W Taraet Quantitative Attributes (Per Scenario; See Section D.S.d) Actual Attributes  
: 9.         The scenarios have been validated. Pursuant to 10 CFR 55.46(d), any open simulator                     J performance deficiencies or deviations from the referenced plant have been evaluated to ensure that functional fidelity is maintained while running the planned scenarios.                 0 I~ )J((
---1. Total malfunctions (5-8) 7 / 8 / 7 llAA W Malfunctions after EOP entry (1-2) 2 / 3 / 2 Ii.W. tf l V 2. 3. Abnormal events (2-4) 4 /5/ 4    4. Major transients (1-2) 2 / 2 / 2 11JA1? 5. EOPs entered/requiring substantive actions (1-2) 1 / 2 / 1 1h"MP .lJ,t 6. EOP continoencies requiring substantive actions (0-2) 0 / 1 / 1   7 C':ritical tasks 12-3\ 2 / 2 I 1 t In-P
a I~ ~
,;;)IIIIUlcILUI  
: 10.         Every operator will be evaluated using at least one new or significantly modified scenario.
,;;)1,;\::lIcUIU  
All other scenarios have been altered in accordance with Section 0.5 of ES-301.
\olUClIILY ull\::I,;I\IISL rorm r::"-,)U'I-4 Facilitv:
i
Palo Verde Date of Exam: 11/10/09 Scenario Numbers: 2 / / OperatinQ Test No.: QUAlITATIVE ATTRIBUTES Initials a b* r:;# 1. The initial conditions are realistic, in that some equipment and/or instrumentation may be out ,!IM1 of service, but it does not cue the operators into expected events. 2. The scenarios consist mostly of related events. 3. Each event description consists of
: 11.         All individual operator competencies can be evaluated, as verified using Form ES-301-6 (submit the form along with the simulator scenarios).                                                 (
                                                                                                                      ! ti ~
: 12.         Each applicant will be significantly involved in the minimum number of transients and events specified on Form ES-301-5 (submit the form with the simulator scenarios).                           0'1    iNtI        ~k'
: 13.         The level of difficulty is appropriate to support licensing decisions for each crew position.           I W             ~
Taraet Quantitative Attributes (Per Scenario; See Section D.S.d)                     Actual Attributes   -       -         -
: 1.         Total malfunctions (5-8)                                                             7   /8   /   7       llAA       W
: 2.          Malfunctions after EOP entry (1-2)                                                 2     /3 /     2       Ii.W.       tflV
: 3.         Abnormal events (2-4)                                                               4     /5/     4   ~   I~              ~
                                                                                                                    ~
: 4.         Major transients (1-2)                                                             2     /2   /   2       11JA1?     ~
: 5.         EOPs entered/requiring substantive actions (1-2)                                     1 /2     /   1       1h"MP     .lJ,t
                                                                                                                                      ~
: 6.         EOP continoencies requiring substantive actions (0-2)                               0 /1     /   1       I~
7           C':ritical tasks 12-3\                                                               2 / 2     I   1     t In-P
 
                                        ,;;)IIIIUlcILUI ,;;)1,;\::lIcUIU \olUClIILY ull\::I,;I\IISL                 rorm     r::"-,)U'I-4 Facilitv: Palo Verde                           Date of Exam: 11/10/09 Scenario Numbers:         2 /       /       OperatinQ Test No.:
QUAlITATIVE ATTRIBUTES                                                           Initials a     b*     r:;#
: 1.         The initial conditions are realistic, in that some equipment and/or instrumentation may be out of service, but it does not cue the operators into expected events.                                             ,!IM1 I~
: 2.         The scenarios consist mostly of related events.                                                                   ~ ~
: 3.         Each event description consists of
* the point in the scenario when it is to be initiated
* the point in the scenario when it is to be initiated
* the malfunction(s) that are entered to initiate the event
                                                                                                                        ~
* the symptoms/cues that will be visible to the crew the expected operator actions (by shift position)
the malfunction(s) that are entered to initiate the event the symptoms/cues that will be visible to the crew the expected operator actions (by shift position) the ellent termination point (if applicable)                                                                 ~~
* the ellent termination point (if applicable)
                                                                                                                                      ~
No more than one non-mechanistic failure (e.g., pipe break) is incorporated into the scenario VMf  4. without a credible precedinQ incident such as a seismic event. 5. The events are valid with reQard to physics and thermodynamics. 6. Sequencing and timing of events is reasonable, and allows the examination team to obtain lwi  complete evaluation results commensurate with the scenario objectives.
VMf ~~6-
: 7. If time compression techniques are used, the scenario summary clearly so indicates. "  >rrf.r Operators have sufficient time to carry out expected activities without undue time constraints.
: 4.          No more than one non-mechanistic failure (e.g., pipe break) is incorporated into the scenario without a credible precedinQ incident such as a seismic event.
(Cues are given. 8. The simulator modelinQ is not altered. /.lW 9. The scenarios have been validated.
: 5.         The events are valid with reQard to physics and thermodynamics.                                                 I~r ~~
Pursuant to 10 CFR 55.46(d), any open simulator performance deficiencies or deviations from the referenced plant have been evaluated to ensure that functional fidelity is maintained while running the planned scenarios.
: 6.         Sequencing and timing of events is reasonable, and allows the examination team to obtain complete evaluation results commensurate with the scenario objectives.                                           lwi ~            ~
: 10. Every operator will be evaluated using at least one new or significantly modified scenario.
: 7.         If time compression techniques are used, the scenario summary clearly so indicates.
IltAt fJrtr AU other scenarios have been altered in accordance with Section D.5 of ES-301. C 11. All individual operator competencies can be evaluated, as verified using Form ES-301-6 l1AM'r  (submit the form alona with the simulator scenarios). ( 12. Each applicant will be significantly involved in the minimum number oftransients and events specified on Form ES-301-5 (submit the form with the simulator scenarios).
Operators have sufficient time to carry out expected activities without undue time constraints.
: 13. The level of difficulty is appropriate to support licensing decisions for each crew position.
Cues are given.                                                                                               (  ~ >rrf.r
r  Target Quantitative Attributes IPer Scenario; See Section D.5.d) Actual Attributes  
: 8.         The simulator modelinQ is not altered.                                                                           Iw~ /.lW
-1. Total malfunctions (5-81 7 / /   2. Malfunctions after EOP entry (1-2) 3 / / , l\m
                                                                                                                            ~ J,~
: 3. Abnormal events (2-4) 4 / / II'J\ i.lr 4. Maior transients (1-2) 1 / /  IJltl f!m 5. EOPs entered/requiring substantive actions (1-2) 1 / / bfl.iP 6. EOP contingencies requirinQ substantive actions (0-2) 0 / / 11k Wllr 7. Critical tasks 12-3\ 2 I I 1 \lAP 1Jtn&
: 9.         The scenarios have been validated. Pursuant to 10 CFR 55.46(d), any open simulator performance deficiencies or deviations from the referenced plant have been evaluated to ensure that functional fidelity is maintained while running the planned scenarios.
ES-301 Transient and Event Checklist Form ES-301-5 Facility:
IltAt fJrtr
Palo Verde Date of Exam: 11/10109 Operating Test Number: 2009 A E Scenarios P V P E #1 #3 #4 T M L N 0 I I T CREW CREW CREW CREW T 1\1 C POSITION POSITION POSITION POSITION A I A T L M N y S A B S A B S A B S A B U T P R T 0 R T 0 R T 0 R T 0 M(*)E 0 C P 0 C P 0 C P 0 C P R I U RO RX 0 1 1 0 0 NOR 1 1 2 1 1 1 SRO-I I/C 2,3,4,6,5, 2,3,4,5,7, 0 7 8,9 13 4 4 2 SRO-U MAJ 6,8 6,8 4 2 2 1[gJ Ul U3 TS 4,5 2,5 4 0 2 2 RO RX 0 1 1 0 0 NOR SRO-I 1 1 2 1 1 1 [gJ SRO-U I/C 2,3,4,5,6, 2,3,4,5,7, 2,4,6 16 4 4 2 0 7 8,9 II MAJ I2 6,8 6,8 5,8 6 2 2 1 I4 IS TS 0 2 2 4,5 2,5 4 I RO RX 4 1 1 1 0 0 NOR SRO-I 1 1 2 1 1 1 [gJ I/C 2,6 2,3,4,5,7, 2,3,4,6,7 14 4 4 2 SRO-U 8,9 0 MAJ 6,8 6,8 5,8 6 2 2 1 I3 TS 4 0 2 2 2,5 2,3 RO RX 0 1 1 0 0 NOR SRO-I 1 1 1 1 1 0 I/C 2,3,4,5,6, 3,5,8,9 10 4 4 2 SRO-U 7 [gJ MAJ 6,8 6,8 4 2 2 1 U-2 TS 4,5 2 0 2 2 Instructions:
: 10.         Every operator will be evaluated using at least one new or significantly modified scenario.
: 1. Check the afElicant level and enter the operating test number and Form ES-D-1 event numbers for each event type; are not applicable for RO applicants.
AU other scenarios have been altered in accordance with Section D.5 of ES-301.                               C l1AM'r ~t
ROs must serve in both the "at-the-controls (ATC)" and "balance-of-plant (BOP)" positions; Instant SROs 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.
: 11.        All individual operator competencies can be evaluated, as verified using Form ES-301-6 (submit the form alona with the simulator scenarios).                                                       (
If an Instant SRP additionally serves in the BOP position, one I/C Malfunction can be credited toward the two I/C malfunctions required for the ATC position.
I~ I~
: 2.
: 12.         Each applicant will be significantly involved in the minimum number oftransients and events specified on Form ES-301-5 (submit the form with the simulator scenarios).
manipulations may be conducted under normal or controlled abnormal conditions (refer to Section .5.d) but must be significant per Section C.2.a of Appendix D. P Reactivity and normal evolutions may be replaced with additional instrument or component mal unctions on a 1-for-1 basis. 3. Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count toward the minimum requirements specified for the applicant's license level in the right-hand columns.
: 13.         The level of difficulty is appropriate to support licensing decisions for each crew position.                 ~~
ES-301 Transient and Event Checklist Form ES-301-5 Facility:
Target Quantitative Attributes IPer Scenario; See Section D.5.d)                         Actual Attributes             -      -
Palo Verde Date of Exam: 11/10108 Operating Test Number: 2008 Scenarios E A P P L I C A N T V E N T T Y P E S R 0 #1 CREW POSITION A T C B 0 P S R 0 #3 CREW POSITION A T C B 0 P S R 0 #4 CREW POSITION A T C B 0 P S R 0 CREW POSITION A T C B 0 P T 0 T A L R M I N I M U M(*) I U RO RX 4 1 1 1 0  SRO-I NOR 1 1 1 1 1 D I/C 3,4,5,7 3,5,8,9 8 4 4 2 SRO-U D Rl R2 MAJ 6,8 6,8 4 2 2 1 R3 R7 R9 TS 0 0 2 2 RO  RX 4 1 1 1 0 SRO-I D NOR 1 1 1 1 1 SRO-U D R4 RB I/C 2,6 2,4,7 5 4 4 2 RlO Rl2 Rl3 MAJ 6,8 6,8 4 2 2 1 Rl5 TS 0 0 2 2 RO RX  4 1 1 1 0 SRO-I D NOR 1 1 2 1 1 1 SRO-U D I/C 3,4,5,7 3,5,8,9 3,4,7 11 4 4 2 R5 Rll MAJ Rl4 6,8 6,8 5,8 6 2 2 1 TS 0 0 2 2 Instructions: Check the afElicant level and enter the operating test number and Form ES-D-1 event numbers for each event type; are not applicable for RO applicants.
: 1.         Total malfunctions (5-81                                                               7   /     /             I~r I~
ROs must serve in both the "at-the-controls (ATC)" and "balance-of-plant (BOP)" positions; Instant SROs 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.
: 2.         Malfunctions after EOP entry (1-2)                                                     3   /     /
If an Instant SRO additionally serves in the BOP position, one I/C Malfunction can be credited toward the two I/C malfunctions required for the ATC position.
                                                                                                                        , l\m ~'}Y1&
manipulations may be conducted under normal or controlled abnormal conditions (refer to Section .S.d) but must be significant per Section C.2.a of Appendix D. hl Reactivity and normal evolutions may be replaced with additional instrument or component mal nctions on a 1-for-1 basis. Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's count toward the minimum requirements specified for the applicant's license level in t e right-hand columns.
: 3.         Abnormal events (2-4)                                                                   4   /     /               II'J\     i.lr
ES*301 Transient and Event Checklist Form ES*301*5 ES-301, Page 26 of 27 ES*301 Transient and Event Checklist Form ES*301*5 Facility:
: 4.         Maior transients (1-2)                                                                 1   /     /           ~ IJltl     f!m
Palo Date of Exam: 11/10108 Operating Test Number: 2008 A E Scenarios P T M E #3 #4 #2 (Spare)#1 I I L N 0 T I\l T CREW CREW CREW CREW C A I POSITION POSITION POSITION POSITION T A L M Y N S S A B A B A B A B S S U T P R T 0 R T 0 R T 0 R T 0 M(*)E P 0 C P 0 C P 0 C P 0 C R I U RO RX 1 1 1 4 0  NOR 1 1 1 1 1 2 SRO-I D I/C 2,4,7 3,4,7 4 4 2,6 2 8 SRO-U MAJ 6,8 5,8 1 6,8 2 2 6 D R6 TS 2 2 0 RO RX 1 1 0 D NOR 1 1 1 1 1 SRO-I D 2,3,4,5,7, I/C 2,7 4 3,4,5,8 4 2 8 SRO-U MAJ 6 6 2 2 6 1 D TS 2,3 2 2 0 RO RX 1 1 0 D NOR 1 1 1 SRO-I IIC D 4 4 2 SRO-U MAJ 2 2 1 D TS 0 2 2 Instructions: Check the afglicant level and enter the operating test number and Form ES-D-1 event numbers for each event type; are not applicable for RO applicants.
: 5.         EOPs entered/requiring substantive actions (1-2)                                       1   /     /               bfl.iP .~
ROs must serve in both the "at-the-controls (ATC)" and "balance-of-plant (BOP)" positions; Instant SROs 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 Instant SRO additionally serves in the BOP position, one I/C Malfunction can be credited toward the two I/C malfunctions required for the ATC position.
: 6.         EOP contingencies requirinQ substantive actions (0-2)                                   0   /     /         11k   Wllr I~~
manipulations may be conducted under normal or controlled abnormal conditions (refer to Section .5.d) but must be significant per Section C.2.a of Appendix D. P Reactivity and normal evolutions may be replaced with additional instrument or component mal unctions on a 1-for-1 basis, Whenever practical, both instrument and component malfunctions should be included; only that require verifiable actions that provide insight to the applicant's count the minimum requirements specified for the applicant's license level in t e right-hand ES-301, Page 26 of 27 ES-301 Competencies Checklist Form ES-301-6 Facility:
: 7.         Critical tasks 12-3\                                                                   2   I     I           1 \lAP 1Jtn&
Palo Verde Date of Examination:
 
Nov 9, 2009 Operating Test No.: APPLICANTS RO 0 RO D RO D SRO-I D RO X SRO-I D SRO-I D SRO-U D SRO-I X SRO-U X SRO-U D SRO-U D SCENARIO SCENARIO SCENARIO SCENARIO Competencies 3 2 3 1 2 1 2 4 1 4 3 4 1 2 3 2,3, 4,6 4,5, 2,4, 4,6 4,5, 2,3, 2,3, 2,3, 2,3, 2,3, 4,5, I nterpretlDiag nose 4,5, 4,5, 4,5, 4,5, 6,8, 5,6, 4,5, 6,8, 6,8 4,5, Events and Conditions 8 6,7, 6,7, 6,7, 6,7, 6,8 9 6,8 9 8 8 8,9 3,4, 3,4, 1,2, 3,4, 3,4, 2,4, 3,4, 3,4, 2,4, 1,2, 1,2, Comply With and 3,4. 5,6, 5,6 5,6, 5,6, 5,6 3,5, 3,4. 3,5, 5,6, 5,6, 5,6, Use Procedures (1 ) 7,8 5,6, 8 8,9 8 8 8,9 8 7,8 5,6, 6,7, 8,9 1,3, 1,2, 2,4, 2,6, 1,2, Operate Control 3,4, 3,4, 4,5, 3,4, 6,7 8 Boards (2) 5,6, 6,7, 5,6, 7,8 8,9 1,2, 2,3, 2,3, 1,2, 2,3, 2,3, 2,3, 1,2, 2,3, 2,3, 2,3, Communicate 3,4, 4,5, 3,4, 4,5, 3,4, 5,6, 4,5, 4,5, 6,8 4,5, 3,4, 4,5, and Interact 7,8 6,8 6,7, 5,6, 6,8 6,7, 5,6, 5,6, 6,7, 5,6, 6,8 8 7,8 8 8,9 8 8,9 1,2, 8 1,2, 1,2, 1,2, 1,2, 1,2, 1,2, 1,2, Demonstrate 3,4, 3,4, 3,4, 3,4, 3,4, 3,4, 3,4, 3,4, Supervisory Ability (3) 5,6, 6,7 5,6, 5,6, 5,6, 6,7 5,6, 5,6, 8 8,9 78 8 8,9 78 2,3 4,5 2,3 2,5 4,5 2,3 2,5 2,3 Comply With and Use Tech. Specs. (3) Notes: (1 ) Includes Technical Specification compliance for an RO. (2) Optional for an SRO-U. (3) Only applicable to SROs. Instructions:
ES-301 Transient and Event Checklist Form ES-301-5 Facility: Palo Verde                                       Date of Exam: 11/10109           Operating Test Number: 2009 A         E                                                             Scenarios P         V P         E               #1                       #3                     #4 T     M L         N                                                                                           0       I I         T CREW                     CREW                   CREW       CREW           T     1\1 C
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.
POSITION                 POSITION                 POSITION     POSITION         A       I A         T                                                                                           L     M N         y       S       A     B       S         A     B     S       A   B S   A       B           U T         P       R       T     0       R         T     0       R       T   0 R   T       0           M(*)
4 ES-403 Written Examination Grading Form Quality
E       0         C     P       0         C     P     0       C   P 0   C       P R     I U RO         RX                                                                                             0   1   1 0 0           NOR         1                       1                                                         2   1   1 1 SRO-I I/C     2,3,4,6,5,               2,3,4,5,7, 13  4    4  2 0                       7                       8,9 SRO-U       MAJ       6,8                     6,8                                                         4   2   2 1
: 2. Answer key changes and question deletions justified and documented Date /Ito,kc; II!ttJlo ? I 11/30/0 1 lelz./cJ'f Date of Exam: 11/' tJ Exam Level: RO Item Descri tion 3. Applicants' scores checked for addition errors reviewers s ot check> 25% of examinations
[gJ Ul U3     TS         4,5                     2,5                                                         4   0   2 2 RO         RX                                                                                             0   1   1 0 0           NOR SRO-I                   1                       1                                                         2   1   1 1
: a. Grader 4. Grading for all borderline cases (80 +/-2% overall and 70 or 80, as a licable, +/-4% on the SRO-onl reviewed in detail Facili : 'Palo \lev-de..
[gJ SRO-U       I/C     2,3,4,5,6,               2,3,4,5,7, 7                      8,9 2,4,6                     16 4   4 2 0     II   MAJ I2               6,8                     6,8                               5,8                       6 2   2 1 I4 IS   TS 4,5                     2,5                                                         4   0    2  2 I
: b. Facility Reviewer(*)
RO         RX                   4                                                                         1 1     1 0 0           NOR                                                                                                 1    1  1 SRO-I                                           1                       1                                 2
: 6. Performance on missed questions checked for training deficiencies and wording problems; evaluate validity of uestions missed b half or more of the a Iicants 5. All other failing examinations checked to ensure that grades are 'ustified
[gJ         I/C                 2,6 2,3,4,5,7, 2,3,4,6,7                             14 4   4 2 8,9 SRO-U 0         MAJ                 6,8           6,8                     5,8                                 6 2   2 1 I3     TS                                 2,5                     2,3                                 4  0    2  2 RO          RX                                                                                               0 1     1 0 0         NOR                                                                                                       1 SRO-I                   1                                                                                   1 1       1 0         I/C     2,3,4,5,6, 7
: c. NRC Chief Examiner (*) 1. d. NRC Supervisor
3,5,8,9                                           10 4   4 2 SRO-U
(*) (*) The facility reviewer's signature is not applicable for examinations graded by the NRC; two inde en dent NRC reviews are re uired. ES-403, Page 6 of 6 ES-201 Examination Security Agreement Form ES-201-3 1. Pre-Examination zooct 1:r-J1:Tr4c.  .1. 1. I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 11(, -ITof the date of my signature.
[gJ         MAJ       6,8                                 6,8                                               4 2   2 1 U-2 TS         4,5                                                                                   2 0   2 2 Instructions:
I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner.
: 1.       Check the afElicant level and enter the operating test number and Form ES-D-1 event numbers for each event type;         are not applicable for RO applicants. ROs must serve in both the "at-the-controls (ATC)"
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).
and "balance-of-plant (BOP)" positions; Instant SROs 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 Instant SRP additionally serves in the BOP position, one I/C Malfunction can be credited toward the two I/C malfunctions required for the ATC position.
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.
Reactivi~ manipulations may be conducted under normal or controlled abnormal conditions (refer to 2.
I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
Section .5.d) but must be significant per Section C.2.a of Appendix D.         P Reactivity and normal evolutions may be replaced with additional instrument or component mal unctions on a 1-for-1 basis.
: 2. Post-Examination To the best of my  not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s)  From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC. PRINTED NAME JOB TITLE / RESPONSIBILITY DATE  "., 1/
: 3.       Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count toward the minimum requirements specified for the applicant's license level in the right-hand columns.
//-13**0q r r rtu--iYr:::P x: 1/.11-1>'1


VI "'lY'v'
ES-301 Transient and Event Checklist Form ES-301-5 Facility: Palo Verde                              Date of Exam: 11/10108                Operating Test Number: 2008 Scenarios A            E V                                                                                                M P            E            #1                  #3                    #4 P                                                                                                            I L            N                                                                                        T      N T          CREW                CREW                  CREW              CREW I                      POSITION            POSITION              POSITION            POSITION        0      I C                                                                                                      T      M T
. _ Nha-\e..r lodfJ,td?J('
A Y      S      A      B      S      A      B      S      A      B    S    A        B A      U N            P                                                                      R                  L    M(*)
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T                  R      T      0      R      T      0      R      T      0          T        0 E      0      C      P    0      C      P      0      C      P    0    C        P R    I U RO          RX                        4                                                                  1  1  1  0
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----_..-
SRO-I      NOR                      1                                                                  1  1  1  1 D          I/C                    3,4,5,7      3,5,8,9                                                8  4  4  2 SRO-U D    Rl R2 MAJ                      6,8          6,8                                                  4  2  2  1 R3 R7 TS 0  0  2  2 R9 RO          RX 4                                                                          1  1  1  0
~
SRO-I      NOR D                                                          1                                            1  1  1  1 SRO-U D  R4      I/C 2,6                        2,4,7                                          5  4  4  2 RB RlO Rl2    MAJ Rl3                      6,8                          6,8                                            4  2  2  1 Rl5 TS 0  0  2  2 RO          RX 4                                                                  1  1    1  0
~
SRO-I      NOR D                                    1                                        1                        2  1  1  1 SRO-U D          I/C 3,4,5,7      3,5,8,9                      3,4,7                      11  4  4  2 R5 Rll      MAJ Rl4                              6,8          6,8                        5,8                        6  2  2  1 TS 0  0  2  2 Instructions:
: 1. Check the afElicant level and enter the operating test number and Form ES-D-1 event numbers for each event type;    are not applicable for RO applicants. ROs must serve in both the "at-the-controls (ATC)"
and "balance-of-plant (BOP)" positions; Instant SROs 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 Instant SRO additionally serves in the BOP position, one I/C Malfunction can be credited toward the two I/C malfunctions required for the ATC position.
Reactivi~ manipulations may be conducted under normal or controlled abnormal conditions (refer to 2.
Section .S.d) but must be significant per Section C.2.a of Appendix D.      hl Reactivity and normal evolutions may be replaced with additional instrument or component mal nctions on a 1-for-1 basis.
: 3. Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's com~etence count toward the minimum requirements specified for the applicant's license level in t e right-hand columns.


\1)[-cVY\.f"Jl 112 w __ ( .....r,J -v .... -zoo, ES-201, Page 27 of 28 ES-201 Examination Security Agreement Form ES-201-3 1. Pre-Examination  I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of as of the date of my signature.
ES*301 Transient and Event Checklist Form ES*301*5 ES-301, Page 26 of 27 ES*301 Transient and Event Checklist Form ES*301*5 Facility: Palo Verde                              Date of Exam: 11/10108                      Operating Test Number: 2008 A          E                                                    Scenarios P          V P          E            #1                  #3                   #4                #2 (Spare)
I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner.
T    M L          N                                                                                              0      I I          T                                                                                              T    I\l C                      CREW                CREW                  CREW                    CREW POSITION            POSITION              POSITION              POSITION          A      I A          T                                                                                              L    M N          Y      S      A      B      S      A      B      S      A      B      S        A      B          U T          P      R      T    0      R      T      0      R      T      0        R        T      0          M(*)
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).
E      0      C      P    0      C      P      0      C      P      0        C      P R    I U RO          RX                4                                                                              1  1    1  0
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.
~          NOR SRO-I                                                     1                    1                            2  1    1  1 D          I/C              2,6                        2,4,7                3,4,7                          8  4    4  2 SRO-U MAJ                                                                                                  2    2  1 D                            6,8                          6,8                  5,8                            6 R6      TS 0    2  2 RO          RX                                                                                                  1    1  0 D          NOR                                                                        1        1              1    1  1 SRO-I D          I/C                                                                    2,3,4,5,7, 8
I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
2,7  3,4,5,8    4    4  2 SRO-U D          MAJ                                                                        6        6      6      2    2  1 TS                                                                        2,3                      0    2  2 RO          RX                                                                                                  1    1  0 D          NOR                                                                                                  1    1  1 SRO-I D          IIC                                                                                                  4    4  2 SRO-U MAJ                                                                                                  2    2  1 D
: 2. Post-Examination To the best of my knoA1tdge,1 did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of <C-\4-. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC. PRINTED NAME JOB TITLE / RESPONSIBILITY
TS                                                                                                  0    2  2 Instructions:
: 1.  
: 1. Check the afglicant level and enter the operating test number and Form ES-D-1 event numbers for each event type;      are not applicable for RO applicants. ROs must serve in both the "at-the-controls (ATC)"
  . Ill..  
and "balance-of-plant (BOP)" positions; Instant SROs 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 Instant SRO additionally serves in the BOP position, one I/C Malfunction can be credited toward the two I/C malfunctions required for the ATC position.
"W< v%'!f.. f--. 4.
2.
l/iili1: 5..,'" QoNVA-c.:1for?JT
Section .5.d) but must be significant per Section C.2.a of Appendix D.       P Reactivi~ manipulations may be conducted under normal or controlled abnormal conditions (refer to Reactivity and normal evolutions may be replaced with additional instrument or component mal unctions on a 1-for-1 basis,
: 6. ::TO
: 3. Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's com~etence count toward the minimum requirements specified for the applicant's license level in t e right-hand columns.
: 7.  ,1. _
ES-301, Page 26 of 27


rrP
ES-301                                Competencies Checklist                        Form ES-301-6 Facility: Palo Verde            Date of Examination: Nov 9, 2009          Operating Test No.:
APPLICANTS RO          X        RO        0        RO        D          RO      D SRO-I      D        SRO-I    X        SRO-I    D          SRO-I  D SRO-U      D        SRO-U    D        SRO-U    X          SRO-U  D Competencies                SCENARIO              SCENARIO            SCENARIO          SCENARIO 1    2    3    4    1    2    3    4    1    2    3    4    1    2  3  4 2,3,  2,3, 2,3,  2,3, 2,3, 4,6 4,5, 2,4, 2,3, 4,6 4,5, 4,5, InterpretlDiagnose            4,5,  4,5, 4,5,  4,5, 4,5,      6,8, 5,6, 4,5,      6,8, 6,8 Events and Conditions          6,7,  6,7, 6,7,  6,7, 6,8        9    8 6,8          9 8    8    8,9  8 1,2,  1,2, 1,2,  1,2, 3,4, 3,4, 3,4, 2,4, 3,4, 3,4, 3,4, 2,4, Comply With and                3,5,  3,4. 3,4. 3,5, 5,6, 5,6 5,6, 5,6, 5,6, 5,6 5,6, 5,6, Use Procedures (1 )            7,8  5,6, 5,6,  6,7,  8        8,9 8      8        8,9 8 7,8  8,9  8 1,2,  1,2,  1,3, 1,2, 2,4,          2,6, Operate Control                3,4,  3,4, 4,5,  3,4, 6,7              8 Boards (2)                    5,6,  5,6, 6,7,  5,6, 7,8  7,8  8,9  7,8 1,2,  2,3, 2,3,  1,2, 2,3, 2,3, 1,2, 2,3, 2,3, 2,3, 1,2, 2,3, Communicate                    3,4,  5,6, 4,5,  3,4, 4,5, 4,5, 3,4, 6,8 4,5, 4,5,  3,4, 4,5, and Interact                  5,6,  7,8  6,7,  5,6, 6,8 6,7, 5,6,      6,8 6,7,  5,6, 6,8 8          8  7,8        8 8,9              8  8,9 1,2, 1,2, 1,2, 1,2, 1,2, 1,2, 1,2, 1,2, Demonstrate                                          3,4, 3,4, 3,4, 3,4, 3,4, 3,4, 3,4, 3,4, Supervisory Ability (3)                              5,6, 6,7 5,6,  5,6, 5,6, 6,7  5,6, 5,6, 8        8,9  78  8        8,9  78 4,5 2,3 2,5    2,3 4,5 2,3    2,5  2,3 Comply With and Use Tech. Specs. (3)
Notes:
(1 )    Includes Technical Specification compliance for an RO.
(2)      Optional for an SRO-U.
(3)      Only applicable to SROs.
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.


__
ES-403                            Written Examination Grading                      Form ES-403-1 Quality Checklist Facili : 'Palo \lev-de..           Date of Exam:   11/'   tJ      Exam Level: RO Item Descri tion 1.
11.12.Le=]
: 2. Answer key changes and question deletions justified and documented
: 12. I !"'Q:..<>J f.CLtft,<!f8l2fn
: 3. Applicants' scores checked for addition errors reviewers s ot check> 25% of examinations
::Jf 13.kVJ l\'"''''
: 4. Grading for all borderline cases (80 +/-2% overall and 70 or 80, as a licable, +/-4% on the SRO-onl reviewed in detail
(seN _5...:..;1 M.;",;""..S.:..;J:+/...c:.P....:...d
: 5. All other failing examinations checked to ensure that grades are 'ustified
,:....:,1=
: 6.     Performance on missed questions checked for training deficiencies and wording problems; evaluate validity of uestions missed b half or more of the a Iicants Date
_
: a. Grader                                                                              /Ito,kc;
    \1 -Zoa1 ES-201, Page 27 of 28 ES-201 Examination Security Agreement Form ES-201-3 1. Pre-Examination  . I acknowledge that I have acquired specialized knowledge about the NRC licensing for the week(s) of n-1.6 -\4 as of the date of my signature.
: b. Facility Reviewer(*)                                                               II!ttJlo ?
I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner.
I
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).
: c. NRC Chief Examiner (*)                                                             11/30/0 1
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.
: d. NRC Supervisor (*)                                                             lelz./cJ'f
I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised. . 2. Post-Examination To the best of my did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of . ..-. . From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or pr vide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC. PRINTED NAME JOB TITLE / RESPONSIBILITY DATE DATE NOTE 1.
(*)    The facility reviewer's signature is not applicable for examinations graded by the NRC; two inde endent NRC reviews are re uired.
S"f'l i>1l?6(=
ES-403, Page 6 of 6
oPeol't I  '\ -.m.-.. 2. De lO
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: 3. 


  ; ... 4. Rc.4I6Jl/-4itiJ tttW IL19
ES-201                                                                  Examination Security Agreement                                      Form ES-201-3
: 5. LAtl(tt  . 6.
: 1.        Pre-Examination                    zooct                        1:r-J1:Tr4c.            E)(~                              .1.        1. ~
It 7+00,,1 e;-f( 0 7.
I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of        11(, -ITof          the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC 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 chief examiner any indications or suggestions that examination security may have been compromised.
: 10. N I Col<.. 'fA I'P A 50
: 2.       Post-Examination To the best of my kno~~ge, ~~d not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of~ From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
PRINTED NAME              JOB TITLE / RESPONSIBILITY                                              DATE
                                                                                                                  ~~',J&-J.VJ~~~tt::oloC:~JP4(
                                                                                                                " . , 1/
                                                                                                                                            ~
                                                                                                                          ,""k7'<L~VC"'-J- //-13**0q r   r rtu-- iYr:::P x:      1/.11-1>'1 JT:T~
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    *          ~VI. "'lY'v'      ~~N~~;,~{~<<:~~rjr~rt~~;.t~~ri~k~&~'C~~=~~~~~~~~~~J~~=~~~~~~~~~~~~~
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                                                                &#xa3;Flrf,n.. ~,- ---~q:::::;~~~~~~!...-.L..~~~t~~~~C~;:=
e
                                        ,/1/" lIC ,;-
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ES-201, Page 27 of 28


t>&#xa3; -- 15. Ji,Ju,4 fvt<NEft  
ES-201                                                                                              Examination Security Agreement                                Form ES-201-3
"=:::::::
: 1.          Pre-Examination                                                                        ~ ~~~A..'-                            ~
vp.,(-+-.....  
I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of                              ~          as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC 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 chief examiner any indications or suggestions that examination security may have been compromised.
: 2.          Post-Examination To the best of my knoA1tdge,1 did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of              <C- \4- . From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
PRINTED NAME                      JOB TITLE / RESPONSIBILITY
: 1. L._-{U'fY~ .o~                                                                                                                  .      .
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                                                                              -Zoa1 ES-201, Page 27 of 28


6<._'\:.;
ES-201                                                         Examination Security Agreement                                                 Form ES-201-3
=
: 1.       Pre-Examination                     ~                  ~ ~~                                                                  .
s;r==_2W1  ES-201, Page 27 of 28 ES*201 Examination Security Agreement Form ES*201*3 1. Pre-Examination CK"A4 . 1v0 I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the 1'/;4as of the date of my signature.
I acknowledge that I have acquired specialized knowledge about the NRC licensing examin~cheduled for the week(s) of -1.6 -              n    \4  as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC 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 chief examiner any indications or suggestions that examination security may have been compromised.                                                              .
I agree that I will not knowingly divulge any information about these examinations to any persons who have not been aJthorized by the NRC chief examiner.
: 2.       Post-Examination To the best of my kno;~g741 did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of . ..-.        . From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or pr vide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
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).
PRINTED NAME              JOB TITLE / RESPONSIBILITY                                                 DATE                          DATE NOTE
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.
: 1. khl'!(}~Ll S"f'l
I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
: 2. De lO lC"!~
: 2. Post-Examination To the best of my not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of" -. From the date that I el')tered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC. JOB TITLE / RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE IJ..O C. 1t1 Ro U) Li'l.. 5" (l.o 1-0 rzo crts RD eJ,Ls -mJ\-HJlAJtr----r Jv'} '[
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ES-201, Page 27 of 28


1Z.0 AU lites Page 1 of 5 Operator Licensing Exam Schedule 04/01/2010 13:10:40 From 10/01/2009 To 01/01/2010 Report 21 Region: 4 Phase Code: 5
ES*201                                                          Examination Security Agreement                                                Form ES*201*3
: 1.        Pre-Examination                            ~, ~,,'-'                                          CK"A4                      . 1v0 I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the            Week(S)~fo 1'/;4as          of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been aJthorized by the NRC 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 chief examiner any indications or suggestions that examination security may have been compromised.
: 2.        Post-Examination To the best of my know7~ge/Jid not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of "        -  . From the date that I el')tered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
JOB TITLE / RESPONSIBILITY                    SIGNATURE (1)              DATE        SIGNATURE (2)      DATE NOTE IJ..O C. 1t1 Ro U)
Li'l.. 5" (l.o 1-0 rzo crts RD eJ,Ls
                                    -mJ\-HJlAJtr----rJv'} '[ ~(:m(L
                                        ~-'2..S 1Z.0 AU lites


..... ,..  
Page 1 of 5                                                    Operator Licensing Exam Schedule 04/01/2010      13:10:40 From 10/01/2009 To 01/01/2010 Report 21 Region: 4                Phase Code: 5
..... ....".
[~~~,:!,~~~] [S~~~~~?*~~~~3pt'#':'A~~:""''''A''* ..... ,..:~1tC~.:, . !,S~~~~=][!&#xa5;~:=:Jt~~~~~~~~!,l!!,;,~.a~i,~~~=-  ....". "T.,*JJi,~~~i.~~!s,~;~~~~~7V''''L. ::Ji 09/01/2009   Palo Verde / 05000529/2009301                                          Prep             GARCHOW, STEPHEN M.         DRAKE, JAMES F.
::Ji 09/01/2009 Palo Verde /
TAC#: X02414                                                                                                          GARCHOW, STEPHEN M.
Prep GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC#: GARCHOW, STEPHEN M. OSTERHOL TZ, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 09/01/2009 Palo Verde /05000530  
OSTERHOLTZ, CLYDE C.
/ 2009301 Prep GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC #: X02415 GARCHOW, STEPHEN M. OSTERHOL Tl, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 09/28/2009 Palo Verde / 05000528 / 2009301 Prep FFF GARCHOW, STEPHEN M. GARCHOW, STEPHEN M. TAC #: X02413 OSTERHOL Tl, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 11/09/2009 Palo Verde /05000528  
PRESBY, PETER A.
/ 2009301 RO-5 SROI -1 Admin FFF GARCHOW, STEPHEN M. CLAYTON, KELLY D. TAC #: X02413 SROU -1 DRAKE, JAMES F. GARCHOW, STEPHEN M. OSTERHOL TZ, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 11/09/2009 Palo Verde / 05000529 / 2009301 RO-5 SROI-'yZ.
lOlA, CHARLES D.
Admin FFF GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC #: X02414 SROU-1 GARCHOW, STEPHEN M. OSTERHOL Tl, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 11/09/2009 Palo Verde / 05000530 / 2009301 RO-JfG SROI-2 Admin FFF GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC #: X02415 SROU-;/, GARCHOW, STEPHEN M. OSTERHOL Tl, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 11/16/2009 Palo Verde / 05000528 / 2009301 Doc GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC #: X02413 GARCHOW, STEPHEN M. OSTERHOL TZ, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 11/16/2009 Palo Verde / 05000529 / 2009301 Doc GARCHOW, STEPHEN M. DRAKE, JAMES F. T AC #: X02414 GARCHOW, STEPHEN M. OSTERHOL Tl, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. Sites: PALO Orgs: 4620 Exam Author: ALL}}
09/01/2009   Palo Verde /05000530 / 2009301                                         Prep             GARCHOW, STEPHEN M.         DRAKE, JAMES F.
TAC #: X02415                                                                                                         GARCHOW, STEPHEN   M.
OSTERHOLTl, CLYDE   C.
PRESBY, PETER A.
lOlA, CHARLES D.
09/28/2009   Palo Verde / 05000528 / 2009301                                       Prep       FFF   GARCHOW, STEPHEN M.         GARCHOW, STEPHEN   M.
TAC #: X02413                                                                                                         OSTERHOLTl, CLYDE   C.
PRESBY, PETER A.
lOlA, CHARLES D.
11/09/2009 Palo Verde /05000528 / 2009301                 RO- 5       SROI -1   Admin       FFF   GARCHOW, STEPHEN M.         CLAYTON, KELLY D.
TAC #: X02413                                 SROU -1                                                               DRAKE, JAMES F.
GARCHOW, STEPHEN M.
OSTERHOLTZ, CLYDE C.
PRESBY, PETER A.
lOlA, CHARLES D.
11/09/2009 Palo Verde / 05000529 / 2009301               RO- 5       SROI-'yZ. Admin       FFF   GARCHOW, STEPHEN M.         DRAKE, JAMES F.
TAC #: X02414                                 SROU-1                                                                 GARCHOW, STEPHEN M.
OSTERHOLTl, CLYDE C.
PRESBY, PETER A.
lOlA, CHARLES D.
11/09/2009   Palo Verde / 05000530 / 2009301               RO-JfG       SROI- 2   Admin       FFF   GARCHOW, STEPHEN M.         DRAKE, JAMES F.
TAC #: X02415                                 SROU-;/                                                               GARCHOW, STEPHEN   M.
OSTERHOLTl, CLYDE   C.
PRESBY, PETER A.
lOlA, CHARLES D.
11/16/2009   Palo Verde / 05000528 / 2009301                                       Doc               GARCHOW, STEPHEN M.         DRAKE, JAMES F.
TAC #: X02413                                                                                                         GARCHOW, STEPHEN   M.
OSTERHOLTZ, CLYDE   C.
PRESBY, PETER A.
lOlA, CHARLES D.
11/16/2009   Palo Verde / 05000529 / 2009301                                       Doc               GARCHOW, STEPHEN M.         DRAKE, JAMES F.
TAC #: X02414                                                                                                         GARCHOW, STEPHEN M.
OSTERHOLTl, CLYDE C.
PRESBY, PETER A.
lOlA, CHARLES D.
Sites: PALO Orgs: 4620 Exam Author: ALL}}

Latest revision as of 19:37, 11 March 2020

PV-2009-11-Public Forms
ML102380106
Person / Time
Site: Palo Verde  Arizona Public Service icon.png
Issue date: 01/08/2009
From: Ryan Lantz
NRC/RGN-IV/DRP/RPB-D
To: Garchow S
Operations Branch IV
References
Download: ML102380106 (18)


Text

{{#Wiki_filter:January 8, 2009 FROM: Ryan Lantz Chief, Operations Branch Division of Reactor Safety TO: Steve Garchow Chief Examiner, Operations Branch

SUBJECT:

INITIAL OPERATOR LICENSING EXAMINATION ASSIGNMENT You have been assigned as Chief Examiner of the Palo Verde, Units 1, 2, and 3, initial licensing examination. The operating test has been scheduled to be completed by November 20, 2009. Thank you for contacting the Palo Verde facility to finalize the details of the examination. You are reminded that the RPS/IP system must be maintained to ensure the examiners and numbers of candidates are accurate. In addition, you are reminded that only qualified examiners are permitted to conduct any part of the examination. ADAMS ACCESSION NO. TEMPLATE NO. S:\DRS\OB\OB-ONLY\ADMIN\ASSIGNMENT SHEETS\CY'08\DEC08_RBS_ASSIGNMENT MEMO_MH.DOC

GP5-APP-A - ASSIGNMENT TICKLER ASSIGNMENT TICKLER

          . ~~c~1 Chief: I,              ',':;;                *.. .         Facility: ~                        First Date of     Exam:~g09 Written Exam Developed By:           NRC ! Facility                         Operating Test Developed By:             NRC ! Facility Due Date                              Description                          Date Complete   Initials                   Notes 5/10/2009    Exam Administration Date Confirmed (C.1.a; C.2.a & b)
                                                                             '/7 ott          ~

7/9/2009 NRC Staff & Facility Contact Assigned (C.1.d: C.2.e) '/"1 IfJ 'I ~fr I Facility Contact Briefed on Security & Other Req's (C.2.c) 1('1 (j}1Ifr 7/9/2009 01 7/9/2009 Corporate Notification letter (ES-201 Att-3) Sent (C.2.d) 2./~/lFf J ~rr- produced by Chief Examiner 8/8/2009 Reference Material Due (if NRC authored) (C.1.e; C.3.c) NPr 13mrr 8/23/2009 Integrated Exam Outlines Due (C.1.e & f; C.3.d) 7 23 DC( 8m{r 8/28/2009 Outlines Reviewed & Feedback Provided (c.2.h; C.3.e) . ., !2)//oc; Id~lr 9/22/2009 Draft Exams wlReferences Due (C.1.e,f,g,h; C.3.d) 'l/2. 0'1 Iii'rJllf 10/7/2009 'Peer Reviewer Completes Review of Exam on ES-401-9 If) /S'dT IY: ~ lOnJ2009 'NRC BC Approves Feedback to Facility (C.2.h; C.3.f) lD /5 olif 1'2 ~ 101712009 'Exams Reviewed wI Fac. (C.1.h;C.2.f & h; C.3.g) /0 ZOlo'J rJ.... " w. VItro 10/7/2009 Preliminary Applications Due (C.1.1;C.2.g; ES-202) /rJ I ~1 1l1hJ tr I 10/12/2009 Preliminary Applications Reviewed (C.1.1:C.2.g)

                                                                               /r) /' OCf   I~r 10/23/2009   Final Applications Due (C.1.I:C.2.i:ES-202)                   /I/2fJ/~CJ j ~
                                                                                             '-II   A, 10/23/2009   On-Site Preparatory Week to Validate Operating Exam            //)/2/0Q fA "n 10/23/2009   On-Site Audit (10%) of License App's (ES-202 C.2.e)            //)/z/t>9 r)'tV 10/30/2009   Final AppJ. OK'ed & Waiver letters Sent (ES-204; C.2.e)
                                                                             /0 ~/o~         fjnt' II 2,/~'l 7/1'10 A /L 10/30/2009   NRC Supervisor Approved Final Exams (C.2.i:C.3.h)
                                                                                             ~

Exam Approval letter (ES-201 Att-4) and List of Applicants {(f2/~1 produced by OlA 10/30/2009 (ES-201-4) Prepared (C.2.i) 10/30/2009 Proctor Rules Review w/Fac. & Written Authorized (C.3.k)

                                                                            "IiIOr           JJrtr 10/30/2009   Exam Material to Exam Team (C.3.i)                                     ocr      .J.A 11/6/2009   Administer Operating Exam On-Site                            ""/1'3/0,,/

2- l{j"~ I~ 11118/2009 Facility Graded Exam & Comments Received H It> 09 ~ r;, A. 11/21/2009 NRC Written Exam Grading Completed "13 0 oct tJrrfJ 11/21/2009 Examiners Document Exam Grades on ES Forms r2./l It:>4 8Jrtr 12/112009 NRC Chief Examiner Grading Review Completed II (30{ bCf ,?trlr 12/2/2009 NRC BC Review Completed 12 / 2,- JO~ ~ 12/6/2009 LicenselDenials Mailed; Facility Notified of Results 1'2- z.. d1 V., T .1 12/6/2009 RPS/IP Number of Examinees Updated "II~'fJ ~ 1'f;r print Report-21 A 12/21/2009 Examination Report Issued (zitS! 6'1 TO produced by Chief Examiner 12/28/2009 Package Closed Out J.{ 'I t>'t 11r' 12/28/2009 Chief QA of ADAMS and SISP review complete 'I I 04 7J1Y1rJ 1/5/2010 Ref Mat'I Returned after Final Res of Appeals N!+ I"""'IAJ U*U

ES-201 Examination Outline Quality Checklist Form ES-201-2 Facility: Date of Examination: Initials Item Task Description a b* c#

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

W R b. Assess whether the outline was systematically and randomly prepared in accordance with I Section D.1 of ES-401 and whether all KIA cateaories are appropriately sampled. T

c. Assess whether the outline over-emphasizes any systems, evolutions, or generic topics.

T E

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

N

2. a. Using Form ES-301-5, verify that the proposed scenario sets cover the required number of normal evolutions, instrument and component failures, technical specifications, S and major transients.

I M b. Assess whether there are enough scenario sets (and spares) to test the projected number U and mix of applicants in accordance with the expected crew composition and rotation schedule L without compromising exam integrity, and ensure that each applicant can be tested using A at least one new or significantly modified scenario, that no scenarios are duplicated T from the applicants' audit test(s), and that scenarios will not be repeated on subsequent days. o c. To the extent possible, assess whether the outline(s) conform(s) with the qualitative R and quantitative criteria specified on Form ES-301-4 and described in Appendix D.

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

(1) the outline(s) contain(s) the required number of control room and in-plant tasks W distributed among the safety functions as specified on the form

   /         (2) task repetition from the last two NRC examinations is within the limits specified on the form T         (3) no tasks are duplicated from the applicants' audit test(s)

(4) the number of new or modified tasks meets or exceeds the minimums specified on the form (5) the number of alternate path, low-power, emergency, and RCA tasks meet the criteria on the form.

b. Verify that the administrative outline meets the criteria specified on Form ES-301-1: 'I (1) the tasks are distributed among the topics as specified on the form (2) at least one task is new or significantly modified (3) no more than one task is repeated from the last two NRC licensing examinations I~
c. Determine if there are enough different outlines to test the projected number and mix of applicants and ensure that no items are duplicated on subsequent days.
4. a. Assess whether plant-specific priorities (including PRA and IPE insights) are covered in the appropriate exam sections.

G b. Assess whether the 10 CFR 55.41/43 and 55.45 sampling is appropriate. E N c. Ensure that KIA importance ratings (except for plant-specific priorities) are at least 2.5. E

d. Check for duplication and overlap among exam sections.

R A e. Check the entire exam for balance of coverage. L

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

Date

a. Author 7 -~~ ......o
b. Facility Reviewer (*) 7A~ '1>'1
c. NRC Chief Examiner (#) C. M. G1a.,..~ 11M '" I~/Z'i JlJq
d. NRC Supervisor Kf\l~

I C.\n..-h-. l 1'oUIL ()

                                                                                           ,~

tl

                                                                                                      -                 10-1).1{ all Note:                 # Independent NRC reviewer initial items in Column "c"; chief examiner concurrence required.
  • Not applicable for NRC-prepared examination outlines ES-201, Page 26 of 28

ES-401 Written Examination Quality Checklist Form ES-401-6 Facility' PALO VERDE Date 'of Exam: Nov 6, 2009 Exam Level: RO eli) SRO c.. Initial Item Description b" c'

1. Questions and answers are technicallY accurate and applicable to the facility. l~\~
                                                                                                                          '~\1f'      IttY 2            a.           NRC KlAs are referenced for all questions.
                                                                                                                         ,(
b. Facility learning objectives are referenced as available. t'~\ ~ ~

W

                                                                                                                              ,1
3. SRO Questions are appropriate in accordance with Section O.2.d of ES-401 l\1V,
4. The sampling process was random and systematic (If more than 4 RO or 2 SRO questions were repeated from the last 2 NRC licensing exams, consult the NRR OL orogram office). I iWrf:' ?irt r
5. Question duplication from the license screening/audit exam was controlled as indicated below (check the item that applies) and appears appropriate:
            =    the audit exam was systematically and randomly develpped; or I

the audit exam was completed before the license exam was started; or .,F the examinations were developed independently; or l'1I~\ A. the licensee certifies that there is no duplication; or _ other (explain) f I~

6. Bank use meets limits (no more than 75 percent Bank Modified New from the bank, at least 10 percent new, and the rest *
f. (,

t,Nr~

                                                                                                                                       ~

new or modified); enter the actual RO ; SRO-only 14/ 19 11/ 15%- SO/ 66 ~ question distribution(s) at riqht.

7. Between 50 and 60 percent of the questions on the RO  ; Memory CiA exam are written at the comprehension/ analysis level; the SRO exam may exceed 60 percent if the randomly r.M
                                                                                                                                        ~

selected KlAs support the higher cognitive levels; enter 32 /43% 43 / 57% ( the actual RO / SRO Question distributionfs) at richt.

8. References/handouts provided do not give away answers or aid in the elimination of distractors. ~ "'J' ~
                                                                                                                        ~h
9. Question content conforms with specific KIA statements in the previously approved '\

J examination outline and is appropriate for the tier to which they are assigned: deviations are justified. ( tllA\ ~

10. Question psvchometric Quality and format meet the Quidellnes in ES Appendix B. \ ~J~r ~

1\

11. The exam contains the required number of one-point. multiple choice items; oJ . II' the total is correct and 3Qrees with the value on the cover sheet. t'- !Vr~\ .hIif Date
a. Author 10/2/09
b. Facility Reviewer (') 10(2(2009
                                                                                                                              ~
c. NRC Chief Examiner (#)
d. NRC Regional Supervisor 3-,
                                                                \                           U   1\
                                                                                                 'I Note:          The facility reviewer's initials/signature are not applicable for NRC-developed examinations.
              # Independent NRC reviewer initial items in Column "CO; dlief examiner concurrence required.

ES-401, Page 29 of 33

ES-401 Written Examination Quality Checklist Form ES-401-6 Facility: PALO VERDE Date of Exam: Nov 6, 2009 Exam Level: RO Lc SRO ~ Initial Item Description I b+ c'

1. Questions and answers are technically accurate and applicable to the facility. d \*,.M'\ rJ,/r
                                                                                                                              ,\
                                                                                                                                             ~
2. a. NRC KlAs are referenced for all questions.
b. Facility learning objectives are referenced as available. ~ r'~~\1~,.
3. SRO questions are appropriate in accordance with Section D.2.d of ES-401 [\I.\-! ~
4. The sampling process was random and systematic (If mOle than 4 RO or 2 SRO questions were reoeated from the last 2 NRC licensina exams, cons!.!lt the NRR OL program office). ~ m~f" ~
5. Question duplication from the license screening/audit 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 i- the licensee certifies that there is no duplication; or _ other (explain) \' t'

                                                                                                                               ,',1'(      Jt,r 1
6. Bank use meets limits (no more than 75 percent Bank Modified New from the bank, at least 10 percent new, and the rest new or modified); enter the actual RO I SRO-only question distribution(s) at right.

4 /16 6 / 24% 15/60':, I'l'~' ~

7. Between 50 and 60 percent of the questions on the RO Memory CIA \

exam are written at the comprehension/ analysis level; I~ the SRO exam may exceed 60 percent if the randomly 9 16/ ~I selected KlAs support the higher cognitive levels; enter I 36% 64% LI,~i'; the actual RO I SRO question distribution(s) at riqht.

8. References/handouts provided do not give away answers or aid in the elimination of distractors. C i',\V, (jn1f
9. Question content conforms with specific KIA statements in the previously approved examination outline and is appropriate for the tier to which they are assigned:

deviations are justified. ( "~ ~If M

                                                                                                                                           ~

I A

10. Question psychometric Quality and format meet the guidelines in ES Appendix B. i\\I\'\
                                                                                                                        ,... 111\~I
                                                                                                                                           ~
11. The exam contains the required number of one-point. multiple choice items;
                                                                                                                                 .~

the total is correct and aarees with the value on the cover :sheet. Printed Nam~~ Date Larry Burton 10/2/09

a. Author b.

c. Facility Reviewer (0) NRC Chief Examiner (#) Warren Po~ter

                                                      ~~
                                                                               !"r ~f/::w W

71hI ..a -- )

0/2/09 iB
d. NRC Regional Supervisor Ktil\J Clo.\I{oi\ *1IlIlIJD, I I7)b..... let d'\
                                                               \         \                        0 Note:        + The facility reviewer's initials/signature are not applicable for NRC*developed examinations.
              # Independent NRC reviewer initial items in Column *c"; chief examiner concurrence required.

ES-401. Page 29 of 33

ES-301 Operating Test Quality Checklist Form ES-301-3 Facility: fh\o \ferJ.e Date of Examination: \ \ "0Ioq Operating Test Number: Initials

1. General Criteria il b* elf.
a. The operating test conforms with the previously approved outline; changes are consistent with sampling requirements (e.(I., 10 CFR 55.45, operational importance, safety function distribution).

f ~ IShlr 1/

b. There is no day-to-day repetition between this and other operating tests to be administered J during this examination. uNJ YJr6'
c. The operatinQ test shall not duplicate items from the applicants' audit test(s). (see Section D.1.a.) wAf rnatr

(~ ~ ~

d. Overlap with the written examination and between different parts of the operating test is within acceptable limits.

{

                                                                                                                                         ~
e. It appears that the operating test will differentiate between competent and less-than-competent applicants at the designated license level. WJJ
2. Walk-Throuah Criteria -- - --
a. Each JPM includes the following, as applicable:
             **     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 inclUde:
                                                                                                                          ;~ ~

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
                    -      identification of critical steps and their associated performance standards
                    -      restrictions on the sequence of steps, if applicable
                                                                                                                          ~ t#l ~
b. Ensure that any changes from the previously approved systems and administrative walk-through outlines (Forms ES-301-1 and 2) have not caused the test to deviate from any of the acceptance criteria (e.g., item distribution, bank use, repetition from the last 2 NRC examinations) specified 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 COpy is attached. I~ ~~ Printed Na (~L 1\ ature ---. Date

a. Author Larry Burton -,\.. ') 09/02/09
b. Facility Reviewer(*) Warren Potter AA~ ---=-- 09/02/09
c. NRC Chief Examiner (#) ~~~~~ t; ,." ~ .....--0 I() /2If /0'1 K~llv QCl1I~~ '\1). ~~I ~ "]";h, 1
d. NRC Supervisor 101 J.l\lqq l \ TJ A NOTE:
  • The facility signature is not applicable for NRC-developed tests.
           #        Independent NRC reviewer initial items in Column "c"; chief examiner concurrence required.

ES-301, Page 24 of 27

Facilitv: Palo Verde Date 0 fExam: 11/10/09 S cenano . Numbers: 1 / 3 / 4 0Jperatlng Test N0.: QUALITATIVE ATIRIBUTES Initials b* elf.

                                                                                                                       )
1. The initial conditions are realistic, in that some equipment and/or instrumentation may be out of service. but it does not cue the operators into expected events. C i &'\\t .k
2. The scenarios consist mostlv of related events. (, ,J W
3. Each event description consists of
                                                                                                                     ~ rill ~

the point in the scenario when it is to be initiated the malfunction(s) that are entered to initiate the event

            **       the symptoms/cues that will be visible to the crew the expected operator actions (by shift position)
  • the event termination ooint (if aoolicable)
4. No more than one non-mechanistic failure (e.g., pipe break) is incorporated into the scenario without a credible precedillQ incident such as a seismic event. I~ I/~
5. The events are valid with regard to physics and thermodynamics. ~ I~ ~~
6. Sequencing and timing of events is reasonable, and allows the examination team to obtain complete evaluati.on results commensurate with the scenario obiectives. I~ 1~6'"
7. 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. Cues are given. C' wAf"

8. The simulator modelinQ is not altered. A !lAW ,~ ~
9. The scenarios have been validated. Pursuant to 10 CFR 55.46(d), any open simulator J performance deficiencies or deviations from the referenced plant have been evaluated to ensure that functional fidelity is maintained while running the planned scenarios. 0 I~ )J((

a I~ ~

10. Every operator will be evaluated using at least one new or significantly modified scenario.

All other scenarios have been altered in accordance with Section 0.5 of ES-301. i

11. All individual operator competencies can be evaluated, as verified using Form ES-301-6 (submit the form along with the simulator scenarios). (
                                                                                                                      ! ti ~
12. Each applicant will be significantly involved in the minimum number of transients and events specified on Form ES-301-5 (submit the form with the simulator scenarios). 0'1 iNtI ~k'
13. The level of difficulty is appropriate to support licensing decisions for each crew position. I W ~

Taraet Quantitative Attributes (Per Scenario; See Section D.S.d) Actual Attributes - - -

1. Total malfunctions (5-8) 7 /8 / 7 llAA W
2. Malfunctions after EOP entry (1-2) 2 /3 / 2 Ii.W. tflV
3. Abnormal events (2-4) 4 /5/ 4 ~ I~ ~
                                                                                                                    ~
4. Major transients (1-2) 2 /2 / 2 11JA1? ~
5. EOPs entered/requiring substantive actions (1-2) 1 /2 / 1 1h"MP .lJ,t
                                                                                                                                     ~
6. EOP continoencies requiring substantive actions (0-2) 0 /1 / 1 I~

7 C':ritical tasks 12-3\ 2 / 2 I 1 t In-P

                                        ,;;)IIIIUlcILUI ,;;)1,;\::lIcUIU \olUClIILY ull\::I,;I\IISL                  rorm     r::"-,)U'I-4 Facilitv: Palo Verde                           Date of Exam: 11/10/09 Scenario Numbers:         2 /       /       OperatinQ Test No.:

QUAlITATIVE ATTRIBUTES Initials a b* r:;#

1. The initial conditions are realistic, in that some equipment and/or instrumentation may be out of service, but it does not cue the operators into expected events. ,!IM1 I~
2. The scenarios consist mostly of related events. ~ ~
3. Each event description consists of
  • the point in the scenario when it is to be initiated
                                                                                                                        ~

the malfunction(s) that are entered to initiate the event the symptoms/cues that will be visible to the crew the expected operator actions (by shift position) the ellent termination point (if applicable) ~~

                                                                                                                                      ~

VMf ~~6-

4. No more than one non-mechanistic failure (e.g., pipe break) is incorporated into the scenario without a credible precedinQ incident such as a seismic event.
5. The events are valid with reQard to physics and thermodynamics. I~r ~~
6. Sequencing and timing of events is reasonable, and allows the examination team to obtain complete evaluation results commensurate with the scenario objectives. lwi ~ ~
7. 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. Cues are given. ( ~ >rrf.r

8. The simulator modelinQ is not altered. Iw~ /.lW
                                                                                                                            ~ J,~
9. The scenarios have been validated. Pursuant to 10 CFR 55.46(d), any open simulator performance deficiencies or deviations from the referenced plant have been evaluated to ensure that functional fidelity is maintained while running the planned scenarios.

IltAt fJrtr

10. Every operator will be evaluated using at least one new or significantly modified scenario.

AU other scenarios have been altered in accordance with Section D.5 of ES-301. C l1AM'r ~t

11. All individual operator competencies can be evaluated, as verified using Form ES-301-6 (submit the form alona with the simulator scenarios). (

I~ I~

12. Each applicant will be significantly involved in the minimum number oftransients and events specified on Form ES-301-5 (submit the form with the simulator scenarios).
13. The level of difficulty is appropriate to support licensing decisions for each crew position. r ~~

Target Quantitative Attributes IPer Scenario; See Section D.5.d) Actual Attributes - -

1. Total malfunctions (5-81 7 / / I~r I~
2. Malfunctions after EOP entry (1-2) 3 / /
                                                                                                                        , l\m ~'}Y1&
3. Abnormal events (2-4) 4 / / II'J\ i.lr
4. Maior transients (1-2) 1 / / ~ IJltl f!m
5. EOPs entered/requiring substantive actions (1-2) 1 / / bfl.iP .~
6. EOP contingencies requirinQ substantive actions (0-2) 0 / / 11k Wllr I~~
7. Critical tasks 12-3\ 2 I I 1 \lAP 1Jtn&

ES-301 Transient and Event Checklist Form ES-301-5 Facility: Palo Verde Date of Exam: 11/10109 Operating Test Number: 2009 A E Scenarios P V P E #1 #3 #4 T M L N 0 I I T CREW CREW CREW CREW T 1\1 C POSITION POSITION POSITION POSITION A I A T L M N y S A B S A B S A B S A B U T P R T 0 R T 0 R T 0 R T 0 M(*) E 0 C P 0 C P 0 C P 0 C P R I U RO RX 0 1 1 0 0 NOR 1 1 2 1 1 1 SRO-I I/C 2,3,4,6,5, 2,3,4,5,7, 13 4 4 2 0 7 8,9 SRO-U MAJ 6,8 6,8 4 2 2 1 [gJ Ul U3 TS 4,5 2,5 4 0 2 2 RO RX 0 1 1 0 0 NOR SRO-I 1 1 2 1 1 1 [gJ SRO-U I/C 2,3,4,5,6, 2,3,4,5,7, 7 8,9 2,4,6 16 4 4 2 0 II MAJ I2 6,8 6,8 5,8 6 2 2 1 I4 IS TS 4,5 2,5 4 0 2 2 I RO RX 4 1 1 1 0 0 NOR 1 1 1 SRO-I 1 1 2 [gJ I/C 2,6 2,3,4,5,7, 2,3,4,6,7 14 4 4 2 8,9 SRO-U 0 MAJ 6,8 6,8 5,8 6 2 2 1 I3 TS 2,5 2,3 4 0 2 2 RO RX 0 1 1 0 0 NOR 1 SRO-I 1 1 1 1 0 I/C 2,3,4,5,6, 7 3,5,8,9 10 4 4 2 SRO-U [gJ MAJ 6,8 6,8 4 2 2 1 U-2 TS 4,5 2 0 2 2 Instructions:

1. Check the afElicant level and enter the operating test number and Form ES-D-1 event numbers for each event type; are not applicable for RO applicants. ROs must serve in both the "at-the-controls (ATC)"

and "balance-of-plant (BOP)" positions; Instant SROs 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 Instant SRP additionally serves in the BOP position, one I/C Malfunction can be credited toward the two I/C malfunctions required for the ATC position. Reactivi~ manipulations may be conducted under normal or controlled abnormal conditions (refer to 2. Section .5.d) but must be significant per Section C.2.a of Appendix D. P Reactivity and normal evolutions may be replaced with additional instrument or component mal unctions on a 1-for-1 basis.

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

ES-301 Transient and Event Checklist Form ES-301-5 Facility: Palo Verde Date of Exam: 11/10108 Operating Test Number: 2008 Scenarios A E V M P E #1 #3 #4 P I L N T N T CREW CREW CREW CREW I POSITION POSITION POSITION POSITION 0 I C T M T A Y S A B S A B S A B S A B A U N P R L M(*) T R T 0 R T 0 R T 0 T 0 E 0 C P 0 C P 0 C P 0 C P R I U RO RX 4 1 1 1 0 ~ SRO-I NOR 1 1 1 1 1 D I/C 3,4,5,7 3,5,8,9 8 4 4 2 SRO-U D Rl R2 MAJ 6,8 6,8 4 2 2 1 R3 R7 TS 0 0 2 2 R9 RO RX 4 1 1 1 0 ~ SRO-I NOR D 1 1 1 1 1 SRO-U D R4 I/C 2,6 2,4,7 5 4 4 2 RB RlO Rl2 MAJ Rl3 6,8 6,8 4 2 2 1 Rl5 TS 0 0 2 2 RO RX 4 1 1 1 0 ~ SRO-I NOR D 1 1 2 1 1 1 SRO-U D I/C 3,4,5,7 3,5,8,9 3,4,7 11 4 4 2 R5 Rll MAJ Rl4 6,8 6,8 5,8 6 2 2 1 TS 0 0 2 2 Instructions:

1. Check the afElicant level and enter the operating test number and Form ES-D-1 event numbers for each event type; are not applicable for RO applicants. ROs must serve in both the "at-the-controls (ATC)"

and "balance-of-plant (BOP)" positions; Instant SROs 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 Instant SRO additionally serves in the BOP position, one I/C Malfunction can be credited toward the two I/C malfunctions required for the ATC position. Reactivi~ manipulations may be conducted under normal or controlled abnormal conditions (refer to 2. Section .S.d) but must be significant per Section C.2.a of Appendix D. hl Reactivity and normal evolutions may be replaced with additional instrument or component mal nctions on a 1-for-1 basis.

3. Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's com~etence count toward the minimum requirements specified for the applicant's license level in t e right-hand columns.

ES*301 Transient and Event Checklist Form ES*301*5 ES-301, Page 26 of 27 ES*301 Transient and Event Checklist Form ES*301*5 Facility: Palo Verde Date of Exam: 11/10108 Operating Test Number: 2008 A E Scenarios P V P E #1 #3 #4 #2 (Spare) T M L N 0 I I T T I\l C CREW CREW CREW CREW POSITION POSITION POSITION POSITION A I A T L M N Y S A B S A B S A B S A B U T P R T 0 R T 0 R T 0 R T 0 M(*) E 0 C P 0 C P 0 C P 0 C P R I U RO RX 4 1 1 1 0 ~ NOR SRO-I 1 1 2 1 1 1 D I/C 2,6 2,4,7 3,4,7 8 4 4 2 SRO-U MAJ 2 2 1 D 6,8 6,8 5,8 6 R6 TS 0 2 2 RO RX 1 1 0 D NOR 1 1 1 1 1 SRO-I D I/C 2,3,4,5,7, 8 2,7 3,4,5,8 4 4 2 SRO-U D MAJ 6 6 6 2 2 1 TS 2,3 0 2 2 RO RX 1 1 0 D NOR 1 1 1 SRO-I D IIC 4 4 2 SRO-U MAJ 2 2 1 D TS 0 2 2 Instructions:

1. Check the afglicant level and enter the operating test number and Form ES-D-1 event numbers for each event type; are not applicable for RO applicants. ROs must serve in both the "at-the-controls (ATC)"

and "balance-of-plant (BOP)" positions; Instant SROs 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 Instant SRO 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. Section .5.d) but must be significant per Section C.2.a of Appendix D. P Reactivi~ manipulations may be conducted under normal or controlled abnormal conditions (refer to Reactivity and normal evolutions may be replaced with additional instrument or component mal unctions on a 1-for-1 basis,

3. Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's com~etence count toward the minimum requirements specified for the applicant's license level in t e right-hand columns.

ES-301, Page 26 of 27

ES-301 Competencies Checklist Form ES-301-6 Facility: Palo Verde Date of Examination: Nov 9, 2009 Operating Test No.: APPLICANTS RO X RO 0 RO D RO D SRO-I D SRO-I X SRO-I D SRO-I D SRO-U D SRO-U D SRO-U X SRO-U D Competencies SCENARIO SCENARIO SCENARIO SCENARIO 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 2,3, 2,3, 2,3, 2,3, 2,3, 4,6 4,5, 2,4, 2,3, 4,6 4,5, 4,5, InterpretlDiagnose 4,5, 4,5, 4,5, 4,5, 4,5, 6,8, 5,6, 4,5, 6,8, 6,8 Events and Conditions 6,7, 6,7, 6,7, 6,7, 6,8 9 8 6,8 9 8 8 8,9 8 1,2, 1,2, 1,2, 1,2, 3,4, 3,4, 3,4, 2,4, 3,4, 3,4, 3,4, 2,4, Comply With and 3,5, 3,4. 3,4. 3,5, 5,6, 5,6 5,6, 5,6, 5,6, 5,6 5,6, 5,6, Use Procedures (1 ) 7,8 5,6, 5,6, 6,7, 8 8,9 8 8 8,9 8 7,8 8,9 8 1,2, 1,2, 1,3, 1,2, 2,4, 2,6, Operate Control 3,4, 3,4, 4,5, 3,4, 6,7 8 Boards (2) 5,6, 5,6, 6,7, 5,6, 7,8 7,8 8,9 7,8 1,2, 2,3, 2,3, 1,2, 2,3, 2,3, 1,2, 2,3, 2,3, 2,3, 1,2, 2,3, Communicate 3,4, 5,6, 4,5, 3,4, 4,5, 4,5, 3,4, 6,8 4,5, 4,5, 3,4, 4,5, and Interact 5,6, 7,8 6,7, 5,6, 6,8 6,7, 5,6, 6,8 6,7, 5,6, 6,8 8 8 7,8 8 8,9 8 8,9 1,2, 1,2, 1,2, 1,2, 1,2, 1,2, 1,2, 1,2, Demonstrate 3,4, 3,4, 3,4, 3,4, 3,4, 3,4, 3,4, 3,4, Supervisory Ability (3) 5,6, 6,7 5,6, 5,6, 5,6, 6,7 5,6, 5,6, 8 8,9 78 8 8,9 78 4,5 2,3 2,5 2,3 4,5 2,3 2,5 2,3 Comply With and Use Tech. Specs. (3) Notes: (1 ) Includes Technical Specification compliance for an RO. (2) Optional for an SRO-U. (3) Only applicable to SROs. 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.

ES-403 Written Examination Grading Form ES-403-1 Quality Checklist Facili : 'Palo \lev-de.. Date of Exam: 11/' tJ Exam Level: RO Item Descri tion 1.

2. Answer key changes and question deletions justified and documented
3. Applicants' scores checked for addition errors reviewers s ot check> 25% of examinations
4. Grading for all borderline cases (80 +/-2% overall and 70 or 80, as a licable, +/-4% on the SRO-onl reviewed in detail
5. All other failing examinations checked to ensure that grades are 'ustified
6. Performance on missed questions checked for training deficiencies and wording problems; evaluate validity of uestions missed b half or more of the a Iicants Date
a. Grader /Ito,kc;
b. Facility Reviewer(*) II!ttJlo ?

I

c. NRC Chief Examiner (*) 11/30/0 1
d. NRC Supervisor (*) lelz./cJ'f

(*) The facility reviewer's signature is not applicable for examinations graded by the NRC; two inde endent NRC reviews are re uired. ES-403, Page 6 of 6

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

1. Pre-Examination zooct 1:r-J1:Tr4c. E)(~ .1. 1. ~

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 11(, -ITof the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC 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 chief examiner any indications or suggestions that examination security may have been compromised.

2. Post-Examination To the best of my kno~~ge, ~~d not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of~ From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME JOB TITLE / RESPONSIBILITY DATE

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ES-201, Page 27 of 28

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

1. Pre-Examination ~ ~~~A..'- ~

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of ~ as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC 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 chief examiner any indications or suggestions that examination security may have been compromised.

2. Post-Examination To the best of my knoA1tdge,1 did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of <C- \4- . From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

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                                                                             -Zoa1 ES-201, Page 27 of 28

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

1. Pre-Examination ~ ~ ~~ .

I acknowledge that I have acquired specialized knowledge about the NRC licensing examin~cheduled for the week(s) of -1.6 - n \4 as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC 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 chief examiner any indications or suggestions that examination security may have been compromised. .

2. Post-Examination To the best of my kno;~g741 did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of . ..-. . From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or pr vide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

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H11~&:::;~' s;r==_ vp.,(-+- ..... ~.-.:r'ft~ 2W1 ~IN\ ES-201, Page 27 of 28

ES*201 Examination Security Agreement Form ES*201*3

1. Pre-Examination ~, ~,,'-' CK"A4 . 1v0 I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the Week(S)~fo 1'/;4as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been aJthorized by the NRC 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 chief examiner any indications or suggestions that examination security may have been compromised.
2. Post-Examination To the best of my know7~ge/Jid not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of " - . From the date that I el')tered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

JOB TITLE / RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE IJ..O C. 1t1 Ro U) Li'l.. 5" (l.o 1-0 rzo crts RD eJ,Ls

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                                       ~-'2..S 1Z.0 AU lites

Page 1 of 5 Operator Licensing Exam Schedule 04/01/2010 13:10:40 From 10/01/2009 To 01/01/2010 Report 21 Region: 4 Phase Code: 5 [~~~,:!,~~~] [S~~~~~?*~~~~3pt'#':'A~~:""'A* ..... ,..:~1tC~.:, . !,S~~~~=][!¥~:=:Jt~~~~~~~~!,l!!,;,~.a~i,~~~=- ....". "T.,*JJi,~~~i.~~!s,~;~~~~~7V'L. ::Ji 09/01/2009 Palo Verde / 05000529/2009301 Prep GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC#: X02414 GARCHOW, STEPHEN M. OSTERHOLTZ, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 09/01/2009 Palo Verde /05000530 / 2009301 Prep GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC #: X02415 GARCHOW, STEPHEN M. OSTERHOLTl, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 09/28/2009 Palo Verde / 05000528 / 2009301 Prep FFF GARCHOW, STEPHEN M. GARCHOW, STEPHEN M. TAC #: X02413 OSTERHOLTl, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 11/09/2009 Palo Verde /05000528 / 2009301 RO- 5 SROI -1 Admin FFF GARCHOW, STEPHEN M. CLAYTON, KELLY D. TAC #: X02413 SROU -1 DRAKE, JAMES F. GARCHOW, STEPHEN M. OSTERHOLTZ, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 11/09/2009 Palo Verde / 05000529 / 2009301 RO- 5 SROI-'yZ. Admin FFF GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC #: X02414 SROU-1 GARCHOW, STEPHEN M. OSTERHOLTl, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 11/09/2009 Palo Verde / 05000530 / 2009301 RO-JfG SROI- 2 Admin FFF GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC #: X02415 SROU-;/ GARCHOW, STEPHEN M. OSTERHOLTl, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 11/16/2009 Palo Verde / 05000528 / 2009301 Doc GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC #: X02413 GARCHOW, STEPHEN M. OSTERHOLTZ, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. 11/16/2009 Palo Verde / 05000529 / 2009301 Doc GARCHOW, STEPHEN M. DRAKE, JAMES F. TAC #: X02414 GARCHOW, STEPHEN M. OSTERHOLTl, CLYDE C. PRESBY, PETER A. lOlA, CHARLES D. Sites: PALO Orgs: 4620 Exam Author: ALL}}