ML18081A491

Draft NRC Form 361N, Non-Power Reactor (NPR) Event Notification Worksheet

ML18081A491
Person / Time
Issue date:	09/27/2018
From:	NRC/OCIO
To:
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Download: ML18081A491 (1)

Text

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

(MM-YYYY) OPERATIONS CENTER Estimated burden per response to comply with this voluntary collection request: 30 minutes. The information provided will be used for evaluation of licensee event description, facility status and for input to the public website.

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

EN #

NRC OPERATIONS TELEPHONE NUMBERS: PRIMARY - 301-816-5100 or 800-532-3469, BACKUPS - [1st ] 301-951-0550 or 800-449-3694,

[2nd] 301-415-0550 and [3rd] 301-415-0553. Licensees who maintain their own ETS are provided these telephone numbers.

FAX - 301-816-5151, EMAIL - hoo.hoc@nrc.gov Notification Time Facility or Organization Unit Name of Caller/Title Call Back #

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

Reactor Type Max Power Max Pulse Pulse Inserted During Event EVENT CLASSIFICATION REPORTABLE CONDITION (varies by facility TS) Offsite Medical AMED GENERAL EMERGENCY GEN/AAEC TS Deviation ADEV Loss Comm/Asmt/Resp ACOM SITE AREA EMERGENCY SIT/AAEC TS Required S/D ASHU Invalid Specified System Act AINV ALERT ALE/AAEC RPS Actuation (scram) ARPS Suspicious Activity UNUSUAL EVENT UNU/AAEC Offsite Notification APRE Security Event SAFEGUARDS EVENT (73 App G) Degraded Condition ADEG MATERIAL/EXPOSURE B???? Unanalyzed Condition AUNA INFORMATION ONLY NNF Specified System Actuation AESF OTHER UNSPECIFIED REQMT (see last column) Safe S/D Capability AINA OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)

Control of Rad Release AINC NONR Accident Mitigation AIND NONR Event Description (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continue on Page 2)

WILL NOTIFICATIONS YES NO BE Anything Unusual or not understood? Yes (Explain above) No HQ NPR STAFF Did all systems function as required? Yes No (Explain above)

STATE(s)

LOCAL Mode of operation until corrected (if applicable)

OTHER GOV AGENCIES Estimate for restart date:

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

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

EVENT NOTIFICATION WORKSHEET (Continued) EN #

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

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

Liquid (tritium) 0.2 Ci/min 5 Ci Total Activity List of Safety Related Equipment not Operational Event Description (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continued from Page 1)

NRC FORM 361N (MM-YYYY)