ML17156A791: Difference between revisions
StriderTol (talk | contribs) (Created page by program invented by StriderTol) |
StriderTol (talk | contribs) (Created page by program invented by StriderTol) |
||
(8 intermediate revisions by the same user not shown) | |||
Line 3: | Line 3: | ||
| issue date = 02/17/2017 | | issue date = 02/17/2017 | ||
| title = 2016 Monticello Nuclear Generating Plant Initial Licensed Examination ES-203-1 - Examination Security Agreement | | title = 2016 Monticello Nuclear Generating Plant Initial Licensed Examination ES-203-1 - Examination Security Agreement | ||
| author name = Reeser D | | author name = Reeser D | ||
| author affiliation = NRC/RGN-III/DRS/OLB | | author affiliation = NRC/RGN-III/DRS/OLB | ||
| addressee name = | | addressee name = | ||
Line 13: | Line 13: | ||
| document type = License-Operator, Part 55 Examination Related Material | | document type = License-Operator, Part 55 Examination Related Material | ||
| page count = 11 | | page count = 11 | ||
}} | }} | ||
=Text= | |||
{{#Wiki_filter:Form ES-201-3, "Examination Security Agreements" OF-1071-- | |||
'(l Xcel Energy* | |||
ev. 2 FP-T-SAT-71 MASTER SECURITY AGREEMENT The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment. | |||
: 1. Pre-Examination (Review FP-T-SAT-71 , Attachment 1 for pre-job briefing requirements) | |||
I acknowledge that I have acquired specialized knowledge about the 2016 MNGP ILT NRC examination(s) scheduled for the date(s) of 11/14/2016 - 11/18/2016 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 an Operations Training Supervisor. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration. I also understand that I am not to evaluate individuals scheduled to be administered these exam inations from this date until the date of administration . Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore , I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised . | |||
: 2. Post-Examination | |||
, did not divulge to any unauthorized persons any information concerning the examinations administered during the date(s) of II . From the date that I entered into this security agreement until the completion of examination administration , I d d not instruct, evaluate, or provide performance feedback to those individuals who were administered these examinations . | |||
PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE DATE NOTE | |||
~mPW 7?&-,1(@ | |||
~=~ | |||
: 1. .S:JZ../~ ;-$~~ -- | |||
: 2. f-1~ | |||
* 1?~ r-ftip !M? | |||
6J8/& | |||
~"' | |||
/ 1 | |||
: 3. . ._"'f i111*' Cr f~( i:k he.l{ .ful.L~~ | |||
: 4. _) l ~l >'ubn9~ ~f II' (t .J./_ (Jf. I 1-".J,,-., J_, ~ -Hf 14. | |||
ttl../J~ - - | |||
: 5. ~~.'/:-Son~ c;t>f~r..,_ ~\-i-<..e.Y ~/c)~ p5u,a;l+11c-t, - -- | |||
: 6. f jj~~- t: :t c r;,, .L~vt. r- 1 fl) It ~ J)4.( /)/~di~ | |||
: 7. -.Jaco~ 6/1 (,k. !"tfll\ 8-m16 ~e~~I - -- | |||
Retention : Life of Plant Retain in: Exam File RECE\\f ED f£0 t 7 10f1 | |||
QF-107Htlv. 2 FP-T-SAT-71 (t Xcel Energy- | |||
* MASTER SECURITY AGREEMENT of 2 The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment. | |||
PRINTED NAME JOB TITLE I RESPONSIBILITY DATE SIGNATURE (2) DATE NOTE | |||
: 8. du/1 /?/t?0~, rt¢~ ~~ , '/ / | |||
/ / / ;?/ ';{. | |||
9. | |||
10. | |||
~r;l,,u Sue <*.n I~~ | |||
11. | |||
12. | |||
13. | |||
14. | |||
15. | |||
NOTES: | |||
Retention : Life of Plant Retain in : Exam File | |||
QF-1071-0~ev. 2 FP-T-SAT-71 | |||
* MASTER SECURITY AGREEMENT Pa--e""I of 2 The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment L Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements} | |||
I acknowledge that I have acquired specialized knowledge about the 2016 MNGP ILT NRC examination(s) scheduled for the date(s) of 11/1412016-11/18/2016 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 an Operations Training Supervisor. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of .examination administration. I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration. Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised. | |||
: 2. Post-Examination | |||
, I id not divulge to any unauthorized persons any information concerning the examinations administered during the date(s) of - II. '/ . From the date that I entered into this security agreement until the completion of examination administration, diCi not i struct, evaluate, or provide performance feedback to those individuals who were administered these examinations. | |||
DATE DATE NOTE s:1z ..J~-1-~~~::...,...:;.l!...-- :::-£-/?> - - | |||
r:fti.fi 6/f.)1~9;iJJ!ll S*- L~.J../o,, 1111.Jr,,sL j;j;,,-=vu- | |||
<)"~I:.(,, ~\.i~ et.cfi~ - - - - - | |||
1'if It Retention: Life of Plant S/1VJ6 ~ #---- | |||
ll/ !tf/'1 - *'./ | |||
Retain in: Exam File | |||
QF-1071-0'i~Rev. 2 FP-T-SAT-71 MASTER SECURITY AGREEMENT Pa "e' 1 of 2 The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment. | |||
: 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements) | |||
I acknowledge that I have acquired specialized knowledge about the 2016 MNGP ILT NRC examination(s) scheduled for the date(s) of 11/14/2016 -11/18/2016 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 an Operations Training Supervisor. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration . I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration. Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised . | |||
: 2. Post-Examination the date(s) of '/, '° . | |||
ledge I id not divulge to any unauthorized persons any information concerning the examinations administered during | |||
.. II From the date that I entered into this security agreement until the completion of examination administration, d. not in truct, evaluate, or provide performance feedback to those individuals who were administered these examinations. | |||
PRINTED NAME DATE NOTE | |||
: 1. /ffampw f?r+.~ ~~ -- | |||
: 2. 11~ *P lfmw 11/r..I. . - | |||
: 3. --~n,).Cc fU .lkhtll !!.ftllL',P - | |||
: 4. }u'fl }'wbn9 k | |||
: 5. /116'A1.;;b ,'C Son} /~it=~ | |||
~* . ~j)t.:t Retention: Life of Plant Retain in: Exam File | |||
QF-1071-02, Rev. 2 (FP-T-SAT-71) | |||
Page 1 of 2 | |||
'(l Xcel Energy* LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment. | |||
: 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements) | |||
I acknowledge that I have acquired specialized knowledge about the 2016 MNGP ILT NRC examination scheduled for the date(s) of 11/14/2016-11/18/2016 as of the date of my signature. I agree that I will not knowingly divulge any information about this examination to any persons who have not been authorized by an Operations Training Supervisor .. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration . I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration. Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore , I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised . | |||
: 2. Post-Examination To the best o m know! d e, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of //,I'/, Ju -- // ~ I. . From the date that I entered into this security agreement until the completion of this examination administra 10 , I did n t instruct, evaluate , or provide performance feedback to those individuals who were administered this examination . | |||
Furthermore, I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination administration . I further understand that violation of the conditions of this agreement may result in cancellation of the examination and/or enforcement action against the facility licensee or me. | |||
PRINTED NAME JOB TITLE I RESPONSIBILITY DATE DATE NOTE | |||
: 1. PG1'i$ J<o"'~~ S<.o 10 *'5-1(, 11-~*/(, | |||
2. | |||
3. | |||
4. | |||
I t | |||
S c<Yl\ V cl\NQ r.-1 ~htlw ""4) | |||
J_~l?¢- | |||
7(2..-u | |||
-:;(lo | |||
~ | |||
IZ{Tltb | |||
~iJJk~ | |||
/, | |||
Retention : Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01. | |||
QF-1071-02, Rev. 2 (FP-T-SAT-71) | |||
LIMITED SECURITY AGREEMENT Page 2 of 2 The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment. | |||
PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE 5. | |||
6. | |||
7. | |||
8. | |||
9. | |||
10. | |||
11 . | |||
12. | |||
13. | |||
14. | |||
15. | |||
NOTES: | |||
Retention : Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01 . | |||
QF-1071-02 , Rev. 2 (FP-T-SAT-71) | |||
'ft Xcel Energy* | |||
LIMITED SECURITY AGREEMENT Page 1 of 2 . | |||
The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment. | |||
: 1. Pre-Examination (Review FP-T-SAT-71 , Attachment 1 for pre-job briefing requirements) | |||
I acknowledge that I have acquired special ized knowledge about the 2016 MNGP IL T NRC examination scheduled for the date(s) of 11/14/2016-11/18/2016 as of the date of my signature. I agree that I will not knowingly divulge any information about this examination to any persons who have not been authorized by an Operations Training Supervisor .. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration . I also understand that I am not to evaluate individuals scheduled to be administered these examinations from th is date until the date of administration . Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore , I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised . | |||
: 2. Post-Examination To the best f y kno le e, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of ' - II I I . From the date that I entered into this security agreement until the completion of this examination administra ion, I did ot instruct, evaluate , or provide performance feedback to those individuals who were administered this examination . | |||
Furthermore , I agree to NOT discuss any aspects associated with the contents of this examination with ANY exam inee until the completion of their examination administration. I further understand that violation of the conditions of this agreement may result in cancellation of the examination and/or enforcement action against the facility licensee or me. | |||
PRINTED NAME JOB TITLE I RESPONSIBILITY SIGN:c DATE NOTE | |||
: 1. ~ lJ~~--* C-..) ~~,.e::.-fcrr _z_ _;;--. 1#1- | |||
: 2. l?'!j~rr ~~ tfoi:~ /~ | |||
a~ | |||
: 3. V:nc.l.. kc..d~ ~~o IZ./S-//c. | |||
: 4. J,J(1Q V\)WJN S\20 \). 'l.\ . t~ | |||
Retention : Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-0 1. | |||
QF-1071,Rev. 2 (FP-T-SAT-71 ) | |||
'fl Xcel Energy* | |||
LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment. | |||
NAME NOTES: | |||
Retention : Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01. | |||
LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment. | |||
: 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements) | |||
I acknowledge that I have acquired specialized knowledge about the 2016 MNGP ILT NRC examination scheduled for the date(s) of 11/14/2016-11/18/2016 as of the date of my signature . I agree that I will not knowingly divulge any information about this examination to any persons who have not been authorized by an Operations Training Supervisor . . I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration . I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration. Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee . Furthermore , I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised . | |||
: 2. Post-Examination | |||
, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of II . From the date that I entered into this security agreement until the completion of this examination administration , I did not instruct, evaluate , or provide performance feedback to those individuals who were administered this examination . | |||
Furthermore , I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination adm inistration . I further understand that violation of the conditions of this ag reement may resu lt in cancellation of the examination and/or enforcement action against the facility licensee or me. | |||
PR INTED NAME JOB T ITLE I RESPONSIB ILITY SIGNATURE (1) DATE S I G~DATE NOTE rc. ~ | |||
~ | |||
: 1. ( o vM tfuL U:.- s- /(. 0 0 | |||
t" !ta/1b / / ,2*.fk _ _ | |||
: 2. 0.,' "-+t.c\ Kov9.neA ~o to/13/11, # 1i_i-1 ft /, - - | |||
3. | |||
4. | |||
' "< Vl"\ | |||
'b~A~ | |||
...\ vvi.olf H E:1,..lo Ro f2-o | |||
~-*~ | |||
f~t. | |||
* I b | |||
/#ftfr;, | |||
* I~ * /(:, | |||
fiA-+/- | |||
1t/JW4:- | |||
; I fl*Z/*16 _ | |||
Retention : Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01. | |||
QF-1071--ev. 2 (FP-T-SAT-71) | |||
LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment. | |||
PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE DATE NOTE | |||
: 5. "fiZ4v.J:;s 6&ucfPl\)15@:'<'. s~ --1LhJtr.. -7'uc:;..L..-'-i'!~_..,..'----,,__- 11/z./a, __ | |||
: 6. Tuv /f,L.L ~(o | |||
* 11/,>/J~ - | |||
: 7. ~ (A-veL IO/lif/6 ~ /( /~/IG | |||
: s. .)~QY\ -r~ 10/,i{it ~ 1/t/7 | |||
: 9. i,.f c>pV>-=- /o-1°1- 1r. | |||
: 10. Je,rv' S,',..p.so"-' | |||
/ I Ao Jo -¥t6 ....,,,.,:::.~~---'~--- ~6-11 . Gev"'1d All~ c~ o / uh.tA __ | |||
: 12. Crc.,~ T~k 1/:1~'6 | |||
: 13. bc1es+ cJc..se 11/I'//JO '1!z ii 16 | |||
: 14. 8RtA~ f(qeNtCr I I ~tl.(-11, __,__&"-"- | |||
~ ------ | |||
- -=---~ | |||
.........~ | |||
~-_ | |||
15. | |||
NOTES: | |||
Retention : Life of plant Retain in : Exam file Form reta ined in accordance with record retention schedule identified in FP-G-RM-01 .}} |
Latest revision as of 16:32, 4 February 2020
ML17156A791 | |
Person / Time | |
---|---|
Site: | Monticello |
Issue date: | 02/17/2017 |
From: | David Reeser NRC/RGN-III/DRS/OLB |
To: | Nuclear Management Co |
Reeser, David | |
Shared Package | |
ML15274A427 | List: |
References | |
Download: ML17156A791 (11) | |
Text
Form ES-201-3, "Examination Security Agreements" OF-1071--
'(l Xcel Energy*
ev. 2 FP-T-SAT-71 MASTER SECURITY AGREEMENT The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment.
- 1. Pre-Examination (Review FP-T-SAT-71 , Attachment 1 for pre-job briefing requirements)
I acknowledge that I have acquired specialized knowledge about the 2016 MNGP ILT NRC examination(s) scheduled for the date(s) of 11/14/2016 - 11/18/2016 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 an Operations Training Supervisor. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration. I also understand that I am not to evaluate individuals scheduled to be administered these exam inations from this date until the date of administration . Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore , I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised .
- 2. Post-Examination
, did not divulge to any unauthorized persons any information concerning the examinations administered during the date(s) of II . From the date that I entered into this security agreement until the completion of examination administration , I d d not instruct, evaluate, or provide performance feedback to those individuals who were administered these examinations .
PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE DATE NOTE
~mPW 7?&-,1(@
~=~
- 1. .S:JZ../~ ;-$~~ --
- 2. f-1~
- 1?~ r-ftip !M?
6J8/&
~"'
/ 1
- 3. . ._"'f i111*' Cr f~( i:k he.l{ .ful.L~~
- 4. _) l ~l >'ubn9~ ~f II' (t .J./_ (Jf. I 1-".J,,-., J_, ~ -Hf 14.
ttl../J~ - -
- 5. ~~.'/:-Son~ c;t>f~r..,_ ~\-i-<..e.Y ~/c)~ p5u,a;l+11c-t, - --
- 6. f jj~~- t: :t c r;,, .L~vt. r- 1 fl) It ~ J)4.( /)/~di~
- 7. -.Jaco~ 6/1 (,k. !"tfll\ 8-m16 ~e~~I - --
Retention : Life of Plant Retain in: Exam File RECE\\f ED f£0 t 7 10f1
QF-107Htlv. 2 FP-T-SAT-71 (t Xcel Energy-
- MASTER SECURITY AGREEMENT of 2 The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment.
PRINTED NAME JOB TITLE I RESPONSIBILITY DATE SIGNATURE (2) DATE NOTE
- 8. du/1 /?/t?0~, rt¢~ ~~ , '/ /
/ / / ;?/ ';{.
9.
10.
~r;l,,u Sue <*.n I~~
11.
12.
13.
14.
15.
NOTES:
Retention : Life of Plant Retain in : Exam File
QF-1071-0~ev. 2 FP-T-SAT-71
- MASTER SECURITY AGREEMENT Pa--e""I of 2 The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment L Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements}
I acknowledge that I have acquired specialized knowledge about the 2016 MNGP ILT NRC examination(s) scheduled for the date(s) of 11/1412016-11/18/2016 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 an Operations Training Supervisor. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of .examination administration. I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration. Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.
- 2. Post-Examination
, I id not divulge to any unauthorized persons any information concerning the examinations administered during the date(s) of - II. '/ . From the date that I entered into this security agreement until the completion of examination administration, diCi not i struct, evaluate, or provide performance feedback to those individuals who were administered these examinations.
DATE DATE NOTE s:1z ..J~-1-~~~::...,...:;.l!...-- :::-£-/?> - -
r:fti.fi 6/f.)1~9;iJJ!ll S*- L~.J../o,, 1111.Jr,,sL j;j;,,-=vu-
<)"~I:.(,, ~\.i~ et.cfi~ - - - - -
1'if It Retention: Life of Plant S/1VJ6 ~ #----
ll/ !tf/'1 - *'./
Retain in: Exam File
QF-1071-0'i~Rev. 2 FP-T-SAT-71 MASTER SECURITY AGREEMENT Pa "e' 1 of 2 The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment.
- 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)
I acknowledge that I have acquired specialized knowledge about the 2016 MNGP ILT NRC examination(s) scheduled for the date(s) of 11/14/2016 -11/18/2016 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 an Operations Training Supervisor. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration . I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration. Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised .
- 2. Post-Examination the date(s) of '/, '° .
ledge I id not divulge to any unauthorized persons any information concerning the examinations administered during
.. II From the date that I entered into this security agreement until the completion of examination administration, d. not in truct, evaluate, or provide performance feedback to those individuals who were administered these examinations.
PRINTED NAME DATE NOTE
- 1. /ffampw f?r+.~ ~~ --
- 2. 11~ *P lfmw 11/r..I. . -
- 3. --~n,).Cc fU .lkhtll !!.ftllL',P -
- 4. }u'fl }'wbn9 k
- 5. /116'A1.;;b ,'C Son} /~it=~
~* . ~j)t.:t Retention: Life of Plant Retain in: Exam File
QF-1071-02, Rev. 2 (FP-T-SAT-71)
Page 1 of 2
'(l Xcel Energy* LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment.
- 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)
I acknowledge that I have acquired specialized knowledge about the 2016 MNGP ILT NRC examination scheduled for the date(s) of 11/14/2016-11/18/2016 as of the date of my signature. I agree that I will not knowingly divulge any information about this examination to any persons who have not been authorized by an Operations Training Supervisor .. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration . I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration. Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore , I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised .
- 2. Post-Examination To the best o m know! d e, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of //,I'/, Ju -- // ~ I. . From the date that I entered into this security agreement until the completion of this examination administra 10 , I did n t instruct, evaluate , or provide performance feedback to those individuals who were administered this examination .
Furthermore, I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination administration . I further understand that violation of the conditions of this agreement may result in cancellation of the examination and/or enforcement action against the facility licensee or me.
PRINTED NAME JOB TITLE I RESPONSIBILITY DATE DATE NOTE
- 1. PG1'i$ J<o"'~~ S<.o 10 *'5-1(, 11-~*/(,
2.
3.
4.
I t
S c<Yl\ V cl\NQ r.-1 ~htlw ""4)
J_~l?¢-
7(2..-u
-:;(lo
~
IZ{Tltb
~iJJk~
/,
Retention : Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.
QF-1071-02, Rev. 2 (FP-T-SAT-71)
LIMITED SECURITY AGREEMENT Page 2 of 2 The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment.
PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE 5.
6.
7.
8.
9.
10.
11 .
12.
13.
14.
15.
NOTES:
Retention : Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01 .
QF-1071-02 , Rev. 2 (FP-T-SAT-71)
'ft Xcel Energy*
LIMITED SECURITY AGREEMENT Page 1 of 2 .
The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment.
- 1. Pre-Examination (Review FP-T-SAT-71 , Attachment 1 for pre-job briefing requirements)
I acknowledge that I have acquired special ized knowledge about the 2016 MNGP IL T NRC examination scheduled for the date(s) of 11/14/2016-11/18/2016 as of the date of my signature. I agree that I will not knowingly divulge any information about this examination to any persons who have not been authorized by an Operations Training Supervisor .. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration . I also understand that I am not to evaluate individuals scheduled to be administered these examinations from th is date until the date of administration . Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore , I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised .
- 2. Post-Examination To the best f y kno le e, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of ' - II I I . From the date that I entered into this security agreement until the completion of this examination administra ion, I did ot instruct, evaluate , or provide performance feedback to those individuals who were administered this examination .
Furthermore , I agree to NOT discuss any aspects associated with the contents of this examination with ANY exam inee until the completion of their examination administration. I further understand that violation of the conditions of this agreement may result in cancellation of the examination and/or enforcement action against the facility licensee or me.
PRINTED NAME JOB TITLE I RESPONSIBILITY SIGN:c DATE NOTE
- 1. ~ lJ~~--* C-..) ~~,.e::.-fcrr _z_ _;;--. 1#1-
- 2. l?'!j~rr ~~ tfoi:~ /~
a~
- 3. V:nc.l.. kc..d~ ~~o IZ./S-//c.
- 4. J,J(1Q V\)WJN S\20 \). 'l.\ . t~
Retention : Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-0 1.
QF-1071,Rev. 2 (FP-T-SAT-71 )
'fl Xcel Energy*
LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment.
NAME NOTES:
Retention : Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.
LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment.
- 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)
I acknowledge that I have acquired specialized knowledge about the 2016 MNGP ILT NRC examination scheduled for the date(s) of 11/14/2016-11/18/2016 as of the date of my signature . I agree that I will not knowingly divulge any information about this examination to any persons who have not been authorized by an Operations Training Supervisor . . I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration . I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration. Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee . Furthermore , I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised .
- 2. Post-Examination
, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of II . From the date that I entered into this security agreement until the completion of this examination administration , I did not instruct, evaluate , or provide performance feedback to those individuals who were administered this examination .
Furthermore , I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination adm inistration . I further understand that violation of the conditions of this ag reement may resu lt in cancellation of the examination and/or enforcement action against the facility licensee or me.
PR INTED NAME JOB T ITLE I RESPONSIB ILITY SIGNATURE (1) DATE S I G~DATE NOTE rc. ~
~
- 1. ( o vM tfuL U:.- s- /(. 0 0
t" !ta/1b / / ,2*.fk _ _
- 2. 0.,' "-+t.c\ Kov9.neA ~o to/13/11, # 1i_i-1 ft /, - -
3.
4.
' "< Vl"\
'b~A~
...\ vvi.olf H E:1,..lo Ro f2-o
~-*~
f~t.
- I b
/#ftfr;,
- I~ * /(:,
fiA-+/-
1t/JW4:-
- I fl*Z/*16 _
Retention : Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.
QF-1071--ev. 2 (FP-T-SAT-71)
LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment.
PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE DATE NOTE
- 5. "fiZ4v.J:;s 6&ucfPl\)15@:'<'. s~ --1LhJtr.. -7'uc:;..L..-'-i'!~_..,..'----,,__- 11/z./a, __
- 6. Tuv /f,L.L ~(o
- 11/,>/J~ -
- 7. ~ (A-veL IO/lif/6 ~ /( /~/IG
- s. .)~QY\ -r~ 10/,i{it ~ 1/t/7
- 9. i,.f c>pV>-=- /o-1°1- 1r.
- 10. Je,rv' S,',..p.so"-'
/ I Ao Jo -¥t6 ....,,,.,:::.~~---'~--- ~6-11 . Gev"'1d All~ c~ o / uh.tA __
- 12. Crc.,~ T~k 1/:1~'6
- 13. bc1es+ cJc..se 11/I'//JO '1!z ii 16
- 14. 8RtA~ f(qeNtCr I I ~tl.(-11, __,__&"-"-
~ ------
- -=---~
.........~
~-_
15.
NOTES:
Retention : Life of plant Retain in : Exam file Form reta ined in accordance with record retention schedule identified in FP-G-RM-01 .