ML15348A168

2015 Fermi Power Plant Initial License Examination Forms ES-201-3

ML15348A168
Person / Time
Site:	Fermi
Issue date:	10/13/2015
From:	Operations Branch III
To:	Detroit Edison, Co
Shared Package
ML15268A032	List: ML15282A474 ML15287A289 ML15287A293 ML15287A295 ML15287A303 ML15287A334 ML15287A338 ML15348A168
References
Download: ML15348A168 (5)

Text

\-z.,l1\I\, ES-201 Examination Security Agreement ES-201-3 1. Pre-Examination I acknowledge that I have acquired spec i alized knowledge about the NRC licensing examinations scheduled for the week(s) of 08/24/15-08/28/15 as of the date of my signature. I agree that I w i ll not knowingly divulge any i nformation about these examinat i ons to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct , or feedback to those applicants scheduled to be adm i nistered these licensing examinations from this date until completion of examina t ion 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 indiv i dual does not select the training content or provide di r ect or indirect feedback). Furthermore , I am aware of the physical security measures and requirements (as documented in the facil i ty licensee's procedures) and understand that violat i on of the conditions of th i s agreement may result i n cancellation of the examinations and/or an enforcement action against me or the fac i l i ty l i censee. I will immediately report to facility management or the NRC ch i ef exam i ner any indications or suggestions that examination security may have been comprom i sed. 2. Post-Examination To the best of my knowledge , I did not divulge to any unauthorized persons any information concerning the NRC licens i ng exam i nations administered during the week (s) of 8/24/15. 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 I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE :..;..u........._-=.;

......._"""'"'-'------

l l'J§!P fl l ..JV I VS:I Vl?lJ r:... , nl*I V lf!J V'f lh H/IJ -!1..LLJJ_

s:,_ , 'Jj.4µ:_ @&: A kJ ... jfufu( I f f&->.______B,, TeJoco-R r:-.... "t!. ........ .. r -wi:L _ , ,q '5: 9 , __ _ :;; ,l.11 **-.....-. ..,.., .... B 3zt E'-s-9. k o:; (L: Sr. N"'s.k I --1 o. _i_icdtv IVl!r/. >"r. #v 4J;;, ,--11. W-11/ec,, Mx.--r t.JJ.,.$.;tv ... 12. -----13. ----14. ----15. ---------------------------

NOTES: ES 201 , Page 27 of 28 i ES-201 1. Pre-Examination IL.<:> -

Examination Security Agreement Form ES-201-3 I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 8/24/2015 as of the date of my signature. I agree that I will riot 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 admin i stered 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 violat i on of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action aga i nst me or the facility licensee. I will immediately report to facility management or the NRC ch i ef examiner any indications or suggestions that examination secur i ty may have been comprom i sed. 2. Post-Examination To the best of my knowledge , I did not divulge to any unauthor i zed persons any i nfo r mation concern i ng the NRC licensing examinations administered during the week(s) of '1/4,Y,;--. From the date that I entered i nto this security agreement until the completion of exam i nation administration , I did not instruct , evaluate , or provide performance feedback to those applicants who were adm i nistered these licensing examinations , except as specifically noted below and authorized by the NRC. PRINTED NAME JOB TITLE I RESPONSIBILITY DATE NOTE 1.iJ.L.&4,ec_,t; L/{)6 2. ?00-.rc. [l: ,'""'-tv.:icx,uc,.v-. C,e_ 3. &.i1:v oN-/....No 'f-1...fS

__ 4. /...<,...., G.<>-* _________ 5. J).At:1r fr Jt'!Jd11f

6. t<cd

__ _________

.........

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f

9. , ,;:: c&;.,;.z , lz L<No -jf%j_fj)_ =

hi

12.

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13. "t ceA M'ffCS C&S '-2-1 5 lf::..f/S

__ 14.Gz.r'AZ AN 3f)Mlf Z7

15.

6-J....L--,/7 !!t=f_::!L___

NOTES: Q) S1c11hiJ> VIA 1!-,V.A1' R6-qcJ1."ST 4>/P

(#1°'4f\Jlao)

ES-201 , Page 27 of 28 ES-201 1. Pre-Examination JL.0 Examination Security Agreement Form ES-201-3 I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 8/z'i/tS.

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 knowledge , I 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 id 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 I RESPONSIBILITY LNO };::: 4. -Jow .sk;;aJAN c.re..s 5.

f!JJ_N1-I-}

r ,..vz 6.

.... _

7. Ze££G¥:Ct/:!t.

SE 8.

1<.. L.SO 9. ______ _ 10. _____ _ 11. _____ _ 12. _____ _ 13. _____ _ 14. _____ _ 15. _____ _ NO TES: CD oFF VJ'-t*,..JfJL

,,11,, toNFIM4'floN (

DATE SIGNATURE (2) DATE NOTE 6-*ry-*> r--A.-_ff2_ t..-JJ-15

-_fil_

1. ." j{[: ---0.. iBl __

11...<> ill/IT ,.-2,.(")/., ES-201 Examination Security Agreement Form ES-201-3 1. Pre-Examination I acknowledge that I have acqui r ed specialized knowledge about the NRC licensing examinat i ons scheduled for the week(s) of 8/24/2015 as of the date of my signature. I agree that I will not knowing l y 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 thes e 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 ope r ato r o r communicator is acceptaole if the individual does not select the training content or provide d i rect or indirect feedback).

Fu r thermore, I am aware of the physical secunty measures and requirements (as documented in the faci l ity l i censee's procedures) and understand t hat violation of the conditions of this agreement may result in can c ellation of the e xaminations and/or an enforcement action against me or the faci li ty licensee.

I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examinat i on security may have been compromised.

2. Post-Examination To the best of my knowledge , I did not divulge to any unauthorized per s ons any information c oncerning the NRC licensing examinations administered during the week(s) of 8/24/2015. From the date that I e ntered mto t his security agreement until the completion of examination administration , I did not instruct , evaluate. or provide performance feedback to those applicants who were administered these l i censing examinations , except as specifically noted below and authorized by the NRC. SIGNATURE (2) 4. -*

&

---4. .pt¢;

O?s F£i ---* -* --12. ______ _ 13. ______ _ 14. 15. ______ _ NOT E S: ' -

ON Fl\'X*"P Slftlf:/

2 -S1C9Pq

1. J '"" l!lf.bJR-(

/tN '/t.1/>i)

DATE NOTE --'-

)

-*-* *-** *-* -*---* Examina t ion

____ . ____ 1. P r e-E xnmlnath;in I acknowledge r:al I have aCQul'ad kno >ied9e aoout ll'e NRC l!CttMlf <!tamur 10 11 s S(;ne..ltlied f o r !i".e wtoek(sl cl as ot ltte dale of my !IJ9nalure I agree 1i 1at I w*ll knowingly d ulge arr/ 1nformal1Qn abcul atit>n !O any oer$0ns who have nol betn authoffilled by

• e NRC chi et exa ner I um1ersland I am not re i 0$fl\JCt.

l\Ja'.e. or provl::e feedback to those <1pp s scheduled to oe administered these "ami ior*s from *t*1s ctat u n 111 comp!etJon cl exam alion adrnll'lls!ril 11 except a'$ spec ifical ly noted heklw 8nd authorized 1))1 the N RC (e g .. acting as a s i mulaJ01 tioot l* ope/H l or or comrnurirotor 1s B!'.oepla le if ti:le' i.dlvldual doe!! ot select the :l'\'l!Om g coment or providB dJ<ecl or indirect le8dback.). Furlt1enrore, I an1 fNI: a of th&

security mea5l.lfc arid 1eQIJi1.emen1$

{* s documen!ed rn 1he riceflSee's prO(;e!J:ures) and underslal'!d thel violattan of the col'ld,1ions of lhis ement may result tfl oMalJ!a el t l'e ;.xamltWllons andior an en!ol'Cem nt acikin aga1nsl me 01 tt-e tadllly licensee. I Will lmmed lt!O>)r t le tlllC!lily -nanagem"'11 or t h NRC c iel eJ<amlTl8t an ( indir.a!ioM o< suggesfo s tha l examination secllfity may hcve been comnromised. 2. Post-Ei:ami!l!llion lo l hb best ot n.y' now!adge I :l*tl .,ot drJul:;w to ant urauttor r ied persons any nfoi111011on the N'l C llcens1119 axaminatMlns dUJlng lhe'weei<j s t of From ti>'l dale !ha l I entered 111to *, is saGt.1111}1 agreement lhe oomptetloo o' P.xarninallon I did n<>t lllstrucl, evaluate. o r flt l w1de pet cnnan..o., f P.P.rlback kl .ose apphcsnt.s

• no '""e ad1111!1istared these licensing exa711nations.

e*cepl as speciflcaly noted b low an autl\ori:!ed by tit NRC PRIN TED NA ME 1 4tJa;.:-l .J.':.G.-r./r.. 4 ________ _

G. 7 --------**--*-a ________ _ 9. 10 ___ _ , 1 12 ----*-*--**-* .. 13 ---*-------t4 *!i _________ _ DATE NOTE --*--*--* *-*------

---**-*--------

\-z.,l1\I\, ES-201 Examination Security Agreement ES-201-3 1. Pre-Examination I acknowledge that I have acquired spec i alized knowledge about the NRC licensing examinations scheduled for the week(s) of 08/24/15-08/28/15 as of the date of my signature. I agree that I w i ll not knowingly divulge any i nformation about these examinat i ons to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct , or feedback to those applicants scheduled to be adm i nistered these licensing examinations from this date until completion of examina t ion 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 indiv i dual does not select the training content or provide di r ect or indirect feedback). Furthermore , I am aware of the physical security measures and requirements (as documented in the facil i ty licensee's procedures) and understand that violat i on of the conditions of th i s agreement may result i n cancellation of the examinations and/or an enforcement action against me or the fac i l i ty l i censee. I will immediately report to facility management or the NRC ch i ef exam i ner any indications or suggestions that examination security may have been comprom i sed. 2. Post-Examination To the best of my knowledge , I did not divulge to any unauthorized persons any information concerning the NRC licens i ng exam i nations administered during the week (s) of 8/24/15. 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 I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE :..;..u........._-=.;

......._"""'"'-'------

l l'J§!P fl l ..JV I VS:I Vl?lJ r:... , nl*I V lf!J V'f lh H/IJ -!1..LLJJ_

s:,_ , 'Jj.4µ:_ @&: A kJ ... jfufu( I f f&->.______B,, TeJoco-R r:-.... "t!. ........ .. r -wi:L _ , ,q '5: 9 , __ _ :;; ,l.11 **-.....-. ..,.., .... B 3zt E'-s-9. k o:; (L: Sr. N"'s.k I --1 o. _i_icdtv IVl!r/. >"r. #v 4J;;, ,--11. W-11/ec,, Mx.--r t.JJ.,.$.;tv ... 12. -----13. ----14. ----15. ---------------------------

NOTES: ES 201 , Page 27 of 28 i ES-201 1. Pre-Examination IL.<:> -

Examination Security Agreement Form ES-201-3 I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 8/24/2015 as of the date of my signature. I agree that I will riot 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 admin i stered 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 violat i on of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action aga i nst me or the facility licensee. I will immediately report to facility management or the NRC ch i ef examiner any indications or suggestions that examination secur i ty may have been comprom i sed. 2. Post-Examination To the best of my knowledge , I did not divulge to any unauthor i zed persons any i nfo r mation concern i ng the NRC licensing examinations administered during the week(s) of '1/4,Y,;--. From the date that I entered i nto this security agreement until the completion of exam i nation administration , I did not instruct , evaluate , or provide performance feedback to those applicants who were adm i nistered these licensing examinations , except as specifically noted below and authorized by the NRC. PRINTED NAME JOB TITLE I RESPONSIBILITY DATE NOTE 1.iJ.L.&4,ec_,t; L/{)6 2. ?00-.rc. [l: ,'""'-tv.:icx,uc,.v-. C,e_ 3. &.i1:v oN-/....No 'f-1...fS

__ 4. /...<,...., G.<>-* _________ 5. J).At:1r fr Jt'!Jd11f

6. t<cd

__ _________

.........

--

f

9. , ,;:: c&;.,;.z , lz L<No -jf%j_fj)_ =

hi

12.

\\s"""e..9>.\IJ; fol'Z-/JS

13. "t ceA M'ffCS C&S '-2-1 5 lf::..f/S

__ 14.Gz.r'AZ AN 3f)Mlf Z7

15.

6-J....L--,/7 !!t=f_::!L___

NOTES: Q) S1c11hiJ> VIA 1!-,V.A1' R6-qcJ1."ST 4>/P

(#1°'4f\Jlao)

ES-201 , Page 27 of 28 ES-201 1. Pre-Examination JL.0 Examination Security Agreement Form ES-201-3 I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of 8/z'i/tS.

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 knowledge , I 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 id 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 I RESPONSIBILITY LNO };::: 4. -Jow .sk;;aJAN c.re..s 5.

f!JJ_N1-I-}

r ,..vz 6.

.... _

7. Ze££G¥:Ct/:!t.

SE 8.

1<.. L.SO 9. ______ _ 10. _____ _ 11. _____ _ 12. _____ _ 13. _____ _ 14. _____ _ 15. _____ _ NO TES: CD oFF VJ'-t*,..JfJL

,,11,, toNFIM4'floN (

DATE SIGNATURE (2) DATE NOTE 6-*ry-*> r--A.-_ff2_ t..-JJ-15

-_fil_

1. ." j{[: ---0.. iBl __

11...<> ill/IT ,.-2,.(")/., ES-201 Examination Security Agreement Form ES-201-3 1. Pre-Examination I acknowledge that I have acqui r ed specialized knowledge about the NRC licensing examinat i ons scheduled for the week(s) of 8/24/2015 as of the date of my signature. I agree that I will not knowing l y 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 thes e 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 ope r ato r o r communicator is acceptaole if the individual does not select the training content or provide d i rect or indirect feedback).

Fu r thermore, I am aware of the physical secunty measures and requirements (as documented in the faci l ity l i censee's procedures) and understand t hat violation of the conditions of this agreement may result in can c ellation of the e xaminations and/or an enforcement action against me or the faci li ty licensee.

I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examinat i on security may have been compromised.

2. Post-Examination To the best of my knowledge , I did not divulge to any unauthorized per s ons any information c oncerning the NRC licensing examinations administered during the week(s) of 8/24/2015. From the date that I e ntered mto t his security agreement until the completion of examination administration , I did not instruct , evaluate. or provide performance feedback to those applicants who were administered these l i censing examinations , except as specifically noted below and authorized by the NRC. SIGNATURE (2) 4. -*

&

---4. .pt¢;

O?s F£i ---* -* --12. ______ _ 13. ______ _ 14. 15. ______ _ NOT E S: ' -

ON Fl\'X*"P Slftlf:/

2 -S1C9Pq

1. J '"" l!lf.bJR-(

/tN '/t.1/>i)

DATE NOTE --'-

)

-*-* *-** *-* -*---* Examina t ion

____ . ____ 1. P r e-E xnmlnath;in I acknowledge r:al I have aCQul'ad kno >ied9e aoout ll'e NRC l!CttMlf <!tamur 10 11 s S(;ne..ltlied f o r !i".e wtoek(sl cl as ot ltte dale of my !IJ9nalure I agree 1i 1at I w*ll knowingly d ulge arr/ 1nformal1Qn abcul atit>n !O any oer$0ns who have nol betn authoffilled by

• e NRC chi et exa ner I um1ersland I am not re i 0$fl\JCt.

l\Ja'.e. or provl::e feedback to those <1pp s scheduled to oe administered these "ami ior*s from *t*1s ctat u n 111 comp!etJon cl exam alion adrnll'lls!ril 11 except a'$ spec ifical ly noted heklw 8nd authorized 1))1 the N RC (e g .. acting as a s i mulaJ01 tioot l* ope/H l or or comrnurirotor 1s B!'.oepla le if ti:le' i.dlvldual doe!! ot select the :l'\'l!Om g coment or providB dJ<ecl or indirect le8dback.). Furlt1enrore, I an1 fNI: a of th&

security mea5l.lfc arid 1eQIJi1.emen1$

{* s documen!ed rn 1he riceflSee's prO(;e!J:ures) and underslal'!d thel violattan of the col'ld,1ions of lhis ement may result tfl oMalJ!a el t l'e ;.xamltWllons andior an en!ol'Cem nt acikin aga1nsl me 01 tt-e tadllly licensee. I Will lmmed lt!O>)r t le tlllC!lily -nanagem"'11 or t h NRC c iel eJ<amlTl8t an ( indir.a!ioM o< suggesfo s tha l examination secllfity may hcve been comnromised. 2. Post-Ei:ami!l!llion lo l hb best ot n.y' now!adge I :l*tl .,ot drJul:;w to ant urauttor r ied persons any nfoi111011on the N'l C llcens1119 axaminatMlns dUJlng lhe'weei<j s t of From ti>'l dale !ha l I entered 111to *, is saGt.1111}1 agreement lhe oomptetloo o' P.xarninallon I did n<>t lllstrucl, evaluate. o r flt l w1de pet cnnan..o., f P.P.rlback kl .ose apphcsnt.s

• no '""e ad1111!1istared these licensing exa711nations.

e*cepl as speciflcaly noted b low an autl\ori:!ed by tit NRC PRIN TED NA ME 1 4tJa;.:-l .J.':.G.-r./r.. 4 ________ _

G. 7 --------**--*-a ________ _ 9. 10 ___ _ , 1 12 ----*-*--**-* .. 13 ---*-------t4 *!i _________ _ DATE NOTE --*--*--* *-*------

---**-*--------