ML24047A140
| ML24047A140 | |
| Person / Time | |
|---|---|
| Issue date: | 02/01/2024 |
| From: | Huda Akhavannik NRC/NMSS/DMSST |
| To: | |
| References | |
| Download: ML24047A140 (1) | |
Text
Reciprocity Applicant Inspection Evaluation& Processing Checklist
Licensee Name:
License Type:
NRC / AS License Number / Issuing Entity:
Application Type: Initial Renewal Fee Paid: Yes No
Notes from License Verification by Issuing Entity :
Request at least the following:
- License expiration date and amendment number on the current license?
- When was the licensee last inspected? Were there violations identified on the inspection? If so, what were the violations and were they corrected?
- Are there any unresolved allegations against the licensee?
- Have there been any recent or on-going events associated with the licensee?
Reciprocity Applicant Inspection Evaluation& Processing Checklist Determination of Risk Score - Risk Score = (Consequence x Likelihood)
Step 1 - Determine Potential Consequence Licensee Program 10 CFR Part 37 Proximity to General Public Consequence Score Code (select the highest from all three categories)
Priority 1 or 2 Cat 1 Quantity Work in areas accessible to general High (5) public Priority 3 Cat 2 Quantity Fixed facilities with ability to limit Medium (3) access Priority 4 or 5 Cat 3 or below Remote areas or areas with established Low (1) access controls
Step 2 - Determine Likelihood Licensee NMP Likelihood Score Inspection Scope of Work Other factors Oversight (select the History (Issuing (CT or Issuing highest)
Entity and CT) Entity)
Serious Activity, Repair or
- Reactive Last Inspection Violations in Modification involving inspection based years recent inspection Source or shield (e.g., on on - going event (for example a exchange, recovery,
- Review of an High (5)
Severity Level I, etc.) allegation, as it II, or II) relates to the work being conducted under reciprocity Minor (Severity
- Repair or
- New or unique Last Inspection Level IV or Modification not technology ars 5 NOVs) intended to involve
- Extended duration years source (i.e., length of
- Work creating work/storage or Medium (3) airborne activity number of visits in
- Radiography a calendar year)
- Source removal in shield Clear Inspection Activities that do not Last Inspection <
directly affect sources of 3 years any size or directly affect sources (e.g., in-field use of portable Low (1) moisture density gauges, support for materials licensees decommissioning activities)
Risk Score = Step 1 x Step 2 = _____________
Reciprocity Applicant Inspection Evaluation& Processing Checklist
RISK SCORE PRIORITY MATRIX Consequences Score Low (1) Medium (3) High (5)
Low (5)* Medium (15)
- High (25) -
High (5) Inspection not Inspect Inspect required Likelihood Very Low (3)* Low (9)* Medium Risk (15)
- Score Medium (3) Inspection not Inspection not Inspect Warranted required Very Low (1)* Very Low (3)* Low (5)*
Low (1) Inspection not Inspection not Inspection not Warranted Warranted required
- Supervisor discretion may be indicated for abnormal work or other considerations leading to a determination to inspect low or very low risk score licensees. Additionally, supervisor discretion may be applied to remove a licensee from inspection due to staffing / resource availability.
Is the licensee a candidate for inspection based upon Risk Score or Supervisor Discretion?
Yes No
Risk Score = ______________________
Inspection Evaluation Notes:
Oncea licensee has been inspected by CT under reciprocity in the calendar year, each new jobsite will be evaluated for a significant change in typical scope of work or material use. For similar job types, inspections will only be performed on a licensee once per calendar year.
CT Reciprocity Issued: Yes No
CT Reciprocity Inspection Required: Yes No
CT Reciprocity License Number (WBL):
Application Processor: Signature:
Approved By: Signature:
(SRCP or designee):
Reciprocity Applicant Inspection Evaluation& Processing Checklist