ML19326C969

Forwards RM Simmons Medical Examination Rept for AEC Medical Consultant Comments Re Licensing Eligibility

ML19326C969
Person / Time
Site:	Arkansas Nuclear
Issue date:	11/06/1970
From:	Cavanaugh W ARKANSAS POWER & LIGHT CO.
To:	Collins P US ATOMIC ENERGY COMMISSION (AEC)
Shared Package
ML19326C963	List: ML19326C969
References
NUDOCS 8004290598
Download: ML19326C969 (8)

Text

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n e t. p i n a aurto annansas ARK ANS AS POWER & l.:GHT COMPANY 9TH & LCulSIAN A STA..TS L,TTL. ACCK A AKANS AS 72203.(5013372-4311 November 6, 1970 Mr. Paul Collins, Chief Operator Licensing Branch Division of Reactor Licensing United States Atcmic Energ/ Co=tission 7920 Ilorfolk Avenue Bethesda, Maryland 21811 SU3 JECT : ARKANSAS ITUCLEAR OIIE PERSOIIIIEL (FILE : 0400)

Dear Mr. Collins :

Enclosed is a copy of the Medical Examination Report for Mr. Robert M.

Si= tons, who is a candidate for a licensed operator position on Arkansas Huclear One.

I would appreciate your doctor's review of this report and whatever cccments he or you might have regarding this tan's eligibility for licensing.

/

Ver'/ truly yours,

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g/L .-_/

William Cavanaugh Assistant Superintendent Arkansas Nuclear One WC:=c Enclosure I 1

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to cy a ss Eureau of Budget No. J8.R084 ATOi!!C ENERGY CO!.t.'.!!SSION CERTIFICATE OF MEDICAL HISTORY Facility Oper: tor's or Senior Operator's License u'cr:ticast Applicant must complete all items en page 1. Typewrite er print in ink. Physician must comple:e ell items en page 2.

1, Lat Name First Name .'.11ddle Name 2. Date -f Birth Simmons Robert Melvin July 30,1937

3. Homa Address

4. Sex 50 Collins Road, Jacksonville, Ark. 72076 male Have you ever had or do you now have any of the following? Give details of any condition answered in the affirmative under item 38.

Yes No Y'S NO

5. Eh umatic fever I i x  ! !6. Bene, joint, or cther deformity  ! X l

6. FPcusnt or severe headaches l l y 117. Painful or " trick" shoulder

'T. Dizziness or fsjnting spells x l l x l 18. Painful cr " trick" elbow X

8. Eye trouble

9. Diacetes l lx i 19. Paralysis x

I x l 20. Epilepsy or fits X

10. Tuberculosis l l 21. Depression er excessive worry v

11. Ch onic shcrtness of breath x

Ix  ! 22. Loss of memcry er amnesia v

12. Pain er pressure in chest or " heart attack" l x l 23. Nervous condition which could impair

13. H!;h blood pressure judgment or reliability X l l x i

14. Low bloed pressure I l 24. Drug or narcetic habit y

L5JNtle ulter i x

y ,25. Excessive drinking habit X Complet2 each of the following. Give details of every affirmative answer under item 37.

.S. Has your work ever been limited or restricted for medical reasons

• Yes No

27. Hava you ever been denied or rated up for life insurance for medical reasons?

x X

ES. !!:va you ever been under observation or received care er treatment for any mental cr nervcus condition as a p:tient in a horpital, sanitoilum, clinic, or other facility, ur from a physician, clinical psychologist, etc.? X

29. nc.70us Hrte you ever been disorder reasons rejected 7 for or discharged from employment er military service for physical, mental. or X

30. comp;nsation H:xe you everfor received existingisdisability?

there pending, have you applied for, or do you intend to apply for pension er x

31. Havo you ever seriously considered committing suicide

• X

32. Itava you ever been convicted of any violation of Federal law. State law. county or municipal law, regulations cr ordinance?

which a fine ofDo

$25notor include less was anything imposed. that happened before your 16th birthday. Do not include violations for X

33. H ve you ever had any major illness er injury other than those already noted?

34. How many jobs have you had in the laat 3 years' l X

35. What is the length of time in your present employment? l gom 3; ,,, g ), 19 ,ay ,,

35, Giv] a brief statement of your present health in your own words: # ~

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Good.

37.affectDitalls of any items 5 through 33 answered in the affirmative. In addition, if y0cr m your ability to function as a facility uperator. Use additional sheet if more space is needed. i Kidne> Stones that caused my life insurance rate to go up cbove normal.

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38. I certify that the foregoing informatica supplied by me is true to the best of my knowledge, and authcrize the Atomic En mission to usc any of the information in this certificate in tne exercise of its authcrity over the licensing o' cperatcrs.

10-21-70 (Dct:)

Ark. Nuclear One h , 6;T7 7 / %v

( F acilit y)

(signatue of applicartt)

S6GN YOUR N WE IN INM AS IT APPEARS ON YOUR APPI.ICATION FOP. OPERATOlt'S Oft SENIOR OPERATOR 1.

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o-m MEDICAL EXAMlliATION ~

39, Doctora it to ocaintit! thIt seah cf thm letms on this p293 bs compi:esJ. Stgn ths Certifiesta cnJ msil to tha Dir:cter, CJvisten of Reactor Licensing, United States Atomic Energy Conimission, Washington, D.C. 20545 f ar is<ctor opsrit:r liesass cop *Iecnts or ee the Director, Division of Materials t.icensing, United States Atomic Energy Commission, Washington, D.C. 20545 t'or opp!!.

. cents.for non-reactor operator licenses.

Use additional sheet if more .po:e is needed,

40. Physicions's Summary and elaboratice of the medical,histery on fronkof repc7t.

.JA 4mt6% em

[yPctient states that kidney 4 stones, acid and that he is on medication for high blood uric

< . (gout? ? ?). .

L Physical Examination. Give details of abnor=al findings under item 21 below.

10-2!-70 2. Height 5'9" 3. weight 222

1. Date of examinaion

4. Blood pressura 170/90 5. Pulse -l00

6. Distant visual aculty uncorrected right 20/25 left 20/20 method used Snellen

I. Distant visual acuity corrected r:ght left (data required cnly if ecrrective lenges are normally werm

8. Naat visual acuity uncorrected right JJ 1 eft Il method used Joeger

'9. Near visual aculty corrected right left (data required cnly if corrective lanses are no = ally worm

10. Color vision normal method used Snellen

11. Gross visual fields normal

12. Hearing right normal left normal method used spoken word

13. Eyes. generr.1 normal 14 FUDil3 normcl

15. Ophthalm: scopic ncrmal

16. Ears general m aj 17. Drums normal

19. Vascular system normol

18. Heart g

m. Date and ev21ustion of chest x *ay taxen within the past year. 10- 21-/ 0 normal

21. Details and evaluation of any item I through 20. above, reported abacr=al and su==ary evaluation of over-all condition.

Moderatcly cbese with some elevation systolic BP.

22. The foregoing er.2-ina !cn (tMM7does not) reveal any mental or physical disability which might cause impaired judgment er meter coordination. no 1 understand that any of the information in this examination may bafshd by the' Atomic Energy Commission in the exercise of its authority over the licensing of operators. ,/

10-21-70 s J- M / 4 (sicnature

• v cw Mt of esam:nang paysses'en)

, (Date)

Howard Schwander, M.D.

Typed or printed name of eaa tr. ins pnyttetan

' DOCTOR: IT IS REQUIRED ll15 Bishop THAT EVERY ITEM ON THIS Little Rock, Ark. 72202

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PAGE DE COMPLETED EX-CEPT THOSE MARXED WITH

• Arkanses WHEN HOT APPLICABLE. e,,,,, . , m ,,,,,

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Date: January 18, 1971 Chief, Health Protection Branch

. Division of Operational Safety CERTIFICATE OF MEDICAL EXAMINATION, DOCKET No. 55-Attached for your review is the Certificate of Medical Examination for Harry. R. Walters

@ Initial Medical Report P

C / rior Medical History Available that.was submitted as part of an application for an operator's license for the Arkansas Nuclear One Plant (W/0. Appl. ) .

It is requested that the Division of Operational Safety review this medical report and indicate below its conclusions as to the applicant's physical condition and general health. Please return the report to this office.

PRIOR MEDICAL HISTORY .

REPORT-In accordance with the above request, a review has been completed to determine

'if the physical condition and general health of the applicant are not such as to be expected to cause operational errors which might endanger public health and safety. 'The following recommendation is submitted:

M.D. The physical condition and general health Date DOS are satisfactory for licensing.

/. 3 fe< 7/ NN M.D.

The physical condition and general health Date DOS are satisfactory for licensing with the condition (s) thatc3/a t.3 m tvr m edCM M.D. The physical condition and general health.

Date DOS are not satisfactory for licensing. The adverse condition (s) is M.D. A determination cannot be made until the Date DOS following additional information is sub-mitted:

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, . .' 'F orm A r c 396 ggg g y Lucase er Eudgst Ns. 38.R084 to cr3 H ATOMIC ENEnGY COMMISSION CERTIFICATE OF MEDICAL HISTORY Facility Operator's or Senior Operator's Lfcense Inctructions! A;pl!ctr.t must cornplete aj! iten:s on page 1. Trenite or print in tri. Physician must complcte a!! items on pace 2.

1. Last Name First Na:ne Mic fle Name 2. Date of Birth WaL 6 CM Ndvrv #

Rel v Sept. 30> l9/9 3.' Home Acidress #

4. Sex for McCles/dy & bd Sorw9s , h/Cwm ~

7/9w A7 ale Have you ever had or do you now have any of the following) 'Give'detalis of'any condition answered in the affirmative under item 33.

Yes No Yes No

? $. Rheumatic fever i p- l 10. Bone. Jrir.t. er cther defermity } l p-

6. Frequent or severe headaches P 17. Paintt:1 or " trick" shoulder l l k"

7. D!zziness er fain!!rg spells V 18. Painful or " trick" eit ow i P

8. Eye trouble y" 19. Paralysis k'

9. Diabetes P 23. E;tlepsy or fits " i

10. Tuberculosis h* 21. Deeression or excessive worry M i

11. Ch*on!c shertness of breath l P 22. Loss of memory or r.=nesta k- l

12. Pain or pressure in chest er " hec.rt sttack" I k 23. Nervous ccndition which could impair

13. High blood pressure k' i

1. "'" 0# 7 "

14. Low blood cressure k- l 24. Drug or narcotic habit "

JJ. Perhu!cer P i 25. Excessive drinkin: habit V l Cortclete each of the following. Give detatis of every affirmt.tive answer under item 37 Yes No

26. Has your werk ever been !!mited or restricted for medical reasons' u-

27. Have you ever been denied er rated uo for life insurance far medical reacc,ns' 4--

28. Have you ever been under observotion er received care er treatment fer any mental or nervous cendition as a patient in a hospita . sanitorium. c11 ic. cr other facility, or frem a physician clinical psychologist. etc.? k.-

29. Have vnu ever haan refce**d rnr nr r4f erhae ad fenra ampf ay~ n* ar e i!!t. - e ~!n f: ;M ci-4 -, ant:'. :- I nervous dis:rder reasons? p.

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30. Have you ever received. is there pending. have you applied for. or do you intend to apply for pension er compensatien for existing rubtlity? p

31. Have you ever se-iously considered ccemittine suicide' i r.- 1

32. Have you ever been convicted of e.ny violat!cn of Fedcral law. State law. county er municip*l law. regulations or ordinsrce? Do not include ant.hin; that ha;;ened before your 16th birthday. Do not include violations for which a fine of 325 or less w:s im;caed. V

33. Have you ever had e.ny rnafor illness er injury other than those already ncted? v-l {

34. How meny fots have you had in the last 3 years) ()pe

35. What is the length cf time in your ; resent em;!ayment? pjge &eg wm

36. Give a trict statement of your present health in your cwn words: Gccg /

1

37. Details of it.y items 5 throu;h 33 uswered in the afttimative. In addition. if yn:r medic 22 h;stc.ty includes any matter relating to physical. Cental, er ne vcus coni!!1on. please describe tr.e concitten and set fr.h nur ex;! ant. tion cf why this matter w ;uld n:t affect your ability to function as a facility ;;erator. Use aaditional sneet if more soace is needed. .

_ SYPhd $&

38. I certify that the f0regt'ng informatice. supplied t;y me is true to the )est cf my+n.

.. . w knnledge'[end .

Ab/7E hhkir keler Gye Mny 7(he]lffb (catel (rn 's:y)

/ fisisut<eer.ptine.:)

S:GN YOUR NA'.iE IN INK AS IT APPFAi;.S ON 10 Lit .WPLICATION FOP. OPEftATOtt*S OR .GNIOP. OPERATO.TS LICE 55U.

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• MEDICAL EXAMINATION

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39. Dsetti: le is assential that occh of the items on this paga he completed. Sign the Cortificate and mell to the Director, Division el rieoctor !.lcensing, United Statss Atomic Ir:ergy Commission, 7/ashington, D.C. 20545 for rea:ter oporeter IIconse applicants er is the .rettor, Civision of Motorio!s I.lcensing, United States Atomic Energy Commission, Wasn' ington, D.C. 20545 for appli.

cz6ts for non. reactor operator IIcenses.

40 Physicions's Summery and elaboration of the medical history on front of report. Use additional sheet if mors space is needed.

n'g L AL& l lO '

6 PAystei.' Examanct:on. Give details of abnormal fincings under item 21 below.

1. Date of examination ), ); y;} 2. Helght [ () k 3. Weight J 7)

4. 3!00d pressure' f.g a /pg 5. Pulse .f a

6. Distant visual acuity uncorrected right M co left 10 method used b ,,,/

'7. L!stant visual eculty correc*ed right A '? / left d data died only if ccrrective lenses de normally worm

8. Near visual acuity uncorrected gjg g Jg ' j m y used [g, j

'9. Ner.t visucl acuity corrected right 7, left .J~, (dal rewired on!y if ccrrec:f y lense re ne nally worn)

10. Color vision mn, pyg ,, _ i ,, /, , , teethod used ),, g/g,, /

11. Gr:ss visual fields ,rf'), ,m j -

.12. Hearing ,

right )4 % k left )t.r%. method uyed L-/.'J c - 4. 6

13. 1'ive,gaueiai , h% j .

15. Ophthalmoscopic

, 14., F uad a )thd / -

kt_ A a . C A . M * ,._ 3 __ D *

16. Ears. general

13. Iturt Yewd__

)g, ,,, f)

17. Drums _hhdn

13. yascular system }4m.~d

20. Date and evduation of chest x ray taken within the past yect.ff/.//) O km,j'1]

21. Details and evaluation of any item I through 20. above reportelab$ormal and summary evaluation of over.all condition.

) '"C Cv-- Y- 4W  %- '

hY 0 4 %& -

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22. The tcregoing exa tination (deesAlces not) reveal a.v mental or physical disability which might cause impaired judgment er motcr coordination.

I understand that Pny of the information in this examination tnay be used by the Atomic E.a.rgy Com ission in the exercise ofits e.uth rity ovcr the licensing of operato,rs.

(Date) ll-4-70 M ,"

-co m. 8 h (Sagetare or,4 ma,risnang phy sician)

Howard Schwender, M.D.

Typed or printed name of enamaning physician DOCTOR: IT 15 REQUIRED THAT EVEkY ITE.i.) ON THIS 1115 Bishop, Little Rock, Ark. 72202 .

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PAGE BE CO.uPLETED EX- ..

CEPT TH05E MARXED WITH * .

Arkansas l

' WHEN NOT APPLICASLE. ,,,,,,,,,,,,ii,,,,,,e 4

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Date: January 18, 1971 Chief, Health Protection Branch Division of Operational Safety 1

CERTIFICATE OF MEDICAL EXAMINATION, DOCKET No. SS-Att' ached for your review is the Certificate of Medical Examination for

$ Initial Medical Report Bobby A. Terwilliger D riorP Medical History Available thatlwas submitted as part of an application for an operator's license for the Arkansas Nuklear One Plant (W/0 Appl) .

It is requested that the Division of Operational Safety review this medical report and indicate below its conclusions as to the applicant's physical condition and general health. Please return the report to this office.

PRIOR MEDICAL HISTORY REPORT In accordance with the above request, a review has been completed to determine if the physical condition and general health of the applicant are not such as to be' expected to cause operational errors which might endanger public health and safety. -The following recommendation is submitted:

[- '

MM* M.D. The physical condition and general health Date' DOS are satisfactory for licensing.

M.D. - The physical condition and general health Date DOS are satisfactory for licensing with the condition (s) that M.D. The physical condition and general health Date DOS are not satisfactory for licensing. The adverse condition (s) is M.D. A determina ;on cannot be made until the Date. DOS following auditional information is sub-

, mitted:

F  %

- . Penen ACC Je6 * '

(949) ** sn us. u.nh.

le cr:1 ss ATO! tlc ENERGY CObl311SSloN CERTIFICATE OF MEDICAL HISTORY Facility Operator's or Senior Operator's License Instructions:

App!! cst! mun co=plete all !: cms on page 1. TnemT!!e cr print in ink. Physician must complete all .tb.s on pue 2.

1. Last NrJne First Name Middle Ncme 2. Date of Birth TidwElli& &'R '

dobby 171.1. n /O (Ipnil If/31

3. Home Address . 4. Sox

$0). ' C l- G Vs l A [sdLbi kadll thlld AR NMM svt Ah

, H;ve you ever had or do you r.ow have any of the (o!!owing' Give details if any condition answered in the affirmative under item 3S.

Yes No Yes No

?S. Rheumatte fever '

X l 16. Bone. M!.9t, or othe deftr-ity l ,Y

6. Frequent er severe headaches X l 17. Painful or " trick" shoulder X

7. Dizziness er fair.ti .;r spe!!s X l 18. Painful or " trick" elbow  %

8. Eye trouble )( l 19. Paralysis

9. Diabetes X

, X j 20. Ep!!eosy or f!:s )/

10. Tuberculosis )( I 21. De ression or excessive wo.rv I)(

11. Chronle sho:tness of trea:h X I 22. Less of memory or ammf-

12. Pain or pressu*e in chezt er "hsart attack" 4

X 23. Nervors condition which could impair

13. Hirh bloed ;rassure )( M W eterrel M ty f

14. Low bloed cressure )( l 24. Drug or narcctic habit __ '

4

15. Peh*ier _d 6 25. Execestre drinkM.; htbi: 4  :

Complete each of the f:llowing. Give detti's of every affirma:ive answer undar item 37.

Yee *

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26. Has your work ever been limited cr restricted for medical reasons' i

27. Have you ever been denied of rated up f:r !!fe insursnee fer edical reasonsS X

28. Have you ever been under cbservation er received care er treatment for any cental or nervous condition as a patient in a hospitd. sr.a.!!crium. c!!nic. or o:her facility, ci from a physician, clinical psychologist. etc.?

[

29. Hnva von ever hama rajanad far ar dienweed imm agiay . ant er m!!!!ary temite fer physica.'.Y.:rtal, Or I[ I i

nervous disorder reasons?

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30. Have you ever rece!ved. !s there pendler, have you applied for, or do you inund to apply for pension er t

compens.tlen for e.tisting disabCity? y A

31. Have you ever serious!) ernsidered cc mitt!nc suicide

• X

32. Have you cver been cont,!:ted of any violation of Federal Ir.w. State law. county or municipal : 2w. rezuintiens 1 or ordina".ce? Do not in !:de anr.hing t.a.tt happened before your 16th birthday. Do not in:1ude violations for V which a fine of 325 cr less was :: posed.

/\

33. llave you ever had any r:1l:r !!! ness er 1-Jury ::her th:.n itese already noted?

34. How er;*y Jcb3 have you t.ad in the las: 3 yea s' l )(  !

35. What is che length of time in your prese.: emp;oyment?

% (2)

/C hws 74 r

36. Give a brief s;atemmet c: your present hed:h in your own w:rds: - +

JYS h 1} gek , l h4 .h .a NW f

'h?

".4, /w .,L U P e y Z w - ~ g .Af ,4,f w4

37. Deta!!s of any items 5 through 33 answered in the affirma::ve. In udition. If y ur medical history includes r.ny ca::er re: 2:in? ::

physlen2. mental. cr nerv::s condi::on. please descr::e t .* eendit:sn and set fr.h you expir=:Lon 3! why this t .;;er wMd nn affect nur 2:llity to fun:t!cn as a facili:y .pera:or. Use a ditional sneet it c:re soace is needed.

- 38. I certify that the f recoPg in!ormatien sunlied by me is true to :he "ts: of my kr'wledge. and authorize the Ato?. c Energy Cot-

. mission to usc any cf the informa: ion n :his certificate in :ne exercise of its at.:r.Ority over the licensing of cper::: s.

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.(Datet 4 .-:'_ $c $ er bLu g.bt.,

(F ac mty)

[ * (!!chh.re of ary! Lear./

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- SIGN

• YOtn NAhtE IN INX as IT APPEAft3 ON YOUn Al'PI! CATION I'O!! GPER \ Toft's On SENIO!

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. o< 5 - MEDICAL EXAMINATION

^

3'1, Doctor lt is essential ther eac% of the items on this page be completed. Sign the Certificate and moll to the Director, Divisien of Reacter Licensing, United Statse Atorate Energy Commission, Vashington, D.C. 20545 for reacter operator licenst. i.pplicants oe t3 the Director, Division of Materlois 1.lcensing, United States Atomic Energy Commission, Washington, D.C. 20.145 for oppfi.

cents for non. react,or operati,r llcansas.

' 43. Physicians's Summary and elaborotton of the medical history on front of raport. Use additional sheer if more space Is needed, u C h d.d.2t. 2 Lo

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4 m a- [ ) * )Y f Physical E:aninstion. Give details of abnormal findings under item 21 below.

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1. D te of examination // p 2. Height f. ',y 3. Welsht / r .d i .7.-t ,

4. Blood pressure // e ,/-@ 5. Pulse .P//

6. Distant visual acuity uncorrected right A kt C teft 8 O//; ,3 method used ,,/,, / . ,y

'7. Distant visualaculty ccrrected right left (data required only tf ccrrective lenses are normally worn)

8. Near visual aculty uncorrected right g left J, method used [,-. , , j-

1. 9. NIar visuti aculty corrected /

richt left (data recuired only if corre::f/tve leni,=s are no mally worn)

10. Color vision />7 f?/ m . [ jq method used M // , # , v

11. Cross vicual fields h_'m'ag g .

12. flesring s right wh left ULSWk methed used 3/3 s % Ltf r i c.

13. Esv., so sv.ed . -

-ht ct.wi 14. Fwiin M% %(/ /-

15. Ophtha!=: scopic bN ~J. , .

. - . /

16. Earc. general _

E 17. Drums (7GJl,%c.&w .7d!&h% %4/MJw. ,

13. !!eart ) h ,J/ , 13.,Vascu12r system La.ug /

p. Date and evaluntica of chest x ray taken wit?.ta the past yect. f f / r, / ) y Mgg,%L

21. Ditalls and evaluation of any item 1 thrvugh.20. above, reported alnorm'al and summary evaluation of over-all condition.

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L*,, L4,.OL,.sc- 4J l' d/) O QL.;zh,$. 4 t,,~(; ,s ' uL + 5'M" L 4 3< ,". ed L"On %o s'~"cn co~au'c. '> gP

%w w & aoif , r ," -

w, e1 %c,-w~JL. L r6 . .

22. ThS foregoing exa:alnation (b-s/does r.ot) reveal any mentalar physical disat!.!!ty which might cacse impalted judg nent er mater coordin: tion.

I understand that any of the information in this exam nation rnay he us d y the Atcmic NC~L .f. ission in the exercise of its authority o' r th licensins of operators. \ / ,/

// (o konee) 7D 1

/w er w G .te m G l (^~ (ssr6re Mum mns any.sassas Howard Schwander, M.D.

.e Typed or printed name of enbbtMi5hGpsn C0CTOR: IT 15 RECU! RED Little Rock, Ark. 72202 THAT EVERY ITEa OH THIS

• PAGE SE COl.'PLETED EX- ^"""

CE?T TiiOSE MAiUED '.VITH * ,

Arkansas

'r! HEN MOT APPLICABLE. ,,,,,,, o ,,,, m ,,,,,

2.