ML040580163

Init Exam - 07/2003 - Public Forms

ML040580163
Person / Time
Site:	Palo Verde
Issue date:	05/21/2002
From:	Gody A, Stetka T Division of Reactor Safety IV
To:	Overbeck G Arizona Public Service Co
References
50-528/03-301, 50-529/03-301, 50-530/03-301, ES-201-1, ES-501-1, Rev 8 50-528/03-301, 50-529/03-301, 50-530/03-301
Download: ML040580163 (23)

Text

Operations Branch Assignment Check Sheet: as of: 5/21/2002 (Includes ES-201-1 & ES-501-1 Rev. 8, Supplement 1 information)

Chief: T. Stetka FacilityPTask: I>V IN EX Task Start Date: 7/21/2003 ITEM DESCRIPTION DUEDATE INlT DATE 1 IExam/lnspection Schedule Agreement (C. 1.a;C.2.a&b) Jan 22,2003 ATG 5/21/2002 1 INRC Staff & Fac. Contact Assigned (C.l .c;C.2.e) I Jan 22,2003 I ATG 15/21/2002 I Z Facility contact briefed on security & other issues (C.2.c)

Corp. Notification Letter Sent (C.2.d) (Exams only) 3 3a llnspection Announcement Letter Sent (PIR & LORT if reqd) I Jun 6, 2003 I u/& I I 4 Task Expectations, Issues, & Standards Discussed w/ BC Apr22,2003 5 [Reference Material Due (C.l .d;C.3.c)] Mar232003 MJA 7

1. Not required for inspections, except as noted.

• Note Supervisor/Peer initials required.

[I Required NRC-auth. exams only.

When complete, for exams, add to pkg & fwd copy to BC, for insp, fwd origl to BC.

Last revised 10/15/01 S:\DRS\OB\EXAMS\ANO\UNIT2\2003-1N-EX\exam assignment sheet.wpc

PVNGS Examination Outline Quality Assurance Checklist PVNGS Form ES-201-2 t --

Facilii : PVNGS

- Examination Start Date: 7/18/03 Initials Item Task Description .a b* c#

1. a. Verify that the outline(s) fit(s) the appropriate model per ES-401.

b. Assess whether the outline was systematically and randomly prepa Writ Section D.l of ES-401 and whether all WA categories are appropriat

-ten c. Assess whether the outline over-emphasizes any systems, evolutioi

d. Assess whether the justifications for deselected or rejected WA sta

2. a. Using form 301-5, verify that the proposed scenario sets cover the required number of normal evolutions, instrument failures, and major transients.

Sim b. Assess whether there are enough scenario sets (and spares) to test the projected number and mix I 1 II of applicants in accordance with the expected crew composition and rotation schedule without I I compromising exam integrity; ensure each applicant can be tested using at least one new or I l l significantly modified scenario, that no scenarios are duplicated from the applicants audit test(s)*, and scenarios will not be repeated on subsequent days.

c. To the extent possible, assess whether the outline(s) conform(s) with the qualitative and quantitative criteria specified on Form 301-4 and described in

3. a. Verify that:

WIT (1) the outline(s) contain(s) the required number of control room and in-plant tasks, (2) no more than 30% of the test material is repeated from the last NRC examination, (3) *no tasks are duplicated from the applicants audit test(s), and I l l (4) no more than 80% of any operating test is taken directly from the: licensees exam bank

b. Verify that:

(1) the tasks are distributed among the safety function groupings as s,pecifiedin ES-301, I l l (2) one task shall require a low-power or shutdown condition, I l l (3) 4 - 6 (2 - 3 for SROU) of the tasks require the applicant to implement an alternate path procedure, (4) one in-plant task tests the applicants response to an emergency or abnormal condition, and I /.I

( 5 ) the in-plant walk-through requires the applicant to enter the RCA.

c. Verify the required administrative topics are covered, dd

d. Determine if there are enough different outlines to test the projected number and mix of applicants and ensure that no items are duplicated on subsequent days.

4. a. Assess whether plant-specific priorities (including PRA and IPE insights) are covered in the appropriate exam section.

Gen-eral b. Assess whether the 10 CFR 55.41/43 and 55.45 sampling is approp

c. Ensure the WA importance ratings (except for plant-specific priorit

a. Author

b. Facility Reviewer (*)

c. NRC Chief Examiner (#)

d. NRC Supervisor Pinled Name / Signature 3-321 d 3 Qate 6 / / b 03 Note:

• Not applicable for NRC-developed examinations.

1. Independent NRC reviewer initial items in Column c; chief examiner concurrence required.

NUREG-1021, Draft Revision 9 1

PVNGS NRC Written Examination Quality Assurance Checklist PVNGS FormES-401-6 Facility: PVNGS Examination Start Date: 7/18/03 Exam Level: RO/SRO Initia

- Item Description a Ib*

1. Questions and answers technically accurate and applicable to facility

2. a. NRC WASreferenced for all questions

b. Facility learning objectives referenced as available

3. SRO questions are appropriate per Section D.2.d of ES-401

4. Question selection and duplication tom the last two NRC licensing exams appears consistent with

- a systematic sampling process.

5. Question duplication from the license screening/audit exam was controlled as indicated below (check the item that applies) and appears appropriate:

-x the audit exam was systematically and randomly developed: or

-the audit exam was completed before the license exam was started or

-the examinations were developed independently; or

-x the licensee certifies that there is no duplication; or

-other (explain)

6. Bank use meets limits (no more than 75 percent Bank from the bank, at least 10 percent new, and the rest modified); enter the actual RO / SRO-only 51/16

- question distribution(s) at right

7. Between 50 and 60 percent of the questions on the RO exam are written at the comprehension/analysis level; the SRO exam -

may exceed 60 percent if the randomly selected WAS support the higher cognitive levels; enter the actual RO / SRO question

- distribution(s) at right 8.

- Referenceshndouts provided do not give away answers

9. Question content confonns with specific WA statements in the previously approved examination outline and is appropriate for the Tier to which they are assigned; deviations are justified 10 11.

Question psychometric quality and format meet ES, Appendix B, guidelines The exam contains the required number of one-point, multiple choice items; the total is correct and lpp-I.

corremonds to value on cover sheet Date

a. Author

b. Facility Reviewer (*) +/03

c. Chief Examiner (#) 7/Pdq

d. NRC Supervisor $c+Tv &Ow / ax&$,

Note:

• The facility reviewers initials/signatureare not applicablefor NRCI-developed examinations.

1. Independent NRC reviewer initial items in Column c; chief examiner concurrence required.

1

PVNGS NRC Operating Test Quality Assurance Checklist PVNGS Form ES-301-3 Facility: PVNGS Examination Start Date: 7/21/03 Operating Test Number: 2003 Initials

1. GENERAL CRITERIA b* C#

a. The operating test conforms with the previously approved outline; changes are consistent with sampling requirements (e,g., 10 CFR 55.45, operationalimportance, safety function distribution).

b. There is no day-to-day repetition between this and other operating tests to be c.

administered during this examination.

The operating test shall not duplicateitems from the applicants audit test(s) (see

%b-Section D. 1.a) -k?b

d. Overlap with the written examination and between different parts of the operating test is within acceptable limits.

It appears that the operating test will differentiatebetween competent and less-than-l!!

e.

competent applicants at the designated license level.

I 2. WALK-THROUGH CRITERIA

a. Each JPM includes the following, as applicable:

Initial Conditions Initiating cues 0 Reference and tools, including associated procedures Validated time limits (average time allowed for completion) and specific designation if deemed to be time critical by the facility licensee 0 Specific performance criteria that include:

- Detailed expected actions with exact criteria and nomenclature

- System response and other examiner cures

- Statements describing important observations to be made by the applicant b-

- Criteria for successful completion of the task

- Identification of critical steps and their associated performance standards

- Restrictions on the sequence of steps, if applicable

b. Repetition from operating tests used during the previous licensing examination is within acceptable limits (30% for the walk-through) and do not compromise test integrity. -b-

c. At least 20 percent of the JPMs and questions on each test are new or significantly modified. +P-I 3. SIMIULATOR CRITERIA

a. The associated simulator operating test (scenario sets) have been reviewed in accordance with Form ES-301-4 and a copy is attached.

Printed Name / Signature

a. Author

b. Facility Reviewer(*)

c.

c. NRC NRC Chief Chief Examiner(#)

Examiner(#) - 7h&3

d. NRC

d. NRC Supervisor Supervisor 0-T && 7 I J ~

103 Note:

• Not applicable for NRC-developed examinations.

1. Independent NRC reviewer initial items in Column c7,;chief examiner concurrencerequired.

NUREG-1021,Draft Revision 9 1

I ES-301 Simulator Scenario Quality Checklist Form ES-301-4 I Facility: PVNGS Date of Exam: 7/21/2003 Scenario Numbers: -

11213 Operating Test No.: 2003 QUALITATIVE ATTRIBUTES

1. The initial conditions are realistic, in that some equipment andor i~

out of service, but it does not cue the operators into expected event

2. The scenarios consist mostly of related events.

3. Each event description consists of

- The point in the scenario when it is to be initiated

- The malfunction(s) that are entered to initiate the event

- The symptomdcues that will be visible to the crew

- The expected operator actions (by shift position)

- The event termination point (if applicable)

4. No more than one non-mechanistic failure (e.g. pipe break) is incorporated into the scenario without a credible meceding incident such as a seismic event.

5. The events are valid with regard to physics and thermodynamics.

6 . Sequencing and timing of events is reasonable, and allows the examination team to obtain comdete evaluation results commensurate with the scenario obiectives.

7. If time compression techniques are used, the scenario summary clearly so indicates.

Operators have sufficient time to carry out expected activities without undue time 117 constraints. Cues are given.

8. The simulator modeling is not altered. K!!.d-lW

9. The scenarios have been validated. Pursuant to 10CFR55.46(d), any open simulator performance deficiencies have been evaluated to ensure that functional fidelity is maintained while running the planned scenarios.

10. Every operator will be evaluated using at least one new or significantly modified scenario.

All other scenarios have been altered in accordance with Section D.5 of ES-301.

11. All individual operator competencies can be evaluated as verified using Form ES-301.6 (submit the form along with the simulator scenarios).

12. Each applicant will be significantly involved in the minimum events specified on Form ES-301-5 (submit the form along; with the

13. The level of difficulty is appropriate to support licensing decisions f TARGET QUANTITATIVE ATTRIBUTES (PER SCENARIO; SEE SECTION D.5.d)

1. Total malfunctions (5-8)

2. Malfunctions after EOP entry (1-2)

3. Abnormal events (2-4)

JWREG- 1021, Draft Revision 9

ES-30 1 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO.: PVNGSl2003 Reactor Operator Candidate #1 Evolution Minimum Scenario Number Type Number 1 2 Total RO BOP R(3 BOP Reactivity 1" 1 1 2 Event # 2 3 Normal 1" 0 1 1 Event # 1 Inst./Comp. 4" 3 3 6 Event # 4,576 3'5'7 Major 1 1 1 2 Event # 7 8 AOP NA 2 2 4 Event # 4'5 374 Instructions: (1) Enter the operating test number and Form ES-D-1 event numbers for each evolution type.

(2) Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.5.d) but must be significant per Section C.2.a of Appendix D. *Reactivity and normal evolutions may be replaced with additional instrument or component malfunctions on a one-for-one basis.

(3) Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count toward the minimum requirement.

Author:

NRC Reviewer:

NUREG- 1021, Draft Revision 9

ES-301 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO. : PVNGS 2003 Reactor Operator Candidate #l/Alternate 13 3 Total BOP 1 2 1

0 0 4 7 3,47577 1 2 6

1 3 I Event# I 3 Instructions: (1) Enter the operating test number and Form ES-D-1 event numbers for each evolution type.

(2) Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.5.d) but must be significant per Section C.2.a of Appendix D. *Reactivity and normal evolutions may be replaced with additional instrument or component malfunctions on a one-for-one basis.

(3) Whenever practical, both instrument and component inalfunctions should be included; only those that require verifiiable actions that provide insight to the applicant's competence count toward the ininiinuin requirement.

Author:

NRC Reviewer:

NUREG-1021, Draft Revision 9

ES-301 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO.: PVNGSI 2003 Reactor Operator Candidate #l/Alteicnate 32 Evolution Minimum Scenario Number Type Number 3 2 Total RO BOP RO BOP Reactivity 1" 1 1 2 Event # 1 3 Normal 1" 0 Event #

Inst./Comp. 4" 3 3 6 Event # 2,394 Major 1 1 Event # 6 AOP NA 2 2 4 Event # 2,3 394 Instructions: (1) Enter the operating test number and Fomi ES-D-1 event numbers for each evolution type.

(2) Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.5.d) but must be significant per Section C.2.a of Appendix D. "Reactivity and normal evolutions may be replaced with additional instrument or component malfunctions on a one-for-one basis.

(3) Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count towavd the minimum requirement.

Author:

NRC Reviewer: --TZ+%w+ J ? ?

NUREG- 1021, Draft Revision 9

ES-301 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO.: PVNGS 2003 Reactor Operator Candidate hi2 Evolution Minimum Scenario Number Type Number 1 2 Total RO BOP RO BOP Reactivity 1" 1 1 2 Event # 2 1-

.)

Normal 1" 1 0 1 Event # 1 Inst./Camp. 4" 3 2 5 Event # 3,576 4.,6 Major 1 1 1, 2 Event # 7 8 AOP NA 2 I! 4 Event # 395 3:4 Instructions: (1) Enter the operating test number and Forrn ES-D-1 event numbers for each evolution type.

(2) Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.5.d) but must be significant per Section C.2.a of Appendix D. *Reactivity and normal evolutions may be replaced with additional instrument or component malfunctions on a one-for-one basis.

(3) Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count toward the minimum requirement.

Author:

NRC Reviewer:

NUREG-1021, Draft Revision 9

ES-301 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO. : PVNGS 2003 Reactor Operator Candidate #2/Alternate 13 Instructions: (1) Enter the operating test number and Form ES-D-1 event numbers for each evolution type.

(2) Reactivity manipulations inay be conducted under normal or controlled abnormal conditions (refer to Section D..S.d) but must be significant per Section C.2.a of Appendix D. *Reactivity and normal evolutions may be replaced with additional instrument or component malfunctions on a one-for-one basis.

(3) Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicants competence count toward the ininiinuin requirement.

Author:

NRC Reviewer:

NUREG-1021, Draft Revision 9

_. -~

ES-301 Transient and Event Checklist FormES-301-5 OPERATING TEST NO.: PVNGS 2003 Reactor Operator Candidate #2/Alternate 32 Evolution I Minimum I Scenario Number 3 2 Total RO BOP B:O BOP Reactivity 1" 1 1 2 Event # 1 3 Normal 1" 0 0 1 Event #

Inst./Comp. 4" 4 3 7 Event # 3949597 4,5,6 Major 1 1 1 2 Event # 6 8 AOP NA 1 :2 3 Event # 3 394

[nstructions: (1) Enter the operating test number and Form ES-D- 1 event numbers for each evolution type.

(2) Reactivity manipulations may be conduc:ted under normal or controlled abnormal conditions (refer to Section D.5.d) but must be significant per Section C.2.a of Appendix D. *Reactivity and normal evolutions may be replaced with additional instrument or component malfunctions on a one-for-one basis.

(3) Whenever practical, both instrument and component inalfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count towcardthe minimum requirement.

Author:

NRC Reviewer:

NUREG-1021, Draft Revision 9

ES-30 1 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO.: PVNGS 2003 (SRO)

Evolution Type Minimum Scenario Number Number 1 2 3 Reactivity 0 1 1 1 Event # 2 3 1 Normal 1" 1 1 0 Event # 1 1 Instrument/Comp 2" 4 4 5 Event # 3,49596 495,697 2,3,4,5,7 Major 1 1 1 1 Event # 7 8 6 AOP NA 3 2 2 Event # 3,495 394 293 Instructions: (1) Enter the operating test number and Form ES-D-1 event numbers for each evolution type.

(2) Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.5.d) but must be significant per Section C.2.a of Appendix D. "Reactivity and normal evolutions may be replaced with additional instrument or component malfunctions on a one-for-one basis.

(3) Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count toward the minimum requirement.

Author:

NRC Reviewer:

NUREG- 1021, Draft Revision 9

ES-301 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO.: PVNGS 2003 (SRO Totals)

Evolution Type Minimum Scenario Number Total Number 1 2 Reactivity 0 1 1 2 Event # 2 3 Normal 1* 1 1 2 Event # 1 1 InstKomp. 2* 4 4 8 Event # 3949596 4357 Major 1 1 1 2 Event # 7 8 AOP NA 3 2 5 Event # 3,495 394 Instructions: (1) Enter the operating test number and Form ES-D-1 event numbers for each evolution type.

(2) Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.5.d) but must be significant per Section C.2.a of Appendix D. "Reactivity and normal evolutions may be replaced with additional instrument or component malfunctions on a one-for-one basis.

(3) Whenever practical, both instrument andl component malfunctions should be included; only those that require veriliable actions that provide insight to the applicant's competence count toward the minimum requirement.

Author:

NRC Reviewer:

NUREG-102 1, Draft Revision 9

~

ES-301 Competencies Checklist Form ES-301-6 OPERATING TEST NO.: 2003 SRO RO BOP ComDetencies SCENARIO

- I SCENARIO I SCENARIO 1 2 2 3 4 InterpreiYDiagnose Events 234 135 356 and Conditions 567 78 7 8

Comply With and 345 345 137 13 Use Procedures (1) 67 678 8 Operate Control 137 135 Boards (2) 8 67 Communicate and 234 234 235 123 Interact 567 567 78 567 8

Demonstrate Supervisory 345 Ability (3) 567 678 Comply With and 3 2 Use Tech. Specs. (3) -

Notes:

(1) Includes technical Specification compliance for an RO.

(2) Optional for an SRO-U.

(3) Only applicable to SROs.

Instructions:

Circle the applicants license type and enter one or more event inumbers that will allow the examiners to evaluate every applicable competency for every applicant.

Author:

NRC Reviewer:

NUREG- 1021, Draft Revision 9

PVNGS Written Examination Grading Quality Checklist PVNGS Form ES-403-1 Facility: PVNGS July 18,2003 RO Written Examination Item Description

1. Clean answer sheets copied before grading

2. Answer key changes and question deletions justified and documented.

3. Applicants' scores checked for addition errors (reviewers spot check > 25% of examinations)

4. Grading for all borderline cases (80% +/- 2% overall and 70 +/- 4% of the SRO-only) reviewed in detail

5. All other failing examinations checked to ensure that grades are justified 6 . Performance on missed questions checked for training deficiencies and wording problems; evaluate validity of questions missed by half or more of the applicants Printed Name / Signature Date

a. Grader Phillip G. Capehart /#!A CkphSf 7/24/2003

b. Facility Reviewer (*)  :  % 7/24/2003

c. NRC Chief Examiner (*) n o F. StefLI,rTTZane ,dh& 7l9llo3

d. NRC Supervisor (*) hT.&by 7!?\!0b W

(*) The facility reviewer's signature is not applicable foir examinations graded by the NRC: two independent NRC reviews are required.

PVNGS Written Examination Grading Quality Checklist PVNGS Form ES-403-1 July 18,2003 SRO Written Examination Initials Item Description a 1 b I C

1. Clean answer sheets copied before grading

2. Answer key changes and question deletions justified and documented.

I 3. Applicants' scores checked for addition errors I I I _ "

I L 1 (reviewers spot check > 25% of examinations)

4. Grading for all borderline cases (80% +/- 2% overall and 70 +/- 4% of the SRO-only) reviewed in detail

5. All other failing examinations checked to ensure that deficiencies an

b. Facility Reviewer (*) 7/24/2003

(*) The facility reviewer's signature is not applicable for examinations graded by the NRC: two independent NRC reviews are required.

Page 1 of 4 Operator Licensing Exam Schedule 08/13/2003 17:31:55 From 07/21/2003 To 07/24/2003 Report 21 Region: 4 Phase Code: 5 Operational 07/21/2003 Palo Verde / 05000528 I2003301 RO-2 Admin FFF STETKA, THOMAS F. STETKA, THOMAS F.

TAC #: X02249 SROU - 1 0712112003 Palo Verde I05000529 / 2003301 RO-2 Admin STETKA, THOMAS F. STETKA, THOMAS F.

TAC #: X02250 -

SROU 1 07/21/2003 Palo Verde I05000530 I2003301 RO-2 Admin STETKA, THOMAS F. LANTZ, RYAN E.

TAC #: X02251 -

SROU 1 MCKERNON, THOMAS 0.

STETKA, THOMAS F.

Sites: PAL0 Orgs: 4620 Exam Author: ALL

4 Page2of4 Operator Licensing Exam Schedule Q8113l2003 17:31:55 From 07/21/2003 To 07/24/2003 Report 2 1 Region: 4 Phase Code: 5 Operational 07/2003 PAL0 Palo Verde RO-6 SROl - 0 SROU - 3 LSRO - 0 Total for Palo Verde: 9 Sites: PAL0 Orgs: 4620 Exam Author: ALL

2003 NRC Examination Security Agreement I acknowledge that I have NOT acquired any specialized knowledge: about the NFX licensing examinations scheduled to start on July 18,2003 and run through July 24,2003. I am aware of the physical security measures and requirements (as documented in the facility licensees procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinat ions and/or an enforcement action against me or the facility licensee. I will immediately report to facility mamgement or the NRC chief examiner any indication or suggestions that examination security may have been compromised.

PRINTED NAME JOB TITLERESPONSIBILITY SIGNATURE DATE

A subsidiay of Pinnacle West cnpital Cmporation Name: Phillip G. Capehart Tel. 623-393-5355 Mail Station 7894

Title:

Instructor Fax 623-3936164 5801 S. Wintersburg Rd.

Department: Training e-mail a56l@aDs.com Tonapah, Arizona 85354-7529 September 16,2003 Tom, enclosed are the Examination Security Agreement forms (3 total) for the 2003 PVNGS NRC Exam. Sorry it took so long to get them back to you but the last remaining individual I needed to sign was gone on vacation until today.

I hope this finds you in good health and that everything is going well. I look forward to working with you again in the fbture.

If you need any additional information or assistance feel fiee to call on me.

ES-201 Examination Security Agreement Form ES-201-3

1. Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week@)of date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who by the NRC chief examiner. Iunderstand 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.Furthermore, Iam 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. Iwill immediately report to facility management or the NRC chief examiner any indications or suggestions that 1 examination security may have been compromised.

I 1

2. Post-Examination i

I I m To the best of my kno led Idid not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of 11-1 2 PI. From the date that I entered into this security agreement until the completion of examination administration, Idid 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 / RESPONSIBILITY NOTES:

NUREG-1021, Revision 8, Supplement 1

[ .f3 24 of 24 t- t-

ES-201 Examination Security Agreement Form ES-201-3

1. Pre-Examination Iacknowledge that Ihave acquired specialized knowledge about the NRC licensing examinations scheduled for the week@)of 7!(V - 7,h 109 as of the date of my signature. I agree that Iwill not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. Iunderstand 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.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 kno led e Idid not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of $@'&)a . From the date that I entered into this security agreement until the completion of examination administration, Idid 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 / RESPONSIBILITY .SIGNATURE

- (1) DATE SIGNATURE (2) DATENOTE NOTES:

NUREG-1021, Revision 8, Supplement 1 24 of 24 2.k 3 t- t-

ES-201 Examination Security Agreement Form ES-201-3

1. Pre-Examination I acknowledge that Ihave acquired specialized knowledge about the NRC licensing examinations scheduled for the week&) of 7!t&-h-!h as of the date of my signature. Iagree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. Iunderstandthat Iam not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administeredthese licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, Iam aware of the physical security measures and requirements(as documented in the facility licensee's procedures) and understandthat 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. Iwill 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 not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the the date that Ientered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administeredthese licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATUREI1) DATE SIGNATURE (2) DATENOTE 1.

2.

3.

4.

8.

9.

10.

11.

12.

13.

14.

15.

NOTES:

NUREG-1021, Revision 8, Supplement 1 24 of 24 I f--