ML050190363

Various Checklists for the Kewanee Retake Examination - Nov 2004

ML050190363
Person / Time
Site:	Kewaunee
Issue date:	11/16/2004
From:	Nuclear Management Co
To:	NRC/RGN-III
Shared Package
ML050190172	List: ML050190332 ML050190363 ML050200017 ML050200021
References
50-305/04-302 50-305/04-302
Download: ML050190363 (14)

Text

ES-201 Examination Preparation Checklist Form ES-201-1 Facility: Kewaunee (RO written retake exam only) Date of Examination: 11/16/2004 Examinations Developed by: / NRC (circle one)

Target Chief Date* Task Description (Reference) Examiners Initials

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-180 1. Examination administration date confirmed (C.1.a; C.2.a and b) I~ 64

-120 2. NRC examiners and facility contact assigned (C.1.d; C.2.e) hGq

-120 3. Facility contact briefed on security and other requirements (C.2.c)

-120 4. Corporate notification letter sent (C.2.d) w4 I l-@l N/A

-75 6. Integratedexamination outline(s) due, including Forms ES-201-2, ES-201-3, 6-4 r rrrn 4 - r

s, ES-401-1/2, ES-401-3, and ES-401-4, Egdpkig 4 4 r e 3

~61~e%~C~wd)

-70 7. Examination outline(s) reviewed by NRC and feedback provided to facility licensee (C.2.h; C.3.e) I@@

-45 8. Proposed examinations (including written, p ,

as applicable), supporting documentation (including Forms

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4 Es r e 3W-6, and ES-401-6), and reference mate%;&?;,fe;f,.e?g ahd h;%) LU

-30 r P 4 I. P

- . . I , . ..-., l-0 NIA I -I4 I 10. Final license applications due and Form ES-201-4 prepared (C.l.1; C.2.i; ES-202)

-14 11. Examination approved by NRC supervisor for facility licensee review (C.2.h; C.3.f) b4 @

1 -14 I 12. Examinations reviewed with facility licensee (C.1.j; C.2.f and h; C.3.g) I PIG4 I -7

-7

13. Written examinations (C.2.i; C.3.h) approved by NRC supervisor

14. Final applications reviewed; examination approval and waiver letters sent (C.2.i; Nc@

Attachment 4; ES-204)

-7 15. Proctoring/written exam administration guidelines reviewed with facility licensee (C.3. k) Mfq I *

-7 I1 . . . I N/A Target dates are keyed to the examination date identified in the corporate notification letter.

They are for planning purposes and may be adjusted on a case-by-case basis in coordination with the facility licensee.

[ ] Applies only to examinations prepared by the NRC.

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ES-201

' Examination Securitv Aareement Form ES-201-3

1. Pre-Examination

• #s I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the w e e k N o f I I 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 een 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.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 j Y $ / b f . From the date that I entered into this security agreement until the completion of examination administration, I did not

- instruct, evaluate, or pr vi e 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-I 021, Revision 8, Supplement 1 24 of 24

W NUREG-1022, Revision B, Supplement I 24 of 24

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 date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons 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.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. I will immediately report to facility management or the NRC chief examiner any indications or slrggestions that examination security may have been compromised.

2. Post-Examinatiou 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 @ b p $ . From the date that I entered into this security agreement until the completion of examhation administration, Idid not instruct, evaluate, or provi e 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) DATENOTE NOTES:

NUT, '-1021, Revision 8, Supplement 1

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

1. Pre-Examination Iacknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week date of my signature. I agree that Iwill not knowingly divulge any information about these examinations to any persons 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. I will immediately report to facility management or the NRC chief examiner any indications or Wggestions that examination security may have been compromised.

2. Post-Examinatipn during the week(s) of wk$

To the best of my knowledge, Idid not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered

. From the date that Ientered into this security agreement until the completion of examination administration, Idid not instruct, evaluate, or provi e performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME JOB TlJLE / RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATENOTE NOTES:

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

1. Pre-Examination r a n enforcement examination security may have been compromised.

2. Post-Examination NRC licensing examinations administered ion of examination administration, I did not PRINTED NAME

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2. Post-xaminatiw noted below end authorized by the NRC.

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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(s) of kb3?ff date of my signature. Iagree that Iwill not knowingly divulge any information about these examinations to any persons who have not been authorized the 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,Furthermore, 1 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 shggestions that examination security may have been compromised.

2. post-Examim To the best of my knowledge, Idi not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of&{2m 4 From the date that Ientered into this security agreement until the completion of examination administration, Idid 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 SIGNATURE (1) DATE SIGNATURE (2) DATENOTE

14. --

15. --

NOTES:

NUT, '-1021, Revision 8, Supplement 1 2' ' 2 4

"-; Pre-Examinalion I

L acknowledge Ibst I have acquired specializedknowledge aboul the NRC Ifcenshg eramlnatlons scheduled for h e wsek(s) of &%Ti, Form ES-201-3

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date of my sigrtatura L sgme that I Will nol knowingty d i l g e any Inlwmau'cnabout lhese examinerions to any perwns who havs nat been aumorized -4 by the MRC chief examiner, I undersland h a t I am not la Insmt evaluate, or prouide perfamameFeedback to !hose applicants scheduled LObe admlnisiwedthese licensing examlnetims from this dab until completion d examinationadrninistra!Jm, except as specifically noled bslow and W aulhurlzed by lhe NRC.FuWwmore, 1 am aware of Ih$phyrimalsecurity measures and raquhrnenb (as documented in ule lacilily licensee's .

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procedures) end undersbnd that V b # a h nl the cond~ons01 ais agreemenl may result in. cancellalion of ha examlnathns andlor an enforcemenl- a, CO acflon agalnst me or Ute faclllty lkensea. I wldl immedlateiyreport tolacfllty managemenlWlhe NRC cMef examiner any fndicatians or sltggixilions \ha1 in w

ewamine~ionsecurlty may bsve k n cornpramked. , P m

not dlvulge to any unauthorked persons any mformalianconcerning the NRC llcensfng ewaminalions sdrninistefed during the the dare thar I enlered inb this securlty agreemen1until the completion of eramination adminisration, I did no[

feedback b those applicants who wem administeredh s e Ilcenshgenamlnau'om. except a5 speclncally noted below and authmlzed by Ihe NRC.

PRINTED NAME JOB TITLE I RESPONSIBILITY SlGNATURE {I) DATE SIGNATURE [ Z ) DATENOTE NOTES:

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NUT, '-1021, Revision 8, Supplement 1' 2' - 2 4 13

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

1. Pre-Examination w

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of I 1s 3 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 een 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.Furthermore, 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 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 N+f~d . From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provi e 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 3.

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5.

6.

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8.

9.

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11. --

12. --

13. --

14. --

15. --

NOTES:

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

ES-201 ExaminationSecurlty Agreement Farm ES-201-3

1. Pm-Examinallon M

f acknowledge (hat I h a m acquired specCalized knwukxtgeeboulthe NRC licsnsiogexaminalions scheduled for the we&@} of I lb a as of fie dated my signature. I agree thal I will no1 knwhglydivulge any infarmalion about ~haseemhations lo m y persons who have nt e m authorized by UleNRC chief examiner. t undeisland Ulal I am not lo imttmt, eualuale, or provide performance feedback to those appllcantsscheduled to be m

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P u) administemd lhese kens tng er(amin8titiorcs Imrm LhIs dale unlilcornptetian or examhalion admimislratioo,excepl as specTkally ncled below and authwized by the NRC.Furlhemom, I am aware dthephysical security rneasuras and requlrements(as documenledin the faclllty ticensads procedures) and uftdersland Ulat violation d the conditions OF this agreement may mull In cancellationcsf [he examinations andlor an enforcemad againsl m e w [hefmlli%y actir~~ licensee. I will Irnmedialdy report tn Jacility management or the NRC chbf examiner any indicelionsor suggeslions uhal mmlnaUm fmurily may have been compromised.

To the best of my knowledge, 1 did not divulge to any unauthorized persons any iniormalion concerning the NRC licensing eKaminafionsadrninislered durlng ihe week(s) of 104 . From ihe data fhal I entered into thiB s~curityagreement until the campletion of examinationadministration, I did no1 InSUuCt, evaluate,or p*de parfrrrrnanoe feedback Io hose applicanls who were adminislsmd these licensing examinations, except as specifically nolsdbelaw and aulhorined by the NRC.

JOB TWLE I RESPONSlBlLlTY SIGNATURE (1) DATE SlGNATURE (2) DATENOTE NOTES:

NURliGIMI, ReYisian 8, Supplement 9 24 of 24

ES-403 Written Examination Grading Form ES-403-1 Quality Checklist