ML22104A052
| ML22104A052 | |
| Person / Time | |
|---|---|
| Issue date: | 04/14/2022 |
| From: | Office of Nuclear Security and Incident Response, NRC/OGC |
| To: | |
| Cecere B | |
| Shared Package | |
| ML22005A062 | List: |
| References | |
| OMB 3150-0238 | |
| Download: ML22104A052 (4) | |
Text
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Home Even: No:ific.ation Form 361 N Form 361 N APPROVED BV 0MB: ND. 3150-0ilg EXPIRE S: 10/3112022 Estimated burden per response to comply with this voluntary collection request 30 minutes. The information provided will be used for evaluation of licensee event description, facility status and for input to the public website. Send comments regarding burden estimate to the FOIA, library, and Information Collections Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by e-mail to lnfocollects.Resource@nrc.gov, and the 0MB reviewer at 0MB Office of Information and Regulatory Affairs, (3150-0238), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e.mail: oira_submis.sion@omb.eop.gov. The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid 0MB control number.
Form 361 N EN Number Notification Date And Time Facility or Organi zation "
V Name of Caller "
Call Back Number
- Provide a telephone number Event Time A nd Zone "
Event Date "
ii Power Mode Before L
Power Mode After Reactor Ty pe Max Power Max Pulse Pulse Inserted During Event?
Event Classification (i)
General Emergency Site Area Emergency Alert No O Yes No O Yes No O Yes Unusual Event Safeguards Event (73 App G) Material Exposure
@ No O Yes @ No O Yes @ No O Yes Information Only Other Unspeci fied Requirement (see Other Unspecified Requirem ent Sec tion) i No O Yes No O Yes Reportable Cond ition (Varies by facility TS)
TS Dev iation TS Required SJ0 RPS Actuation (scram)
No O Yes No O Yes No O Yes Offsite Notification Degraded Condit ion Unanalyzed Condit ion No O Yes No O Yes @ No O Yes Specif ied System Actuation Safe SID Capabili ty Control of Rad Release
@ No O Yes @ No O Yes @ No O Yes Accident Mitigation Offsite Medical Loss Comm/AsmtfResp,onse
@ No O Yes @ No O Yes @ No O Yes Inval id Speci fied System Actuation Suspic ious Activ ity Sec urity Event
@ No O Yes @ No O Yes @ No O Yes Other Unspecified Req uirement (Identify)
NONR Identify Unspecified Requirement
@ No O Yes NONR Identify Unspecified Requirement
@ No O Yes 1
Description (Include: System affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.)
Event Descr i ption fi Notifications HQ NPR Staff An ythi ng Unu su a.l Or Not Un der stood?
No OYes V
State(s) Di d A ll System s Func tion A s Requi red?
No OYes V
Loca.l Mode O f Operation s Un til Correct ed (if appl icable)
V Oth er Gov Agenci es Esti mate f0<r Restart Date V ii Media/Pr ess Rel ease V
Rad iological Releases: Check Or Fill In Applicable Items (specific details/explanations should be covered in event description)
Liquid Release Gaseou s Rel ease Unp l an ned Release No O Yes No O Yes No O Yes Plan ned Release Ongoing Termina ted No O Yes No O Yes No O Yes Moni tored Unmoni tored Offsite Rel ease
@ No O Yes @ No O Yes @ No O Yes Offsite Protection Actions Recommended T.S. E.xceeded RM A larms No O Yes No O Yes No O Yes Areas Evacuated Per son nel E.xpose<I or Contami nated
@ No O Yes @ No O Yes
Noble Gas (Release Rate (Cil se-c)) Noble Gas (% T. S. Limit) Noble Gas (Total Activ ity (Ci)) Nobl e Gas (% T.S. Limit 2)
Iodine (Release Rate (Ci/sec)J Iodine (% T.S. Limit ) Iodine (Total Activit y (Ci)) Iodine (% T.S. Limit 2)
Particulate (Rel ease Rate (Ci/sec)) Parti cul ate (% T.S. Limit ) Particul ate (Tot.al Activ ity (Ci)) Particul ate (% T. S. Limit 2)
Liquid (excluding tritium and Liqui d (excluding tlit ium and Li qui d (exc luding trit ium and Liqu.i d (excluding tritium a.nd di ssolv ed noble gas) (Release dissolved noble gas)(% T. S. di ssolv ed nobl e gasJ (Total di ssolved nobl e gas)(% T.S. Limit Rate (Ci/sec)J Limit ) Activit y (Ci)) 2)
Liquid (t rit ium) (Release Rate Liqui d (tri tium)(% T.S. Limit ) Li qui d (tri tium) (Total Activ ity (Ci)) Liqu.i d (tritium)(% T. S. l imi t 2)
(Ci/sec))
Total (Release Rate (Ci/sec)) Total (% T.S. Limi t) Total Activi ty (Tota.I Activi ty (Ci)) Total (% T.S. Limit 2) 1 list Of Safety Retat ed Equipment Not Operational L