ML22104A050
| ML22104A050 | |
| 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 | |
| Download: ML22104A050 (6) | |
Text
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Home Even: No:ific.ation Form 361 Form 361 APPROVED BY OMS: NO. 3150-0238 EXPIRE S: 10/31/2022 Estimated burden per response lo 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 regardin g 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 0 MB control number.
Create Dr aft Form 361 Review Ora.ft Form 351 i inaJ Form 351 Form 361 EN Number Notificati on Date And Time "
ii Facility or Organi zation "
Select ?bnt V Unit" Name of Caner/Tit l e "'
Call Back Number "
Provide a telephone number Event Time A nd Zone "
Event Date "'
ii Power Mode At Time Of Event "'
a.
Power Mode At Time Of Notif i cati on "'
a.
Event Classification General Emergency Site Area Emergency A lert
@ No O v es @ No 0 Yes @ No 0 Yes Unusual Event 50,72 Non Emergency 4 Physical Security
@ No O Yes @ No O Yes @ No O Yes Material Exposure Fitness For Duty Other Unspecified Requirement
@ No O Yes @ No O Yes @ No O Yes Information Only
@ No O v es 1-HR Non-Emergency 10 CFR 50 72(b)(1)
TS Deviation
@ No O v es 4-HR Non-Emergency 10 CFR 50 72(b)(2)
TS Required SD ECCS Discharge to RCS RPS Actuation
@ No O v es @ No 0 Yes @ No 0 Yes Offsite Notification
@ No O v es 8-HR Non-Emergency 10 CFR 50 72(b)(3)
Degraded Condition Unanalyzed Condition Specified System Actuation
@ No O v es @ No 0 Yes @ No 0 Yes Safe SD Capability RHR Capability Control of Rad Release
@ No O Yes @ No O Yes @ No O Yes Accident Witigation Offsite Medical Loss CommfAsmt/Response
@ No O Yes @ No O Yes @ No O Yes 60-Day Optional 10 CFR 50.73(a)(1)
Invalid Specified System Actuation
@ No O Yes Other Unspecified Requirement (Identify)
NONR NONR
@ No O Yes @ No O Yes
Event Description (Include Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc ) (Continue on Page 2)
Event Description fi Notifications NRC Resident Anything Unusual Or Not Understood
@No O ves V
State Did All Systems Function As Required
@No O Yes V
Local Mode Of Operations Until Corrected V
Other Gov Agencies Additional Information
@No O ves V
Media Press Release V
Radiological Releases Check Or Fill In Applicable Items (specific details/explanations should be covered in event description)
Liquid Release Gaseous Release Unplanned Release
@ No O v es @ No O v es @ No O ves Planned Release Ongoing Terminated
@ No O Yes @ No O Yes @ No O Yes Monitored Unmonitored Offsite Release
@ No O Yes @ No O Yes @ No O Yes T, S. Exceeded RM Alarms Areas Evacuated
@ No O v es @ No O v es @ No O ves Personnel Exposed or Contaminated Offsite Protection Actions Recommended
@ No O v es @ No O v es Noble Gas (Release Rate (Ci/sec)) Noble Gas(% T, S, Limit) Noble Gas (Total Activity (Ci)) Noble Gas(% T, S, Limit 2}
Iodine (Release Rate (Ci/sec)) Iodine(% T, S, Limit) Iodine (Total Activity (Ci)) Iodine(% T, S, Limit 2}
Particulate (Release Rate (Ci/sec}) Particulate(% T.S. Limit} Particulate (Total Activity (Ci)) Particulate(% T.S. Limit 2}
Liquid (excluding tritium and Liquid {excluding tritium and Liquid (excluding tritium and Liquid {excluding tritium and dissolved noble gas) (Release dissolved noble gas}(% T,S, dissolved noble gas) (Total dissolved noble gas}(% T,S, Limit Rate (Ci/sec)) Limit) Activity (Ci)) 2)
Liquid (tritium) (Release Rate Liquid (tritium}% T.S. limit Liquid (tritium) (Total Activity (Ci)) Liquid (tritium) (% T. S. Limit 2)
(Ci/sec))
Total (Release Rate (Ci/sec)) Total (% T.S. Limit) Total Activity (Total Activity (Ci)) Total {% T.S. Limit 2) 1 1
RAD Monitor Readings (Plant RAD Monitor Readings RAD Monitor Readings (Main RAD Monitor Readings (SG Stack) (Condenser/Air Ejector} Stream Line} Slowdown)
Alarm Setpoi nts (Plant Stack) Alarm Setpoints (Condenser/Air Alarm Setpoints (Main Stream Alarm Setpoints ( SG Slowdown)
Ej ector) line)
% T. S. Limit (Plant Stack) % T.S. limit (Condenser!Air % T, S. Limit (Main Stream Line} % T.S. Umit (SG Slowdown}
Ej ector)
RAD Monitor Readings (Other) 1 i Alarm Setpoi nts (Other)
% T, S. Limit (Other}
RCS Or SG Tube Leaks Check Or Fill In Applicable Items (specific details/explanations should be covered in event description)
Location Of The Leak (e.g,1 SG #, valve 1 pipe, etc.)
Leak Rate Units: gpm/gpd T,S, limits Sudden Or Long Term Development Leak Start Date Leak Start Time Coolant Activity and Units Coolant Activity and Units (Primary) ( Secondary) ii
List Of Safety Related Equipment Not Operational Event Description fi Ill HOME ABOUT US POPU LAR DOCUMENTS STAY CONNECTED NEWS RELEASES STRATEGIC PLAN INFO DIGEST 11:1 11:1 11:1 r.l Ir.II Ir.II