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Created by Krista Ziebell on Nov 7, 2013 2:42:33 PM
SID (New)
ILTAB
Draft
General Information
Access Control
Released NRC Only
Released All
Unreleased
All Tabs
Last Comment
Record Number
Please Save
EN #
N/A
Incident Status
Open
Closed Resolved
Closed Unresolved
General Information
Incident / Communication Document Date
*
Subject/Short Description
*
Reporting Organization
Site/Licensee
Site/Licensee Name
State
Region
Timezone
Report Category
Non-Sensitive Attachments
(R) Sensitive Attachments
Document Links
External Links
External Reference Number
Vehicle(s) Involved (Query)
More
*
(R) Vehicle Type
(R) Make
(R) License Plate State
(R) Model
(R) Year (e.g. 2011)
(R) License Plate #
(R) Color
(R) Partial
(R) VIN #
(R) N-Number
(R) Partial
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(R) Additional Information
Add Record
Person(s) Involved (Query)
More
(R) First Name
(R) Middle Name
(R) Last Name
(R) Street Address
(R) Date of Birth
(R) Phone (e.g. 3015551234)
(R) City
(R) Gender
(R) SSN
(R) Driver's Lic. State
(R) Passport Country
(R) State
(R) Zip
(R) Driver's License #
(R) Passport / Registration #
(R) Comments
Add Record
Incident Information
73.71 Report?
Yes
37.57 Report?
No
Yes
37.81 Report?
No
Yes
No
Notification Date/Time/Timezone
*
(R) Caller Name
(R) Caller Title
Caller Affiliation
*
(R) Call Back Phone #
*
HOO/HERO
*
(R) Detailed Description of Incident
Prepare to Redact
This report is open pending ILTAB review. ILTAB will update or close this report when appropriate.
Redacted Description of Incident
*
Redact Selected Text
Updates / ILTAB Summary
Last Updated
* Nov 7, 2013 14:42:33 EST
https://pws.nrc.gov/reliance/reliance?ETQ$CMD=CMD_SUBFORM_INSERT_RECORD_BELOW&E... 11/07/2013
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Caller's Notification Information
More
(R) Name
(R) Organization
(R) Phone
Add Record
NRC's External Notifition Information
More
(R) Name
(R) Organization
(R) Phone
Add Record
(R) = "Restricted Field" (not viewable by general users)
https://pws.nrc.gov/reliance/reliance?ETQ$CMD=CMD_SUBFORM_INSERT_RECORD_BELOW&E... 11/07/2013
| File Type | application/pdf |
| File Title | https://pws.nrc.gov/reliance/reliance?ETQ$CMD=CMD_SUBFORM_INSER |
| Author | KXJ3 |
| File Modified | 2013-11-07 |
| File Created | 2013-11-07 |