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pdfNRC FORM 366
U.S. NUCLEAR REGULATORY COMMISSION
(MM-YYYY)
EXPIRES: (MM/DD/YYYY)
APPROVED BY OMB: NO. 3150-0104
Estimated burden per response to comply with this mandatory collection request: 80 hours. Reported lessons
learned are incorporated into the licensing process and fed back to industry. 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 [email protected], and the OMB reviewer
at: OMB Office of Information and Regulatory Affairs, (3150-0104), Attn: Desk Officer for the Nuclear Regulatory
Commission, 725 17th Street NW, Washington, DC 20503; e-mail: [email protected]. 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 OMB control number.
LICENSEE EVENT REPORT (LER)
(See Page 2 for required number of digits/characters for each block)
(See NUREG-1022, R.3 for instruction and guidance for completing this form
http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1022/r3/)
1. Facility Name
050
3. Page
2. Docket Number
1 OF
052
4. Title
5. Event Date
Month
Day
6. LER Number
Year
Sequential
Number
Year
-
7. Report Date
Revision
No.
Month
Day
8. Other Facilities Involved
Year
-
Facility Name
050
Facility Name
9. Operating Mode
052
Docket Number
Docket Number
10. Power Level
11. This Report is Submitted Pursuant to the Requirements of 10 CFR §: (Check all that apply)
10 CFR Part 20
20.2203(a)(2)(vi)
10 CFR Part 50
50.73(a)(2)(ii)(A)
50.73(a)(2)(viii)(A)
73.1200(a)
20.2201(b)
20.2203(a)(3)(i)
50.36(c)(1)(i)(A)
50.73(a)(2)(ii)(B)
50.73(a)(2)(viii)(B)
73.1200(b)
20.2201(d)
20.2203(a)(3)(ii)
50.36(c)(1)(ii)(A)
50.73(a)(2)(iii)
50.73(a)(2)(ix)(A)
73.1200(c)
20.2203(a)(1)
20.2203(a)(4)
50.36(c)(2)
50.73(a)(2)(iv)(A)
50.73(a)(2)(x)
73.1200(d)
50.46(a)(3)(ii)
50.73(a)(2)(v)(A)
10 CFR Part 73
73.1200(e)
50.69(g)
50.73(a)(2)(v)(B)
73.77(a)(1)
73.1200(f)
20.2203(a)(2)(iii)
50.73(a)(2)(i)(A)
50.73(a)(2)(v)(C)
73.77(a)(2)(i)
73.1200(g)
20.2203(a)(2)(iv)
50.73(a)(2)(i)(B)
50.73(a)(2)(v)(D)
73.77(a)(2)(ii)
73.1200(h)
20.2203(a)(2)(v)
50.73(a)(2)(i)(C)
50.73(a)(2)(vii)
20.2203(a)(2)(i)
20.2203(a)(2)(ii)
10 CFR Part 21
21.2(c)
OTHER (Specify here, in abstract, or NRC 366A).
12. Licensee Contact for this LER
Licensee Contact
Phone Number (Include area code)
13. Complete One Line for each Component Failure Described in this Report
Cause
System
Component
Manufacturer Reportable to IRIS
14. Supplemental Report Expected
No
Yes (If yes, complete 15. Expected Submission Date)
16. Abstract (Limit to 1326 spaces, i.e., approximately 13 single-spaced typewritten lines)
Cause
System
Component
15. Expected Submission Date
Manufacturer
Month
Reportable to IRIS
Day
Year
NRC FORM 366
(MM-YYYY)
LICENSEE EVENT REPORT (LER) (Continued)
REQUIRED NUMBER OF DIGITS/CHARACTERS FOR EACH BLOCK
BLOCK
NUMBER
NUMBER OF
DIGITS/CHARACTERS
TITLE
1
UP TO 127 / 2 LINES
FACILITY NAME
2
CHECK BOX FOR 050 OR 052
10 TOTAL
5 IN ADDITION TO 050 OR 052
DOCKET NUMBER
3
VARIES
PAGE NUMBER
4
UP TO 230 / 2 LINES
TITLE
5
8 TOTAL
2 FOR MONTH
2 FOR DAY
4 FOR YEAR
EVENT DATE
6
9 TOTAL
4 FOR YEAR
3 FOR SEQUENTIAL NUMBER
2 FOR REVISIONS NUMBER
LER NUMBER
7
8 TOTAL
2 FOR MONTH
2 FOR DAY
4 FOR YEAR
REPORT DATE
8
UP TO 29 -- FACILITY NAME
CHECK BOX FOR 050 OR 052
10 TOTAL -- DOCKET NUMBER
5 IN ADDITION TO 050 OR 052
OTHER FACILITIES INVOLVED
9
1
OPERATING MODE
10
3
POWER LEVEL
11
VARIES
CHECK ALL BOXES THAT APPLY
REQUIREMENTS OF 10 CFR
12
UP TO 90 FOR NAME
10 FOR TELEPHONE
LICENSEE CONTACT
13
CAUSE VARIES (UP TO 8)
2 FOR SYSTEM (UP TO 8)
4 FOR COMPONENT (UP TO 8)
4 FOR MANUFACTURER (UP TO 8)
IRIS VARIES (UP TO 10)
EACH COMPONENT FAILURE
14
1
CHECK BOX THAT APPLIES
SUPPLEMENTAL REPORT EXPECTED
15
8 TOTAL
2 FOR MONTH
2 FOR DAY
4 FOR YEAR
EXPECTED SUBMISSION DATE
16
13 LINES OF TYPING
ABSTRACT
| File Type | application/pdf |
| File Modified | 2022-09-06 |
| File Created | 2022-06-09 |