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NRC FORM 361
(07-13-2022)
U.S. NUCLEAR REGULATORY COMMISSION
OPERATIONS CENTER
REACTOR PLANT EVENT
NOTIFICATION WORKSHEET
APPROVED BY OMB: NO. 3150-0238
EXPIRES: 10/31/2022
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 Information Services Branch (T-6 A10M), U.S. Nuclear Regulatory
Commission, Washington, DC 20555-0001, or by e-mail to [email protected], and to the Desk Officer,
Office of Information and Regulatory Affairs, NEOB-10202, (3150-0238), Office of Management and Budget,
Washington, DC 20503. If a means used to impose an information collection does not display a currently valid OMB
control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information
collection.
EN #
NRC OPERATIONS TELEPHONE NUMBERS: PRIMARY - 301-816-5100 or 800-532-3469ǂ, BACKUPS - [1st ] 301-951-0550 or 800-449-3694ǂ,
[2nd] 301-415-0550 and [3rd] 301-415-0553. ǂLicensees who maintain their own ETS are provided these telephone numbers.
FAX - 301-816-5151, EMAIL - [email protected]
Notification Time
Facility or Organization
Unit
Event Time & Zone
Event Date
Power/Mode (At Time of Event)
EVENT CLASSIFICATION
GENERAL EMERGENCY
Name of Caller/Title
Power/Mode (At Time of Notification)
1-HR. NON-EMERGENCY 10 CFR 50.72(b)(1)
(v)(A)
Safe S/D Capability
AINA
ADEV
(v)(B)
RHR Capability
AINB
SIT/AAEC 4-HR. NON-EMERGENCY 10 CFR 50.72(b)(2)
(v)(C)
Control of Rad Release
AINC
AIND
GEN/AAEC
SITE AREA EMERGENCY
Call Back #
TS Deviation
ALERT
ALE/AAEC
(i)
TS Required S/D
ASHU
(v)(D)
Accident Mitigation
UNUSUAL EVENT
UNU/AAEC
(iv)(A) ECCS Discharge to RCS
ACCS
(xii)
Offsite Medical
AMED
(iv)(B) RPS Actuation (scram)
ARPS
(xiii)
Loss Comm/Asmt/Response
ACOM
(xi)
APRE
60-DAY OPTIONAL 10 CFR 50.73(a)(1)
50.72 NON-EMERGENCY
(see next columns)
PHYSICAL SECURITY
Offsite Notification
B???? 8-HR. NON-EMERGENCY 10 CFR 50.72(b)(3)
MATERIAL/EXPOSURE
FITNESS FOR DUTY
OTHER UNSPECIFIED REQMT.
Invalid Specified System Actuation
AINV
OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)
HFIT
(ii)(A)
Degraded Condition
ADEG
(see last column)
(ii)(B)
Unanalyzed Condition
AUNA
NONR
AESF
NONR
INFORMATION ONLY
(iv)(A) Specified System Actuation
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)
NOTIFICATIONS
NRC RESIDENT
STATE(s)
LOCAL
YES
NO
WILL
BE
Anything Unusual or not understood?
Yes (Explain above)
No
Did all systems function as required?
Yes
No (Explain above)
OTHER GOV AGENCIES
Mode of operations until corrected (if applicable)
MEDIA/PRESS RELEASE
Additional Information continued on next page?
NRC FORM 361 (07-13-2022)
Yes
No
Continued on next page
Page
NRC FORM 361
(07-13-2022)
of
U.S. NUCLEAR REGULATORY COMMISSION
OPERATIONS CENTER
REACTOR PLANT EVENT NOTIFICATION WORKSHEET (Continued)
EN #
RADIOLOGICAL RELEASES: CHECK OR FILL IN APPLICABLE ITEMS (specific details/explanations should be covered in event description)
Liquid Release
Gaseous Release
Unplanned Release
Planned Release
Ongoing
Terminated
Monitored
Unmonitored
Offsite Release
T.S. Exceeded
RM Alarms
Areas Evacuated
Personnel Exposed or Contaminated
Offsite Protection Actions Recommended
Release Rate (Ci/sec)
% T.S. Limit
HOO Guide
*State release path in description
Total Activity (Ci)
% T.S. Limit
HOO Guide
Noble Gas
0.1 Ci/sec
1000 Ci
Iodine
10 μCi/sec
0.01 Ci
Particulate
1 μCi/sec
1 mCi
Liquid (excluding
tritium and dissolved
noble gas)
10 μCi/min
0.1 Ci
Liquid (tritium)
0.2 Ci/min
5 Ci
TOTAL
Plant Stack
Condenser/Air Ejector
Main Steam Line
SG Blowdown
Other
RAD Monitor
Readings
Alarm Setpoints
% T.S. Limit (If
applicable)
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., SG #, valve, pipe, etc.)
Leak Rate
Units: gpm/gpd
Leak Start Date
Time
T. S. Limits
Coolant Activity
and Units:
Sudden or Long-Term Development
Primary
Secondary
List of Safety Related Equipment not Operational
Event Description (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continued from Page 1)
NRC FORM 361 (07-13-2022)
File Type | application/pdf |
File Modified | 2022-09-07 |
File Created | 2022-07-12 |