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NRC FORM 361N
(07-13-2022)
U.S. NUCLEAR REGULATORY COMMISSION
OPERATIONS CENTER
NON-POWER REACTOR (NPR)
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
Name of Caller
Call Back #
Event Time & Zone
Event Date
Power/Mode Before
Power/Mode After
Reactor Type
Max Power
Max Pulse
Pulse Inserted During Event?
EVENT CLASSIFICATIONS
GENERAL EMERGENCY
REPORTABLE CONDITION (Varies by facility TS)
GEN/AAEC
SITE AREA EMERGENCY
SIT/AAEC
TS Deviation
ADEV
Accident Mitigation
AIND
TS Required S/D
ASHU
Offsite Medical
AMED
ACOM
ALERT
ALE/AAEC
RPS Actuation (scram)
ARPS
Loss Comm/Asmt/Response
UNUSUAL EVENT
UNU/AAEC
Offsite Notification
APRE
Invalid Specified System Actuation
PHYSICAL SECURITY
Degraded Condition
ADEG
SUSPICIOUS ACTIVITY
MATERIAL/EXPOSURE
Unanalyzed Condition
AUNA
SECURITY EVENT
Specified System Actuation
AESF
Safe S/D Capability
AINA
NONR
Control of Rad Release
AINC
NONR
INFORMATION ONLY
NNF
OTHER UNSPECIFIED REQMT.
(see last column)
AINV
OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)
Description (Include: System affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continue on Page 2)
NOTIFICATIONS
YES
NO
WILL
BE
Anything Unusual or not understood?
Yes (Explain above)
No
Did all systems function as required?
Yes
No (Explain above)
HQ NPR STAFF
STATE(s)
LOCAL
Mode of operation until corrected (if applicable)
OTHER GOV AGENCIES
Estimate for restart date:
MEDIA/PRESS RELEASE
Additional Information continued on next page?
NRC FORM 361N (07-13-2022)
Yes
No
Continued on next page
Page
NRC FORM 361N
(07-13-2022)
of
U.S. NUCLEAR REGULATORY COMMISSION
OPERATIONS CENTER
NON-POWER REACTOR (NPR)
EVENT NOTIFICATION WORKSHEET (Continued)
EN #
RADIOLOGICAL / CHEMICAL 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
Release Rate (Ci/sec)
Offsite Protection Actions Recommended
% 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 ACTIVITY
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 361N (07-13-2022)
File Type | application/pdf |
File Modified | 2022-09-08 |
File Created | 2022-07-12 |