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NRC 361S
ICR 202607-3150-002 · OMB 3150-0238 · Object 171080700.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | NRC 361S |
| Last Modified By | Designer 6.5 |
| File Modified | 2026-06-23 |
| File Created | 2026-06-15 |
| Conversion State | complete |
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Page NRC FORM 361S (MM-DD-YYYY) U.S. NUCLEAR REGULATORY COMMISSION OPERATIONS CENTER PART 53 PLANT EVENT NOTIFICATION WORKSHEET of EXPIRES: (MM/DD/YYYY) APPROVED BY OMB: NO. 3150-0238 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 FOIA, Library, and Information Collections Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by email to [email protected], and and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0238), Attn: Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503. 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. 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) Power/Mode (At Time of Notification) 1-HR. NON-EMERGENCY 10 CFR 53.1630(b)(1) EVENT CLASSIFICATION GENERAL EMERGENCY Call Back # Name of Caller/Title GEN/SAEC TS Deviation 60-DAY OPTIONAL 10 CFR 53.1640(a)(1) SDEV Invalid Specified System Actuation 4-HR. NON-EMERGENCY 10 CFR 53.1630(b)(2) SINV OTHER 10 CFR REPORTING REQUIREMENT SITE AREA EMERGENCY SIT/SAEC ALERT ALE/SAEC (i) TS Required S/D SSHU 10 CFR 20 RAD MATERIAL/EXPOSURE UNUSUAL EVENT UNU/SAEC (ii) RPS Actuation (scram) SRPS 10 CFR 21 DEFECT/NON-COMPLIANCE CCCC (iv) Rad Release within Plant SRAD 10 CFR 26 FITNESS FOR DUTY HFIT 53.1630 NON-EMERGENCY OTHER REQUIREMENT (see next column) (see last column) NNF INFORMATION ONLY 8-HR. NON-EMERGENCY 10 CFR 53.1630(b)(3) 10 CFR 73 SECURITY EVENT (i)(A) Degraded Condition SDEG (i)(B) Unanalyzed Condition SUNA NONR (v) Loss Comm/Asmt/Response SCOM NONR OTHER UNSPECIFIED REQUIREMENT (IDENTIFY) 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? Yes No Page NRC FORM 361S (MM-DD-YYYY) of U.S. NUCLEAR REGULATORY COMMISSION OPERATIONS CENTER PART 53 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)