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SSINS No. 6870 Accession No. 8011040260 IN 81-03 UNITED STATES NUCLEAR REGULATORY COMMISSION OFFICE OF INSPECTION AND ENFORCEMENT February 12, 1981 Information Notice No. 81-03: CHECKLIST FOR LICENSEES MAKING NOTIFICATIONS OF SIGNIFICANT EVENTS IN ACCORDANCE WITH 10 CFR 50.72 Description of Circumstances: Significant events reported to the NRC Operations Center receive prompt evaluation by NRC technical staff. To assure that adequate information is obtained for evaluation, in an expedient manner, checklists have been developed for the various types of events and are currently in use by the duty officers manning the NRC Operations Center. In an effort to communicate to licensees the most useful types of information needed depending on the event, a combined checklist has been developed and is attached to this information notice. We recognize that this list is not all inclusive, nor are all of its sections applicable to each event. Rather, it is an attempt to list certain key data elements that, based on past experience, appear to suffice for the vast majority of notifications. Having this type of information available at the time of notification, or shortly thereafter, will serve to expedite the notification and evaluation process and make it more efficient. It is not intended that licensees complete the checklist prior to, or as a condition of, making a notification. Instead, the list is intended to inform licensees of the types of information about events that have been useful to the NRC. We solicit your cooperation in obtaining any other information that may aid NRC in understanding the event and request that you volunteer such information where appropriate. Recommendation to Licensees: This information notice is provided for general information to licensees. Recipients should review the information for applicability to their facilities. No specific action or response is requested at this time. If you have any questions regarding this matter, please contact the Director of the appropriate NRC Regional Office. Attachments: 1. Checklist 2. Recently issued IE Information Notices . Attachment 1 IN 81-03 CHECKLIST FOR NOTIFICATION OF SIGNIFICANT EVENTS MADE IN ACCORDANCE WITH 10 CFR 50.72 A. Identification: Date Time Name of Person Making Report Licensee Facility Affected Applicable Part of 10 CFR 50.72 B. Description: Date of Event Time Description of What Happened C. Consequences of Event: (Complete depending on type of event) Injuries Fatalities Contamination (personnel) (property) Overexposures (known/possible) Safety Hazard (describe - actual/potential) Offsite Radiation Levels Integrated Dose Location Meterology (wind speed) From (direction) Weather Conditions (rain, clear, overcast, temperature) Equipment/Property Damage D. Cause of Event: E. Licensee Actions: Taken Planned . Emergency Plan Activated (Yes/No) Classification of Emergency
Resident Inspector Notified (Yes/No) State Notified (Yes/No) Press Release Planned (Yes/No) News Media Interest (Yes/No) F. Current Status: (Complete depending on type of event) 1. Reactor System Status Power Level Before Event After Event Pressure Temp. (thot) (tcold) RCS Flow (Yes/No) Pumps On (Yes/No) Heat Sink: Condenser Steam Atm. Dump Other Sample Taken (Yes/No) Activity Level ECCS Operating (Yes/No) ECCS Operable (Yes/No) ESF Actuation (Yes/No) PZR or RX Level Possible Fuel Damage (Yes/No) S/G Levels Feedwater Source/Flow Containment Pressure Safety Relief Valve Actuation (Yes/No) Containment Water Level Indication Equipment Failures Normal Offsite Power Available (Yes/No) Major Busses/Loads Lost Safeguards Busses Power Source D/G Running (Yes/No) Loaded (Yes/No) See Emergency Action Levels, Appendix 1, NUREG-0654, Revision 1, Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants. . 2. Radioactivity Release Liquid/Gas Location/Source Release Rate Duration Stopped (Yes/No) Release Monitored (Yes/No) Amount of Release Tech Spec. Limits Radiation Levels in Plant Areas Evacuated 3. Security/Safeguards Bomb Threat: Search Conducted (Yes/No) Search Results Site Evacuated (Yes/No) Intrusion: Insider Outsider Point of Intrusion Extent of Intrusion Apparent Purpose Strike/Demonstrations: Size of Group Purpose Sabotage: Radiological (Yes/No) Arson (Yes/No) Equipment/Property Extortion: Source (phone, letter, etc.) Location of Letter Demands General: Firearms involved (Yes/No) Violence (Yes/No) Control of Facility Compromised or Threatened (Yes/No) Stolen/Missing Material Agencies Notified (FBI, State Police, Local Police, etc.) Media Interest (present, anticipated) See 10 CFR 73.71(c), effective April 6, 1981.
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