Information Notice No. 91-08: Medical Examinations for Licensed Operators

                                UNITED STATES
                          WASHINGTON, D.C.  20555 

                              February 5, 1991 



All holders of operating licenses or construction permits for nuclear power, 
test and research reactors.


This information notice is intended to alert addressees to recent problems 
identified in the administration and documentation of medical examinations 
for licensed operators and operator license applicants.  It is expected that 
recipients will review the information for applicability to their facilities 
and consider actions, as appropriate, to avoid similar problems.  However, 
suggestions contained in this information notice do not constitute NRC 
requirements; therefore, no specific action or written response is required.

Description of Circumstances:

During recent inspections at the Palo Verde Nuclear Generating Station and 
the Trojan Nuclear Plant, the staff of the U.S. Nuclear Regulatory 
Commission (NRC) identified concerns regarding the administration and 
certification of medical examinations for licensed operators and operator 
license applicants.  The NRC staff reviewed the facility licensees' 
documentation and determined that the licensees' examining physicians had in 
several instances not performed some of the tests specified by American 
Nuclear Society Standard ANSI/ANS 3.4-1983 to meet the NRC's requirements 
for operator medical qualifications (e.g., standard urinalysis, 
electrocardiogram, depth perception, and stamina tests).  In other cases, 
operators were performing licensed duties with disqualifying medical 
conditions without the licensee having provided NRC notification as required 
by Section 55.25 of Title 10 of the Code of Federal Regulations (10 CFR).  
The inspections also indicated that some medical examinations were not 
performed within the required 2-year period resulting in some operators 
performing licensed duties without having a current medical examination.  
When those operators with incomplete or lapsed medical examinations were 
examined, several were determined to have medically disqualifying 

The inspection findings indicate that these facility licensees had provided 
insufficient management guidance or oversight to the examining physicians to 
ensure complete, accurate, and timely medical examinations.  Both facility 
licensees had attested on the Certificates of Medical Examination (Form 


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NRC-396) submitted with their applications for operator licenses that the 
guidance contained in ANSI/ANS 3.4-1983 was followed, when in fact it was 


10 CFR 55.21 requires each applicant for an operator license to have a 
medical examination by a physician as a precondition for licensing and every 
two years thereafter.  The physician must determine that the licensed 
operator or license applicant meets the requirements of 10 CFR 55.33(a)(1), 
such that the applicant's [licensed operator's] medical condition and 
general health will not adversely affect the performance of the assigned 
operator duties or cause operational errors endangering public health and 
safety.  The facility licensee must certify the license applicant's medical 
fitness by submitting Form NRC-396, "Certification of Medical Examination by 
Facility Licensee," in accordance with 10 CFR 55.31(a)(6) or 55.57(a)(6), 
for initial and 6-year license renewal applications, respectively.  

Form NRC-396 specifically identifies American Nuclear Society Standard 
ANSI/ANS 3.4-1983, "Medical Certification and Monitoring of Personnel 
Requiring Operator Licenses for Nuclear Power Plants," or 
ANSI/ANS-15.4-1977(N380), "Selection and Training of Personnel for Research 
Reactors," as the criterion to be used for the medical examination of 
individuals applying for initial or renewal licenses.  Regulatory Guide 
1.134, "Medical Evaluation of Licensed Personnel for Nuclear Power Plants," 
endorses ANSI/ANS 3.4-1983 as an acceptable method for determining that the 
medical condition and general health of nuclear operators will not cause 
operational errors and for determining whether an applicant or operator has 
an abnormal health condition that could result in disqualification.

If, during the term of a license, an operator's medical condition changes 
and no longer meets the standards set forth in ANSI/ANS 3.4-1983 or 
ANSI/ANS-15.4-1977(N380), as certified to the NRC with the individual's 
license application, then the facility licensee must notify the Commission 
pursuant to 10 CFR 55.25 within 30 days of learning of the diagnosis.  If 
the examining physician indicates that the condition can be accommodated as 
noted in Section 5.1 of ANSI/ANS 3.4-1983, then an authorized representative 
of the facility licensee may request a conditional license by submitting 
Form NRC-396 with the supporting medical evidence for NRC evaluation.  The 
facility licensee may return the operator to licensed duties before 
obtaining the NRC's permission, provided the examining physician, using the 
guidance in ANSI/ANS 3.4-1983 or ANSI/ANS-15.4-1977(N380), has recommended 
to the facility's management that the operator can return to duty.  This 
recommendation of medical qualification must be documented and retained for 
future NRC inspection.

The NRC's regulations do not require Form NRC-396, which invokes the medical 
examination criteria established in ANSI/ANS 3.4-1983 or 
ANSI/ANS-15.4-1977(N380), to document an operator's medical condition and 
general health during the second and fourth years after the initial or 
renewal license is issued.  However, the facility licensee must continue to 
conduct those biennial medical examinations in accordance with the ANSI 
Standard to detect any changes in the operator's medical condition.  The 
facility licensee is responsible, pursuant to 10 CFR 55.27, to document and 
maintain the results 

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of medical qualifications data, test results, and the medical history of 
each operator and senior operator for the current license period and to 
provide the documentation to the Commission upon request.

It is important to note that the deficiencies identified during NRC 
inspections and described herein may provide some insight into the adequacy 
of addressees' medical examination programs for licensed operators and 
license applicants.  The NRC is concerned that some facility programs may 
not be receiving sufficient management oversight to ensure that all license 
applicants and licensed operators are medically qualified to safely perform 
their assigned operator duties.  The NRC cautions facility licensees to 
ensure the completeness and accuracy of the medical examinations performed 
by their physicians prior to certifying the fitness of their license 
applicants to the NRC on Form 396.

This information notice requires no specific action or written response.  If 
you have any questions about the information in this notice, please contact 
one of the technical contacts listed below or the appropriate NRR project 

                              Charles E. Rossi, Director
                              Division of Operational Events Assessment
                              Office of Nuclear Reactor Regulation

Technical Contacts:  D. J. Lange, NRR   R. M. Gallo, NRR   L. F.  Miller, RV
                     (301) 492-3171     (301) 492-1031     (415) 943-3869

                     T. A. Peebles, RII G. C. Wright, RIII J. L. Pellet, RIV
                     (404) 331-5541     (708) 790-5695     (817) 680-8159

                     L. Bettenhausen, RI
                     (215) 337-5291

Attachment:  List of Recently Issued NRC Information Notices

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