Operations Branch Assignment Check Sheet: (Includes ES-201-1 & ES-501-1 Rev. 8 information)

as of: 4/4/00

Chief: M MURPHY

Facility/Task: RB EX

Task Start Date: 10/30/00

ITEM DESCRIPTION DUE DATE INIT DATE

0 Exam/Inspection Schedule Agreement (C.1 .a;C.2.a&b) May 3, 2000 JLP 4/4/2000

1 NRC Staff & Fac. Contact Assigned (C. l.c;C.2.e) May 3, 2000 JLP 4/4/2000

2 Facility contact briefed on security & other issues (C.2.c) May 3, 2000 JLP 4/4/2000

3 Corp. Notification Letter Sent (C.2.d) (Exams only) May 3, 2000

3a Inspection Announcement Letter Sent (PIR & LORT if req'd) Sep 15, 2000 / '.4-

4 Task Expectations, Issues, & Standards Discussed w/ BC Aug 1, 2000

5# [Reference Material Due (C.1.d;C.3.c)] Jul 2, 2000 111 4r

6' Integrated Exam Outlines Due (C.l.d&e;C.3.d) Jul 2, 2000 .,/L ?/3/,

7# Outlines reviewed by NRC & Feedback Sent (c.2.h;C.3.e) Jul 16, 2000 •4•/ /

8' Preliminary Applications Due (C. 1.j;C.2.g;ES202) Sep 30, 2000

9# Draft Exams w/ Doc./Ref. Due (C. 1.d/e/f;C.3.d) Aug 31, 2000 , 7!j/.

10' Peer Reviewer Initials As Reviewed All Parts* Sep 10, 2000 C1112-O0

11' NRC Supervisor. Initials Approving for Fac. Rev. (C.2.h;C.3.f)* Sep 10, 2000

12# Exams Reviewed w/ Fac. (C.l.h;C.2.f&h;C.3.g) Sep 10, 2000 L Iv_•"• 13# Final Appl. Due & Assign. Sheet Prepared (C.1.j;C.2.h;ES202) Oct 16, 2000 rvo

14# NRC Supervisor Approved Final Exams (C.2.i;C.3.h)* Oct 23, 2000 IoI2S-o,

15" Final Appl. Rec'd & Waivers Sent (C.2.g) Oct 23, 2000 -7'/

164 Proctor Rules Reviewed w/ Fac. & Written Authorized (C.3.k) Oct 23, 2000

17 Examw-•sp Material to Team (C.3.i) Oct 23, 2000 / fJ.

18# Fac. graded exam & Comments Rec'd Nov 11, 2000 •

19# NRC Written Grading Completed Nov 14, 2000 / ,

20" Examiners Finished Grading Op. Tests Nov 14, 2000 /

21# NRC Ch. Ex. Review Completed Nov 24, 2000 117' )

22 NRC BC Review Completed* Nov25, 2000 7d ii 6

23# RPS/IP # Examinees Updated Before Report Issued Nov 30, 2000 PA 3, /•

24 License/Denials Signed & Report Issued Nov 30, 2000 ! /,_i •

25 Package Closed Out Dec 21, 2000 Aq -/

Final Inspection Report Issued, Exam Package to OLA, Facility. Contact Notified of Results

# Not required for inspections, except as noted. * Note Supervisor/Peer initials required.

[]Required NRC-auth. exams only. When complete, for exams, add to pkg & fwd copy to BC, for insp, fwd orig'I to BC. Last revised 4/4/00. S:\DRS\OB\Boilerplate\MISC-BOX\assignment-sheet.wpd

07/06/00 16:25

ES-201 Examination Outline Form ES-201-2 Quality Che.cklist

Facif ~ t~6 ~A-t • -7 "-'Date of Examination: 4;/, -. A

Item Task Description Initials

a b* c

1. a. Verify tlhat the outline(s) fit(s) the apprnprinle ntndfil per rS.401.At R b. Assess whether the outline was systematically prepared and whether all knowledge and ability

ctadgo**: are appropriately sampled. 0

T . Assess-Whether the outline over-emphasizes, any systems, evolutions, or generic topics. T N d. Assess whether the repetition from previous examination outlines in excessive.

Z. a. Using Form ES-301.5, verify that the proposed scenario sets cover the required number of e normal evo!l ,J Instrument and component failures, and major transients.

I b. Assess whether there are enough scenario sets (and spares) to test the projected number and

M mix of applicants in accordance with the expected crew composition and rotation schedule without d t/ compromising exam Integrity; ensure each applicant can be tested using at least one new or significantly modified scenario, that no scenarios are duplicated from the applicants' audit test(s)', and scenarios will not be repeated over successive days.

c. To the extent possible, assess whether the outline(s) cunform(s) with the qualitative and quantitative criteria specified on rorm ES.301.4 and described In Appndix 0.

3. a. Verify that. (1) the outline(s) cuntaln(s) the required number of control room and in-plant tasks,

W (2) no more than 30% of the test material is repeated from the last NRC examination, 1 (3)' no tasks are dupFlcated from the applicants" audit test(s), and T (4) no more than 80% of any operating test Is taken directly from the licensee's exam banks.

b. Verify that.(1) the tasks are distributed among the sarety function groupings as specified in ES-301, (2) one task Is conducted In a low-power or shutdown condition, 0,PWWAJT' (3) 40% of the tasks require the applicant to Implement an alternate path procedit$, (4) one In-plant task tests the applicant's response to an emergency or abnormal condition, and (5) the in-plant aIlk-throuag remquires the applicam to enter the RCA,

c. Verify that the required administrative topics are covered, with emphasis on performance-based

0, Detemi•ne If there are enough different outlines to test the projected number and mix of applicants and ensure that no items are dupllcated on sucessve days..

4, a. Assess whether plant-specifc priorities (Including PRA and IPE Insights) are covered in the appmprmdate exam section.

E b. Assess whether me '10 CFR 55.41143 and 55.45 sampoiin is apropilate. m -u

cE . Ensure that IA Importance ratings (ecept for plant.specifc eprlorltles) are at least z.5.

A d. Check for duplication and overap_ among exam sectlons. L

9. Chck the entire exam for balanc•• of coverage,

___ I. Assess whether the exam fits the appropriate Job level CRCor SRO),

a. Author b. Facility Revwer() C, i.77-. c. Chief rxnmbier All. E, Y ,7.44y 0d. NRC Supervisor .

(') Nut atluable go; NRC-devaloied examilntiurm. 4 2. *14. P•gn" 6 lil

NUREG-1021, Revision a

RIUJERBEND 002

23 of 24

07/06/00 16:25 R I ERBEND,

Mikc Murllhy Fax: (917) 860-8212

From: Mike Caiircll Date; 07106/00

Re: QA Checklist Pages: 2

CC:

21 Urgnt 03 For Review 11 Please Comment 0 Pleave Reply C3 Please Recycle

'liAthed is the revised QA checklist with the discrepancy on the 2 alternate path

JPMs noted, M::.,Mike Cantrell

............ .......

To:

001

ENTEROY OPERATIONS, INC, 5495 us tlwy 61 P.O. Box 220 St, Frnosisville, LA 70775 TOl: (225) 37K-•522 I'x: (225) 378-3372

... .• .• • '" . . ii .':,. •5': '*; , •' 't . ,:. • :li ,

. . . . . . . . . . * . . . . . . . . . . . .

...... .. ...........

V1 a'CS I NM I .. :

_____09/25/00 163 Rif,

SEP-25-WOCmfS1:47 DRS fMIL ROWMý

r--3:401 Wrifttn E~aMination Formh ES. 401-7 ____ ___Qualgy 2!!icklist

II

1. Questions gd answersu nitaIN accrato ad aob t af

a- the KAs~l refamn e fws yte tia# i an admydaeoe;o

tY'e~pco licns exm asp*$tw

e IaUto ReIewet

4. fR hrfEumw'

N~e thei aucilty examwas systeaticllure rsntapp Olcabl Ve f or N e.deiel Or flhtn;tw n~sdn

NRCf revbwalls e rque 6.fe;t"ttee s dpl~al o tiejie sq2a swcla ksiuct o e*(SetOn E..N fRCIes14?5

NUREG- 1021, Revision 8 404 ue20Jutle 200042of46

ES-401 Written Examination Form ES-401-7 Quality Checklist

Facilit )G ^ 6eJJb ýý*zTh-- J Date of Exam: 0/ 3' L Exam Level: R SRO

Initial

Item Description a b* ct

1. Questions and answers technically accurate and applicable to facility

2. a. N RC K/As referenced for aN qu~ics b. Faci lear objtives re a aA_ I

3. ROISRO overlap is no more than percernf., .luestions are appropriate Section D.2.d of ES-401 •X• ..

pi Mr I ic, iexamd ý #ah e'.I j ... i e

that applies) and appears appropriate: __the audit exam was systematically and randomly developed; or_ ,

teaudit exam was completed before the license exam wa~s started; or , / V,--the licensee certifies that there isA4 duplication; or :

__the license exam was prepared th• NR.•. ,•

5. Bank use meets limits (no more t• , • daI• ifed New

percent from the bank, at least 1 perce -. and the rest modified); enter the actual q.estio.n j fL P7

distribution at right 55 - '1 q.3 6. Between 50 and 6,., ent of the questions on Memoly C/A

the exam (including _ new question are written at the com~p nn enter the actual qun&, d n ri

7. Referencesihand• • •• , I. . .• / ... " :

8. Question content conforms with specific K/A statements in the dis•triu 'n eets . previously approved examination outline; deviations are justified I"

9. Question psychometric quality aýormat~neet ES, Appendix B, guidellines .- .

10. The exam contains 100. one- poin ultip ctwe it is, " e total is correct and agrees with value on cover sheet (. I

_ Printed. Na~me JSignature , Date

a. Author 01J, a~ oý4T /lL• • t, -- • L- •-?.cm b. Facility Reviewelr(). AL•• " _ •'./=,•,"

c. NRC Chief Examiner(*) 12/VAN6"T2 EJ•. ý/M ,6 ..... .. -•

Note: The facifity reviewer's signature is not applicable for NRC- developed examinations; two independent NRC reviews are required. # See special instructions (Section E.2.c) for Items 1,-4- 5, and 68.

1 [, The ...... .............. ... N G re afe e ernne ns

NUREG-1021, Revision 8 42 of 45 June 2000

ES- 301 Operating Test Quality Checklist Form ES- 301-3

Facility: f2. JVeZ )30, & 0>-) Date of Examination:/ y13 ,Operatirg Test Number:

Initials 1. GENERAL CRITERIA

a b "

a. The operating test conforms with the previously approved outline; changes are consistent with sampling requirements (e.g., 10 CFR 55.45, operational importance, safety fumction distribution). _._

b. There is no day-to-day repetition beivwen this and odt operatiqrtests to be administered

during this examination.

c. The operating test shall not duplicate *ns from U aplar' audit test(s)(see Section D.l.a).

d. Overlap with the written examination and between operating test categories is within acceptable limits.. l:

e. It appears that the oR ting test wil differentiate betwen competent and less-than-competent applicants at th i~g~dlicense level.

'tWALK- TIWOJ(I(W*Rf Al~

a. Each JPM mnclii& the atoig a$ppab~

* initial conditions initiating cues references and tools, including associated procedures

* validated time limits (average time allovad for completion) and speleflc designation if deemed to be time critical by the facility ficenseespecific performance criteria that inclu. ...

detailed expected actions with =etct' ,tena ,d n tui• system response and otfhe exs '

statements describing importatb i o b# .r . bye•e applicant criteria for successful comp; of thd.&WOL' identification of critical steps and their associated performance standards restrictions on the sequence of steps, if applicable

b. The prescripted quepqs Category A are predominantly open reference and meet the criteria in Attachment !4' ES- 301.

c. Repetition from operati' tes urie.w the evn.s i g% hn acceptable limits (30%r the lk-n a e c promi tes et

d. At least 20 percent e4 P? n h t re o canr,..,tl e.

3. SIMULATOR (CATEGORY C) CRITERIA

a. The associated simulator operating ttujsceno sets) have been reviewd in accordance with 'AN

Form ES- 301-4 and a copy is atache

a.~~~~ ~~~ Auhr.. .. b. Facility Revlewer(*) 1A -- 4 1

c. NRC Chef Examiner () 74(4 L$WAT-9-, " ,

d. NRC Supervisor 1()

() The facility signature is not applicable for NRC-developed tests; two independent NRC reviews are re2%red.

NUREG-1021, Revision 8

AIk

June 2000 23 of 26

ES- 301 Operating Test Quality Checklist Form ES- 301-3

4)6~vZL~ ?,%e-1~~' d~t&~X (6AIt( 7'-2O ,'e/3/ch)

NUREG-1021, Revision 823 of 26June 2000

ES- 301 Simulator Scenario Quality Checklist Form ES. 301-4

Fac:illty /•t'e• IiC3Z/3(~Q- •]l:Jate of Exam: OO•:VScenarioNumbers l1 12 13 Oneraino Test No.:

Q(ALITATIVE ATTRIBUTES Initials

a b c

1. The initial conrrtions are realistic, in somer quipment and/or instrumentation may be out of

service, but it does not cue the operat 31 4t eM%" VM24.

2. The scenarios consist mostly of relate;ves. o 1 on

3. Each evert description consists of the point in the scenario when it is to be initiated the malfunction(s) that are entered to initiate the event the symptom•icues that will be visible to the crew the e " - or actions (by shift position) the e•iW termition oi. (if app . ..abl.... A

4. No more than d m non-mec. "stic0lu.'(e.•pi0br•) i og scer nwithout a cred nm2etda de as rseism e.tc

5. The events are valid with recqard to physics and tiermodywamics. .

6. SequencWng and timing of events is reasonable, and allows the examination team to obtainb scomplete evaluation results commensurate with the scenario obectives.

7. If time compression techniques are us. t . scenario•ar. so indicates. Operators- j5 / have sufficlert time to carry out expected aies •o i* tk constraints. Cues are7

iven.

8. The simulator modeling is not alterelF A %

9. The scenarios have been validated. Any open simulator performance deficiencies have been / . evaluated to ensure that fuidional fidelity is maintained while runninq the planned scenarios.

10. Every operator will be 4uated using at lostonenewor significý modified scenano. All other scenarios have ben a e c nc Sectioa4 o. ES ,,•"

11. All individual operator .. petq,& • ev~te fiaseied rln rrS-4-6 (submit the form alonq wt theL. s4 ...... .' So l

12. Each applicant will be significantly involved in the minimum number of transients and events /1._ specified on Form ES-301-5 (submit the form with the simulator scenarios).

13. The level of difficulty is appropriate ,2110rt ftensinq decisions for each crew position. -. _

TARGET QUANTITATIVE ATTRIBUTES (PER ENAI O; S E.,,MA* D.4.D) Actual Attributes -

1. Total malfunctions (5-8) L_,_,,____ . . . . ............... ..- /.•, 4 ®+,./ • •

2. MaWinctions after EOP entry (1-2) P/ 3. Abnonrmal events (2-4) C-I

4. Majortransients(1-2) IIII __

5. EOPs entered/requwinn, substantive actions (1 -2) ,3

6. EOP contirwencies requiring substantive actions (0-2) /3I 0 L a

7. Crticaltasks (2-3)

NUREG- 1021, Revision 8 24 of 26 June 2000

ES- 301 Simulator Scenario Quality Checklist Form ES-301-4

Facility: PI• v-- / ?" 7) Date of Exam: /0/h =.4 Scenario Numbers.., 51 Operatinq Test No.:

QUALTATIVE ATTRIBUTES Initials

a b c

1. The initial conditions are realistic, in thgsome kpment and/tor instrumentation may be o°t of service, but it does not cue the operatilf into. ••

2. th s enro consist mosrtly atons (by hiftposion 3. Each event descr ition consists of

the point in the scenario when it is to be initiated the malfuntion(s) that are entered to initiatheh evant s t.e tym ptoecues atrt will be mbatot crew sidasOr

h a v eo r a csion s (b y s h i t p o sctn r)a s C t e termimionaor Of app c. i oI

4. eo more than sr tMI f..chp iti w an ne sce.anos

0. The events are valid wt regarted u sing an toeneodrn a mics.---- sea.A

6. Sequrncenano hav e nts is reasonable, and alows the exaSiinatior team to obaincomplete evaluation results commensura" .with the scenario • ,.ys.

have suffiien time to carr out exect• • es:•" 16i cntrit. Cues are /'' qrven.' / 4

9. The scenarios have been validated. Any open simulator performance deficiencies have beents evaluated to ensure that functional Fidelity is maintained while ruontinq the planned scenarios. ,

se E fled on Form ES-301-5 sumit the form with the simulator scenarios. Al

13. The level of difficul t is ap te t rt n decisions for each crew 6ositionu

TARGET QUANIITATIVE ATTRIBUTES (PRENAR. E $E(-fftD.4.D) Actual Attributes

1. Total malfunctions -5-8• 17 1 2. M~affunctikon after EOP enr (1-2) * <" ""/> ./ Iv -'

3. Abora evnt (2-4) 4. Mao transients (1-2) 1 'J • /

5. EOPs erteredlrequring, substantive actions (1 -2) 1' 1 6. EOP continge~ncies reqluiringjsubstantive actions (0-2) O/01IL . J

7.$ Crtia taks(23

NUREG-1021, Revision 8 24 of 26 June 2000

16:59 RIUERBEND

ES- 301 Transient and Event Checklist Form ES.301.5

OPERATING TEST NO.:

Applicant Evolution Ivnum Scenario Number S•py pe e Num er 1 2 3 4

Reactivity 1 I I _____

_______ Major 1________

Reactivity 1

Mor rV, 1 I

SRO. It

A SROU IaQstrume t T.

Component -/

•i•"Major •

,I! d" 11' At

Maorma

SRO.U instrum~oent / 12,=_ 1

Instructions,

Author:

Chief Examine

(1) Enter the operj.1,ý,p t t kao FArm ES.D-1 event numbers for each evolu ion •' " " " (2) Reactivity manipulations may be conducted under normal or controlled

abnormal conditions (refer to Section D4.d) but must be significant per Section C.2.a of Appendix D.

(3) Whenever practictf, both instrument anid coitponent fnalfunctions sliould be included; only those that require verifiable actions that provide insiqht to tal ap#icant's corn otmce count torfard the minimum requirement.

r:

NUREG.10Z1, Revision 8

00602/06/01

June 2000 25 of2.6

16:57 RIVERBEND

Competencies Checklist

Competencies

Applicant #1 ROtSRO. 0 /R

Applicant #2 RO-IISRO-U

pplicant #3 ~ RO-I(SRO- U

SCENARIO SCENARIO SCENARIO

4 1 12 3 4 12 31

Understand and Interpret -

Annunciators and Alarms ____

Diagnose Events .,_7 (.

and Conditions - -

Understand Plant 0" -2 . , and System Respo se !! . ; , _ C

AI k

Comply With and ' - ,. Use Procedures (1) "

Operate Control Boards (2) V 1 Communicate and _ _

Interact With the Crew UR I_

Demonstrate Supervisory Ability (3) ,.

Comply With and lo . A A, 1114( Use' Tech. Specs. (3) L

Notes:

(1) Includes Technical Specificati .•ompJnce for an RO. (2) Optional for an SRO- U. "

(3) Only applicable to SROs.

Instructions:

Circle the applicant's license type and enter one or more event numbers that will allow the examiners to evaluate every applicable competency for e ry applicant.

Author: ~ ,~C~((Chief Examiner: -�. 2* -

NUREG.1021, Revision 8

LS- 301

4

1`14 h9,

00202/06/01

F6F ES. 301.6ES-301

26 of 26 June 2000

02/06/01 16:58

a a

Competencies Checklist -- Form ES.-3uht

Circle the applicant's license type and enter one or more event numbers that will allow the examiners to evaluate every applicable competency for every applicant.

Author: xomAo I Chief Examiner:-_____________

NUREG,1021, Revision 8

ES. 301

Instructions:

RIUERBEND 004

26 of 26 June 2000

02/06/01 16:59

ES- 301 Competencies Checklist F6?m ES-30i.6

A nt #1 Apgpiant #2 Applicant #3 R R'O-I __O RW / 0 LSRQ- U J 0 'RO l/SRQ U

Competencies SCENARIO SCENARIO .SCENARIO

243 4 1 2 3 4

Understand and Interpret Annunciators and Alarms 4''I __

Diagnose Events ' /..4 •and Conditions ._, _

Understand Plant I L and System Respse . . _!

Comply With and II' i;,•, 111 . Use Procedures (1) V ;

Operate Control Boards (2) .. _

Communicate and Interact With the Crew Al _ _

Demonstrate Supervisory (! Ability (3) ,..= .• ;..

Comply With and

Use Tech. Specs. (3) .i .. Notes:

X, A. 17-A

(1) Includes Technical Specificatio .. ompjJ•pnce for an RO, (2) Optional for an SRO, U. (3) Only applicable to SROs. of SuJ ,•.Dg],• .,.,,," ......... ,

Instructions: ,!Rk*0 lq. 0Circle the applicant's license type and enter one or more event numbers that will allow the examiners to evaluate every applicable cornetency for ever applicant.

Chief Examiner:-� K

NUREG-1021, Revision 8

005RJUERBEND

26-of 2>6 June 2000

12:49 RIUERBEND

ES. 301 Competencies Checklist Form ES. 301.6

Applicant#. .. Applicant #2 Applicant #3

RO/SRO. IE&aJ Q/SRO, ISRO-U dDýRO-I/SRO.U

Competencles SCENARIO __ SCENARIO _.SCENARIO

3 4 1 2 3 4 1 2 3 4

Understand and Interpret " 1 li Annunciators and Alarms

Diagnose Events -7 , and Conditions

Understand Plant ý and System Res ackse toI

Comply With and . . ,.L,

Use Procedures (1) /

Operate Control Boards (2)__

Communicate- and Interact With the Crew ___,___

Demonstrate Supervisory Ability (3)

Comply With and -$ i

Use Tech. Specs, (3)

Notes: J. ..

(1) Includes Technical SpecificatiQ pm nce for an RO.

(2) Optional for an SRO-U.

(3) Only applicable to SROs. T ~Instructions:

Circle the applicant's license type and enter one or more event numbers that will allow the

examiners to evaluate every applicable c mpetency for e ery applicant.

Author, =" .

Chief Examiner: '�A� �-

June 2000NUREG.1021, Revision 2

02/15/01 002

26 of 26

ES-403 Wrtten Examination Grading Form ES-403-1 Quality Checklist

Facility: P, v 459- ep-Ao fr,,,,, Date of Exam: Exam Leve' R1RO

Initials

Item Description a b c

1. Answer key changes and question deletions justified and documented tAU

2. Applicants' scores checked for addition errors (reviewers spot check > 25% of examinations) t ;A/1

3. Grading for all borderline cases (80% +/- 2%) reviewed in , detail ..

4. All other failing examinations checked to ensure that grades 0 are justified

5. Performance on missed questions checked for training deficiencies and wording problems; evaluate validity of questions missed by half or more of the applicants

Printed Name / Signature Date

a. Grader ___ H C)C

b. Facility Reviewer(*) C oy J'/- //1

c. NRC Chief Examiner(*) _ __ _

d. NRC Supervisor (*) U

(") The facility reviewers signature is not applicable for examinations graded by the NRC; two independent NRC reviews are required.

NUREG-1021, Revision 85 of 5

ES-403 V. Written Examination Grading Form ES-403-1 Quality Checklist

Facility: Z/, v £,- r1 2- 5p-F - Date of Exam: /I/z-7/1o Exam Level: RSRDO

Initials

Item Description a

1. Answer key changes and question deletions justified and documentedM

2. Applicants' scores checked for addition errors (reviewers spot check > 25% of examinations)

3. Grading for all borderline cases (80% +/- 2%) reviewed in detail

4. All other failing examinations checked to ensure that grades are justified

5. Performance on missed questions checked for training deficiencies and wording problems; evaluate validity of questions missed by half or more of the applicants

Printed Name I Signature Date

a. Grader M IK IO~yi CIOt~~~

b. Facility Reviewer(*) 72 ,4 V',2.k/

c. NRC Chief Examiner (*) / E. ,zr,-/.

d. NRC Supervisor (*) JLFa(4 1}•C

(*) The facility reviewer's signature is not applicable for examinations graded by the NRC; two independent NRC reviews are required.

NUREG-1021, Revision 85 of 5

09:35:28Operator Licensing Exam Schedule

From 10/01/2000 To 12/31/2000

Page 1 of 1

01/31/2001

Report 21

Region: 4

Exam Week Site/Docket NoJInsp Rpt #

10/02/2000 River Bend Station / 05000458 / 2000301

10/30/2000 River Bend Station / 05000458 / 2000301

1 .# Candidates

RO- lt6

SROU- ,3SROI- %3

S .e Exam Author Chief Examiner

Prep MURPHY, MICHAEL E.

Admin FFF MURPHY, MICHAEL E.

IExaminers Assigned

MURPHY, MICHAEL E.

LANTZ, RYAN E. MURPHY, MICHAEL E. STETKA, THOMAS F.

Sites: RBS Orgs:4620 Exam Author:ALL

Phase Code: 5 Operational

S.... 1•

ES-201 Exa'ainati--n Security Agreement Form ES-201-3

1. Pre-Examination

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) crf t k o, -,,w as of the date of my signature. 1 agree that 1 will not knowingly divulge any inftri.ation about these.examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to pz,,rticipate in any instuction, evaluation, or other training-related activities involving those applicants scheduled to be administered these [icensi,-g examinah-ons from this date unti completion of-exarnination administration.

I further understand that violation of the conditions of this agreement may result in cancellation of the exarrinations and/or an enrorcernent acton

against me or the facility licensee. I will immediately report to faciiity .anagemnent or the NRC chief exari ner any indication s or sug gesti ns that examination security may have been compromised.

2. Post-Examinaton

To the best of my knowledge, I did n 'ov/I. e 0 any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of From the date that I entered into this security agreement until the completion of examination administration, I did not participate in a ytraining-related activities involving those applicants who were administered these licensing examinations.

PRINTEO NAME JOB TITLE / RESPONSIBILITY SIGNATURE (1) DATE SIGGNATURE (2)

2. Ml . GWdQi1 00'Jc~ sc lulao¶ 3.07,o& Y_ A .

4. CAPb(-,a t, •A ) ,•PiL- cj.dT•c •

8. ,.DWZ•t.- C4ý.n- . ,,_ - -Lg .e , ,.. o

13. .F

14•

85 4/ / _- ,.,- q . c, n "- .,c

Cu1�io�L�>

NUREG-1021

m ul

DATE

CS)