ML20006D903

Forwards Revised NRC Forms 398 & 396 Re Personal Qualifications statement-licensee & Certification of Medical Exam by Facility Licensee,Respectively.Applications for Licenses Should Be Submitted on Revised Forms by 900201

ML20006D903
Person / Time
Site:	Millstone, Haddam Neck, 05000000
Issue date:	01/05/1990
From:	Gallo R NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I)
To:	Mroczka E NORTHEAST NUCLEAR ENERGY CO.
References
NUDOCS 9002150230
Download: ML20006D903 (9)

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' ' low 5 1990 y:

Docket Nos. 50-213 50-245 t

50-336 50-423 0-)o' l Northeast Nuclear-Energy Company

' ATTN: Mr. E. J.' Mroczka Senior Vice President - Nuclear Engineering and 0perations P. O. Box-270 Hart. ford,= Connecticut - 06141-0270 Gentlemen:

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SUBJECT:

REVISED NRC' FORMS 396 AND 398 Enclosed is,a copy of.the revised NRC Form-398'(Enclosure 1), Personal

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LQualifications Statement - Licensee and revised NRC Form-396.(Enclosure 2),

Certification'of-Medical Examination By Facility-Licensee.

F All changes to the NRC Form-396 are detailed:in Enclosuret3, Changes to NRC Form-398 are detailed in Enclosure 4.

Alicapplications-for licenses are to be submitted on these. revised forms no D1ater,than February 1,'1990.

iThe enclosed applications are for your use. Additional copies can be obtained by conta' ting Beverly-Martin, U.S'. ; Nuclear Regulatory Commission, by telephone c

(301)' 492-8138: or_ by writing to her, U.S. Nuclear Regulatory Commission,-

,Information and Records' Management Branch, Mail Stop NMBB 7714,; Washington, LD.C. :20555.

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If youshave any questions regarding these forms, please contact Richard J.

Conte at;(P.15) 337-5120 or Peter W. Eselgroth'at (215) 337-5211.

.- g Sincerely, a-Originni Signed Mt' 2

Robert M. Gallo, Chief Operations Branch Division of Reactor Safety e$

Enclosures:

As stated g

'4 0FFICIAL RECORD COPY 396 & 398 FORMS - 0001.0.0 12/14/89 l9002150230 900:05

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ADOCK0500g3 DR.

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.91x Northeast Nuclear Energy Company 2

cc w/o enc 1:

W. D. Romberg, Vice President, Nuclear Operations S. E. Scace, Station Superintendent D. O. Nordquist, Director of Quality Services R. M. Kacich, Manager, Generation Facilities Licensing D. B. Miller,- Station Superintendent, Haddam Neck l

Gerald Garfield, Esquire R. Lueneberg, Supervisor, Operator Training (w/ enclosures)

R. Statts, Training Manager (Millstone 3) (w/ enclosures)

R. Heidecker, Supervisor, Operator Training (H.N.) (w/ enclosures)

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NRC Resident Inspector (H.N.)

NRC Resident Inspectors Millstono 1, 2, 3 Public Document Room (PDR)

Local Public Document Room (LPDR)

Nuclear: Safety Information Center (NSIC)

NRC Resident Inspector l

State of Connecticut bec w/o enc 1:

Region I Docket Room (with concurrences)

Management Assistant, DRMA (w/o enc 1)

DRP Section-Chief j

W. Raymond, SRI,= Millstone M. Boyle, LPM, NRR J. Shedlosky, SRI, Haddam Neck OL Facility File i

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1 0FFICIAL RECORD COPY 396 & 398 FORMS - 0002.0.0 12/14/89

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943:

INSTiUCTIONS FOR COMPLETING NRC FORM 300 PE RSONAL OUALIFICATION CTATEYENT-LICENSEE TO REMAIN VAllD,THIS FORM MUST NOT BE ALTERED n

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TYPE CF APPLICATION 2.s HEW "X" IF YOU ARE A HEW APPLICANT. COMPLETE LACH CATEGOMY OF THE FORM COMPLETELY, FOLLOWING THE INSTRUCTIONS BELOW. THIS IS TO INCLUDE ALL EDUCATION, TRAINING AND EXPERIENCE THAT YOU HAVE RECEIVED UP TO THE DATE OF THIS APPLICATJON. NOTE: SEE / TEM F4 - THERE IS AN EXCEPTION. ALSO, THIS BLOCK IS TO BE MARKED IF PREVIOUS NEW APPLICATION WAS WITHDRAWN. PLEASE WRITE " WITHDREW" NEXT TO "NEW,"

2.b thru 2.e-FOR 2.b THRU 2.e, COMPLETE EACH CATEGORY COMPLETELY, BUT INDICATE ONLY THE EDUCATION, TRAINING, AND EXPERIENCE YOU HAVE RECEIVED SINCE YOUR LAST APPLICATION, NOTE: SEE ITEM 74 - THERE IS AN E XCEPTION.

2.b RENEWAL

'X"(F YOU ARE RENEWING CURRENT LICENSE.

2.c UPGRADE "X"lF YOU HOLD A RO LICENSE AND ARE NOW APPLYlNG TO UPGR ADE YOUA LICENSE TO A SRO.

2.d MULTI. UNIT "X" IF YOU CURRENTLY HOLD A LICENSE AT YOUR FACILITY AND ARE APPLYING TO AMEND YOUR CUR.

RENT LICENSE TO ADD AN ADDITIONAL UNIT.

2.e RE APPLICATION "X"IF YOU HAVE PREVIOUSLY BEEN DENIED A LICENSE AND ARE REAPPLYING, 2.f WAIVER REQUESTED "X" THE APPLICABLE WAIVER REQUESTED AND JUSTIFY IN COMMENTS SECTION (ITEM 17),

2.g DATE PASSED GENERIC FUNDAMENTALS EXAMINATION SECTION (GFES).

THIS IS NOT APPLICABLE TO RESEARCH REACTORS. ENTER THE MONTH AND YEAR THE GENERIC FUNDAMENTALS EXAMINA.

TION SECTION OF THE WRITTEN EXAMINATION WAS PASSED. IF THE GFESWAS NOT TAKEN, YOU MUST HAVE PASSED AN NRC LICENSING EXAMINATION ON THE APPLICABLE REACTOR TYPE (PWR OR BWR) AFTER FEBRUARY 1,1982,WHICH LED TO THE ISFUANCE OF A LICENSE. THl$ DOES NOT INCLUDE INSTRUCTOR CERTIFICATION EXAMINATIONS OR REQUALIFICATION EXAMINATIONS.

~ 11.

EDUCATION - INDICATE BOTH ACADEMIC AND VOCATIONAL / TECHNICAL POST HIGH SCHOOL EDUCATION, FOR MAJOR AREA (S) OF STUDY, INDICATE THE NUMBER OF YEARS SPENT IN EACH COLLEGE CURRICULUM AND THE HIGHEST DEGREE RECEIVED, USING THE DEGREE CODE PROVIDED. FOR VOCATIONAL / TECHNICAL EDUCATION, INCLUDE PROGRAMS SUCH AS NUCLEAR POWER SCHOOL, MILITARY TRAINING, AIR CONDITIONING /PEFRIGERATION, DIESEL MECHANIC SCHOOL, ETC, INDICATE THE NUMBER OF MONTHS IN EACH PROGRAM AND WHETHER A CERTIFICATE OR DEGREE WAS AWARDED. IF ADDl-TIONAL SPACE IS NEEDED, CONTINUE UNDER COMMENTS (ITEM 17).

12.

TRAINING - INDICATE THE TRAINING YOU HAVE RECEIVED TO MEET THE REQUIREMENTS OF ANSI N18.1/ANS 3.1. THE.

DREAKDOWN OF TRAINING IN THIS CATEGORY PARALLELS THE ANS STANDARDS. REFER TO THE STANDARDS IF YOU NEED FURTHER CLARIFICATION. INCLUDE BOTH BEGINNING AND COMPLETION DATES AND THE TOTAL NUMBER OF WEEKS SPENT IN EACH TYPE OF TRAINING. THE NUMBER OF WEEKS IS PROVIDED,IN ADDITION TO BEGINNING AND COMPLETlON DATES, TO ACCOUNT FOR INTERMITTENT TRAINING (FOR EXAMPLE,4 WEEKS OF CLASSROOM TRAINING SPREAD OVER A 2. MONTH

' PERIOD). THEREFORE, THE DATE COLUMNS MAY INDICATE A LARGER TIME SPAN THAN THE ACTUAL NUMBER OF WEEKS SPENT IN FULL. TIME TRAINING. TIME IN TRAINING FOR THE LICENSE APPLIED FOR CANNOT BE DOUBLE COUNTED UNDER EXPERIENCE (ITEM 13).

ALL REQUALIFICATION TRAINING TIME IS TO BE ACCOUNTED FOR IN THE REOUAllFICATION ITEM, PLEASE DO NOT " DOUBLE

- LIST" THE T!ME SPENT IN REQUALIFICATION TRAINING UNDER ITEM 12.6, REC'JALIFICATION, EVEN THOUGH IT MAY INCLUDE CLASSROOM OR SIMULATOR TIME, 13.

EXPERIENCE - A MINIMUM OF 6 MONTHS AT THE SITE FOR WHICH THE LICENSE IS SOUGHT IS REQUIRED FOR EACH POSITION HELD, COMPLETE ITEM 16. DO NOT DOUBLE COUNT TIME. IF YOU HAD OVERLAPPING DUTIES,THE MONTHS SHOULD REFLECT THE PROPORTIONATE AMOUNT OF TIME YOU WERE ASSIGNED TO THOSE PARTICULAR DUTIES. IN NO CASE SHOULD THE NUMBER OF MONTHS REPORTED FOR A PARTICULAR TIME PERIOD EXCEED THE NUMBER OF MONTHS THAT ARE IN THAT TIME PERIOD, 14.

FACILITY OPERATOR TRAINING PROGRAM - INDICATE a. GRADUATE OF INPO ACCREDITED OPERATOR TRAINING PROGRAM; AND b. CERTIFIED (ON NRC FORM 474) OR NRC APPROVED SIMULATION FACILITY IS USED IN THE OPERATOR TRAINING PRO-GRAM. IF "YES" IS CHECKED IN BOTH ITEMS 14A AND 14.b, THEN ITEMS 11 (EDUCATION),12 (TRAINING),13 (EXPERIENCE),

AND 16 (EXPERIENCE DETAILS) DO NOT HAVE TO BE DOCUMENTED, NEW APPLICATIONS MUST STILL INCLUDE THE NUMBER OF SIGNIFICANT CONTROL MANIPULATIONS UNDER ITEM 12.3 NOTE: INPO ACCHEDITED MEANS ACCREDITATION BY THE NATIONAL NUCLEAR ACCREDITING BOARD AND MEANS THAT AT LEAST THE MINIMUM REQUIREMENTS OF REGULATORY

= GUIDE 1.8, REV. 2, ARE MET.

15.

. FOR RENEWALS ONLY - (1) ENTER THE APPROXIMATE NUMBER OF HOURS SINCE PREVIOUS RENEWAL OR ISSUANCE OF LICENSE IF FIRST RENEWAL. (2) ENTER DATE AND RESULT OF MOST RECENT NRC ADMINISTERED REQUAllFICATION EXAMI.

NATION, 16.

EXPERIENCE DETAILS - INCLUDE POSITION TITLE, TIME PERIOD-FROM/TO, FACILITY, AND A BRIEF DESCRIPTION OF DUTIES PERFORMED WHILE SERVING IN THAT POSITION, IF MORE SPACE IS NEEDED, USE COMMENTS (ITEM 17), OR IF NECESSARY, ATTACH ADDITIONAL INFORMATION.

.17.

COMMENTS - USE THIS SPACE TO INCLUDE ANY EXTRA INFORMATION OR CLARIFICATION FOR OTHER ITEMS ON THE APPLl-CATION FORM IF THE SPACE PROvlDED IS NOT SUFFICIENT, YOU MAY ATTACH EXTRA INFORMATION WITH YOUR APPLICA-TlON.

18.

NRC FORM 396, CERTIFICATION OF MEDICAL EXAMINATION BY F ACILITY LICENSEE - MUST ACCOMPANY THIS APPLICATION.

19.. SIGNATURES - SIGN AND DATE ITEM 10.a. OBTAIN YOUR TRAINING COORDINATOR'S SIGNATURE AND THAT OF YOUR SENIOR MANAGEMENT REPRESENTATIVE ON SITE.

DETACH THESE INSTRUCTIONS AND SUBMIT THE COMPLETED NRC FORMS 398 IORIGINAL AND TWO COPIES EACH) TO THE APPRO.

PRIATE REGIONAL ADMINISTRATOR.

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U.E6 NUCLEAa AtLULATO.'.Y COnesiassON t.PPROYE1SY OMA NO. 81640090 DATE LECElyED g gpggg, g,3gg (T7 80 0smebM8d hP NCCI

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? 4 CP.4 M.31,66.36, SSA7, peul M M ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH TH18 INFORMATION COLLE.CTION REOVEST2 2 0 HRS.

PORWARD COMMENTS REGARDING BURDEN ESTIMATE i

PERSONAL QUALIFICATION STATEMENT-LICENSEE TO THE INFORMATION AND RECORD 8 MANAGEMENT j

mRANCH IP.swt U.S. NUCLE A4 REoVLATDRY CoMMis.

SiON, WASHINGTON, DC 20b66. AND TO THE PAPERWORK REDUCTION PROJECT (316040001, OFFICE OF MANAGE.

TO REMAIN VAllO, THit FORM MU$t NOT BE ALTERED MENT AND BUDGET, W ASHINGTON, DC 20603.

1. APPLICANT *S FULL NAME Ilest, First, M,dclieJ AND ADORESS (mcludeI/P Codel

4. TYPE OF APPLICATION (@eck app /kable bones) fEQ

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6. TYPE OF LtCENSE APPLtED FOR

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12. TR AlN1NO (SINCE l AST APPLICA TION - SEE INSTRUCTIONS)

13. E KPERIENCE (D0 NO T COUBLE COUNT-SEE INSTRUCTIONSI e MON Y H A N D Y E A R e MONTHaNDYEAR

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FOSSIL SIMULATOR NAMES

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13. STAFF / SHIFT ENGINEER (t/ceamtl 7 -0THER f3esci&l 14 AUX./EQUlP. OPER ATOR INonskeaanti

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18 NRC FORM 386, CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE,IS ATTACH 3D -

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ANY F ALSE STATEMENT OR OMISSION IN THIS DOCUMENT. INCLUDING ATTACHMENTS. MAY BE SUBJECT TO CIVIL AND CRIMINAL SANCilONS.

Ste. I certify under panelly of portury that the triformation in thte Oocument and ettschmente is Inse end correct. I funhor certify that I haws notlesed mV Current en910Ver of: I1I eil prowlous engloyen;

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(2) eny instanse ephere I heue Deen tested by e Heefth and Human Servleen lHHS) Certtiled Drug Testing LahoreforY or e Licenest's testing fertWty for alcohol of a controlled eutetence, enal the test

- esauste eseguend the autoff inveis atennehad pursuant to 10 CF A Part 26. (3) any instance e=here I have been errested for the ease. vee er possesseen of e contreated Buterease elesertted in 10 CFR Port 26; and 441 any resenne tar rumouse or revoseteen of unescorted eeeens et a nuessert tecluty, a esso authDetae the NRC to submit the results el osamenetens to my emedeyers for use in propering retreenme psesseme. m nessusa#%

SeOfeATURE-APPLICAN1 DAlt i

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CHECK APPLICA8LE BOX

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] k I estify that the emove named ladshhmt has succenfun somodeted the betni,iceneses requirements to tw hcensed en en Operstor/5ensor Operator pursuant to Tale 10. Code of Federes v

.J Part 96;and that tfee Waffweshant has a need our en Operator / Senior Operator 84ense to perform his/her ensigned slutses and that the '

-ul be made stedshie for eneminetton. 4 elop sortify unster

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penalty of portury that the information in thee concument and ettechments h true and correct.

4 i & REf6WAL ONLY = 6 certify that the eDoge named ledlwtdual meets the enerowed fequellfatetton progrom (w/FA escoprJons notedin frern f 7/ at feQuired by section 60.64 (6 41 et to CFR 60, and that he/she has descherged his/her incereesd responalbllntet turnpetently and estely. I eles certify unster pensity of perjury that the Inforrnetton in this document eruf ettechments ?

Is true end correct.

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TR AINING COORDINATOR SENIOR MANAGEMENT REPHESENTATIVE ON StTE PR188TIO OR TYPED NAME PRINTED OR TYPED NAME

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slGNATURE lDATE SIONATURE DATE

- FOR NRC USE WAlVE R (Check or (bmpete horns. es applicebel l MEET 8 P EQUIREMENTS l l DOES NOT MEET REQUIREMENTS (hpJain bemw/

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H& ADQu AR TE RS R E G ION HE AD0LlanTf nt nfG'ON CRITTEN

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MEDICAL 7 SIGNATURG-REVikVIER DATE OTHER:

NRC FORGA 305 41000}.

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BY FACIUTY LICENSEE o He, A atoucteue Paoarc7 assoco2ai. ossect op MANAos.

ME NT AND 9Uof q t,vt ASHINGTON. 0C J0to)

WAME OF APPLICANT F ACILITY l F ACILITY DOCKET NUM8E R A. MEDICAL EXAMINATION CERTIFICATION THIS IS TO CE HilF Y THAT THE ABOVE NAMED APPLICANT FOR AN OPER ATOR! SENIOR OPE R ATOR LICENSE HAS BEEN E X AMINED BY A PHYSICIAN i AAMIN ATION DATE P;;iN T E D N AME (of phys #csant lSl ATE AND LICENSE NUVSEFt B ASED ON THE RESULTS OF THE EX AMIN ATION. INCLUDING INFORMATION FURNISHED 8y THE APPLICANT, THE PHYSICIAN HAS DE TERMINED THAT THE APPLICANT'S PHYSICAL CON 0lTION AND GENERAL HEALTH ARE NOT SUCH THAT IT MIGHT CAUSE OPERATIONAL E RRORS ENDANGERING PUBLIC HE AND SAF ETY. l CE RTIFY THAT IN RE ACHING THIS DETE RMINATION. THE GUIDANCE (X)NTAINED IN ANSI /ANS 3 41983,OR ANSI /ANS 15A19U (N3160) WAS FOLLOWED AND THAT DOCUMENT ATION 15 AVAILA8LE FOR REVIEW BY NRC ON THE BASIS OF THE RECOMMENDATION OF THE PHYSICIAN. I RECOMMEND THAT THE APPLICANT'S OFERATOR LICENSE BE CONDITIONED A FOLLOWS:

1. NO RESTRICTIONS

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2. CORRECTIVE LENSES BE WORN WHEN PERFORMING LICENSED DUTIES

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3. HEARING AfD BE WORN WHEN PE RFORMING LICENSED DUTIES 4 RE STRICTED I,1 CENSE OR E XCFPTION.Proute detads below ared attach oupportmg modical evulence for NRC review

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5. RESTRICTION CHANGE FROM PRE vlOUS SUBMITTAL. Provide detadt below tml attach supporting medical evittence for NRC review.

e ROPOSED WORDING OF RESTRICTION (8/urk J abovel RE LATIONSHIP OF R EST RICTION TO DISOUALIF YlNG CONDITION (Staefly imferere how restracten wdicorrect the esquetery,ng conistrenf REMARKS FOR RESTRICTION CHANGE (Seck 3 atiovel 1

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0. NONMEDICAL CERTif tCAllON i4AT THE APPLICANT HAS BEEN FOUND TO MEET THE SAF EGUARDS' AND FITNESS FOR DUTY M)WE R HE ACTORS.

THIS CER Tif IE S REOUIREMENT'5ti# THIS F ACILITY FOR LICENSED OPER ATORS NON POWER RE ACTORS.

THIS CERTIFIES ThMT THE APPLICANT HAS BEEN FOUND TO MEET THE SAFEGUAROS' REQUIREMENTS OF THIS F ACILITY FOR LICENSED OPf'IATORS. AND I HAVE NO KNOWLEDGE OF THE APPLICANT EXCEEDING THE CUTOFF LEVELS FOR ALCOHOL i

I OR CONTROLLED SUBSTANCES AS EST ABLISHED PURSUANT TO 10 CF R 7(i.

d.N V e AL$t St A tt ME N OH OMISSION IN f MIS DOCUMtNt. #NCLUOiNu AT f ACh.utNi3. MAv St tusJtC t tu Civik AND CHIMINAL baNClluNE i CtH tit v UNutH PkNAL t V Ot PEMJURV THA f IHE INe0HMATION IN THI$ DOCUMENT AND ATT ACHMENTS IS THUG AND CORRECT, lDATE PAINTED NAME AND SIGN ATURE (Sen,or Management nearewnrative on S,ref TIT LE 1

in accordance with 10 CF R 55.5. Commumcatens this form shall be submitted to the NRC as fol6ows. BY MAIL ADDRESSED TO.

Regional Admmistrator, Region l Regional Admimitrator, Region 11 Regional Admmntrator, Region lil U.S. Nuclear Repatory Comm mon U.S. Nuclear Regulatory Commmion U S. Nuclear Replatory Commessen 475 Allemsaae Road 101 Marietta Strut. Suite 310t) 799 Roowvelt Roal King of Prussia. PA 19406 Atlanta. GA 30373 Glen Ellyn, f L 6013/

Regional Admeantrator, Reton IV Regenal Admmistrator. Region V U.S. Nucler Regulatory Commission U S. Nuciear Regulatory Commimon 611 Ryan PfaJa Drive. Suite 1000 1450 Maria Lane, suite 210

' Arlmyton TX 16011 Watnut Cruk, CA 94596 PRiv ACY ACT ST AIEMENI Pursuant to 5 USC 55?aleH3), enacted mio law by wetion 3 of the Pinacy Act of ROUTINE USES The iriformaten may be dmiosed to an appiopriate Fmierai, State or 1974 (Public Law 93 579). the followmq statement is t rnnhet to mdividuait *ho local agency m the event the mtormation arvlicates a violation or cotential violation of le*

u supply mformation to the U.S Nuclear Regulatory Commnison on NRC Form 3% and m the event the mformaten ind cces a volaten or potatial violet on of law arvim This tidormation is mamtamed in a system of records deisgnated so NRC 16 and the tourte of an administretsve or sud>cial procealmq in aldition, tt:.iinformaten may be descritwd at 51 Faletal Register 33167 (September 18.19861 tr4nsferret to an appropriate Federal, State. and local arjency so the== tent relevant and AUTHORITY; Sections 10F and 16184 of the Atomic Energy Act of 1954, as necessary for en NRC tteemon atmvt you.

amemfaf H2 U S C 2131 ervj 270lb)).

WHETHE ft DISCLOSURE IS M Ah0 A TOR Y OR VO LUN T AR Y ANO E F F E CT ON INDIVIDUAL OF NOT PROV10tNG INFORMATION Dwetosure n wiuntary. If the PRINCIPAL PURPOSEtS); Informaten enterms on this form is uwd tu determine

'equested efurmat.on is not providuel, however. the appbcation for a facility oturator's whether the physical comfation anal general health of the apphr: ant are such that they will not cause operational eraors erulangermg puolic health and safety This mforma or te*Pr opera'er 8 l'cerms am Pe demed ten may be siet by the NRC statt to determme if the imlividual meets the require SYSTEM MANAGER (S) AND ADDRESS Chitit. Osserator iscensing Branch. 0+*#e of monts of 10 CF R 56 to taae an enemmaten or to be issual an operator's license Nuclear Reactor Regdat on U S Noctear Regulatory Commisvon, Wasnmgton. DC 2r)6%

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Han-Medical Certification Changed nonWia=1 oortification statament to: Power Anactors-This certifies that the applicant has been found to meet the safeguards' and i

fitness for duty reauirgments of this this facility for licensed operators.

L Honpouer-lhis certifies that.the applicant has been found to meet the

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l safasuards* requirwnents of.this facility for licensed operators and l

I have no kreuledge of the applicant w ing the cutoff levels ~for alcohol or controlled substances as' established pursuant to 10 CFR 26.

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t liNC14SURE 4 ~

t SUtttARY OF CHANGES '!O NBC P0HN 398 Item 4.d

- Added clarifying statement to indicate this is to be=

checked only if application is to amend license to add additional unit (s).

. Item 4.f Added "(Category)" to Operating.

Added "Nadiml".

Item ~4.g Added a new item "Date Passed Generic Fundamentals D

Examination Sectim".

'~ Item 12.3 Changed wortiins to " Certified Startup T.w.

Completed'.

for clarificatien.

E Item 12.5 Changed wortiing to " Extra Person & Shift In Ccatrol Room (13-week =4n4==)" for clarification.

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Item 12.Sa Added a new item " Time On Shift Above 205 Power (6-week minimum)",

i Item 14.a Added the words "That Is Based Upon A Systems Approach to Training" for clarification.

Item 15 Added "Date and Mesult of Host Booent NBC Administered pequalification Examination".

s Item 19.a

~ Added the wording "I further certify that I have notified my current employer of: (1) all previous employers: (2) any instance where I have been tested by a Health and Human Services (HHS) Certified Drug Testing Imboratory or a Licensee's testing facility for alechol or a controlled substance, and the test results av= adad the cutoff levels established pursuant to 10 CFR Part 26; (3) any instance where I have been arrested for the sale, use or. possession-L of a centrolled substance described in 10 CFR Part 26 and-(4) any reasons for removal or revocation of unescorted

- a at a nuclear facility".

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Item 19.b and-

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Item 19.c Noved'19.b and 19.c together. Applicable box aust now be checked. Also added block for typed name of Training Coordinator and Senior Management ?---;_nrative & Site.

POR NRC USE Under waiver category added " Medical".

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