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{{#Wiki_filter:2 *(t XceIEnergy-, MASTER SECURITY AGREEMENT The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment.  
{{#Wiki_filter:2 *(t XceIEnergy-, MASTER SECURITY AGREEMENT The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment.
: 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)
: 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)
I acknowledge that I have acquired specialized knowledge about the QJtI GP examination(s) scheduled for the date(s) of /-Q?8-13h  
I acknowledge that I have acquired specialized knowledge about the QJtI GP examination(s) scheduled for the date(s) of /-Q?8-13h  
Line 24: Line 24:
I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.
I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.
Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee.
Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee.
Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.  
Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.
: 2. Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the examinations administered during the date(s) of IIz'1h! -;;(./13 . From the date that I entered into this security agreement until the completion of examination administration,/1 did not i'nstruct, evaluate, or provide performance feedback to those individuals who were administered these examinations.
: 2. Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the examinations administered during the date(s) of IIz'1h! -;;(./13 . From the date that I entered into this security agreement until the completion of examination administration,/1 did not i'nstruct, evaluate, or provide performance feedback to those individuals who were administered these examinations.
PRINTED NAME JOB TITLE / RESPONSIBILITY TNOTE Z ZZf3  
PRINTED NAME JOB TITLE / RESPONSIBILITY TNOTE Z ZZf3  
Line 38: Line 38:
Life of Plant Retain in: Exam File QF-1071-A,V.
Life of Plant Retain in: Exam File QF-1071-A,V.
2 (FP-T-SAT-71)
2 (FP-T-SAT-71)
* P.Of2 LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary  
* P.Of2 LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary
: 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)
: 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)
I acknowledge hat I have acquired specialized knowledge about the J1'IN("l ZCH,3 \\,T examination scheduled for the date(s) of to 2. 'I (:s as of the date of my signature.
I acknowledge hat I have acquired specialized knowledge about the J1'IN("l ZCH,3 \\,T examination scheduled for the date(s) of to 2. 'I (:s as of the date of my signature.
Line 45: Line 45:
I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.
I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.
Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee.
Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee.
Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.  
Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.
: 2. Post-Examination To the best 9f I1lY knowle ge, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of 'll1(13 -.;) 13 . From the date that I entered into this security agreement until the completion of this examination . administration, I did not instruct, evaluate, or provide performance feedback to those individuals who were administered this examination.
: 2. Post-Examination To the best 9f I1lY knowle ge, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of 'll1(13 -.;) 13 . From the date that I entered into this security agreement until the completion of this examination . administration, I did not instruct, evaluate, or provide performance feedback to those individuals who were administered this examination.
Furthermore, I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination administration.
Furthermore, I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination administration.
Line 54: Line 54:
Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.   
Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.   
--------plof2 QF-1071-A,Vo 2 (FP-T-SAT-71) III XcelEnergrJ LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment.
--------plof2 QF-1071-A,Vo 2 (FP-T-SAT-71) III XcelEnergrJ LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment.
PRINTED NAME -) 7. 8. 9. tlER6 K  
PRINTED NAME -) 7. 8. 9. tlER6 K
: 10. [;.,'-<,-#O!fY\5JJt  
: 10. [;.,'-<,-#O!fY\5JJt
: 11. if.. -I h .e,' 5. <--"-< 12. 13. 14. '[):;..v i J A r-de/j{X/\  
: 11. if.. -I h .e,' 5. <--"-< 12. 13. 14. '[):;..v i J A r-de/j{X/\
: 15. NOTES: fo "5R-o . Sf4,) (C(J ,,"0 @ ;/r Ob 7.. DATE NOTE z/I'lioa...  
: 15. NOTES: fo "5R-o . Sf4,) (C(J ,,"0 @ ;/r Ob 7.. DATE NOTE z/I'lioa...  
?Ll1jJ) ::J4F43 cZb-13 2 1.co!8 ffb Retention:
?Ll1jJ) ::J4F43 cZb-13 2 1.co!8 ffb Retention:
Line 67: Line 67:
PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE -) 5. Z'b.wQ'cnc/  
PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE -) 5. Z'b.wQ'cnc/  
.N II} I 6. /["k" f2'2J.-eh.i.v  
.N II} I 6. /["k" f2'2J.-eh.i.v  
.2/f'o -. .  
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: 7. ((&#xa3;.;;c-f R.o  
: 7. ((&#xa3;.;;c-f R.o
: 8. *f?o t5j7/rL 9. b6Re.K GutoSS"'"'W Slfta. 5-rl;J 10. t;tv JtclPl5hJt ft; 11,  
: 8. *f?o t5j7/rL 9. b6Re.K GutoSS"'"'W Slfta. 5-rl;J 10. t;tv JtclPl5hJt ft; 11,  
'5'<-0 ;'--1-0_ . Sf-h 12.
'5'<-0 ;'--1-0_ . Sf-h 12.
Line 75: Line 75:
Life of plant Retain in: Exam tile. Fonn retained in accordance with record retention schedule identified in FP-G-RM-01.
Life of plant Retain in: Exam tile. Fonn retained in accordance with record retention schedule identified in FP-G-RM-01.
OF-1071 Rev. 2 (FP-T-SAT-71)
OF-1071 Rev. 2 (FP-T-SAT-71)
* 1.1012 I fl xCiI Energr I LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary  
* 1.1012 I fl xCiI Energr I LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary
: 1. Pre-Examination (Review FP-T -SAT -71, Attachment 1 for pre-job briefing requirements)
: 1. Pre-Examination (Review FP-T -SAT -71, Attachment 1 for pre-job briefing requirements)
I acknowledge tbat I have acquired specialized knowledge about the Millie 21)/3 J2r examination scheduled for the date(s) of -"t -1hzas of the date of my signature.
I acknowledge tbat I have acquired specialized knowledge about the Millie 21)/3 J2r examination scheduled for the date(s) of -"t -1hzas of the date of my signature.
Line 82: Line 82:
I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.
I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.
Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee.
Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee.
Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.  
Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.
: 2. Post-Examination To the best f y knowle ge, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of I l' I'J -z 13 . From the date that I entered into this security agreement until the completion of this examination administration, I did not Instruct, evaluate, or provide performance feedback to those individuals who were administered this examination.
: 2. Post-Examination To the best f y knowle ge, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of I l' I'J -z 13 . From the date that I entered into this security agreement until the completion of this examination administration, I did not Instruct, evaluate, or provide performance feedback to those individuals who were administered this examination.
Furthermore, I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination administration.
Furthermore, I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination administration.
Line 95: Line 95:
JOB TITLE I RESPONSIBILITY DATE NOTE f'D ;2.-7-/3 7. Ji<o /k/z.. -I J 8. SbO .. /O 9. .5rz 0 cJ/.d..!J
JOB TITLE I RESPONSIBILITY DATE NOTE f'D ;2.-7-/3 7. Ji<o /k/z.. -I J 8. SbO .. /O 9. .5rz 0 cJ/.d..!J
_ 10. .
_ 10. .
SilO .y,r/I''lj>  
SilO .y,r/I''lj>
: 11. 5'9.-. Jc;-d-f /?" k.. "=-12. M2 13.
: 11. 5'9.-. Jc;-d-f /?" k.. "=-12. M2 13.
100.) 2/7b3 14. [;kA-N Sk.>B.M ]: r C4. 15. t.@c,( t N.!.,I\.1oI(;10'l. 1l/2.'1Jlt zla6s NOTES: Retention:
100.) 2/7b3 14. [;kA-N Sk.>B.M ]: r C4. 15. t.@c,( t N.!.,I\.1oI(;10'l. 1l/2.'1Jlt zla6s NOTES: Retention:
Line 101: Line 101:
--QF-1071-lev.
--QF-1071-lev.
2 (FP-T-SAT-71)
2 (FP-T-SAT-71)
* P.Of2 III Xcel Energy I LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary  
* P.Of2 III Xcel Energy I LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary
: 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)
: 1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)
I acknowledge hat I have acquired specialized knowledge about the 2"/3111#1,1' ILl examination scheduled for the date(s) of /-Z -/ l) 2. I) as of the date of my signature.
I acknowledge hat I have acquired specialized knowledge about the 2"/3111#1,1' ILl examination scheduled for the date(s) of /-Z -/ l) 2. I) as of the date of my signature.
Line 108: Line 108:
I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.
I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.
Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee.
Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee.
Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.  
Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.
: 2. Post-Examination To the best of [y I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of 1/2'1 /3 -From the date that I entered into this security agreement until the completion of this examination cJ, 13. . administration:
: 2. Post-Examination To the best of [y I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of 1/2'1 /3 -From the date that I entered into this security agreement until the completion of this examination cJ, 13. . administration:
I did not instruct, evaluate, or provide performance feedback to those individuals who were administered this examination.
I did not instruct, evaluate, or provide performance feedback to those individuals who were administered this examination.
Line 116: Line 116:
Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.   
Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.   
------_012 QF-1071.1ev.
------_012 QF-1071.1ev.
2 (FP-T-SAT-71) I fl Xcf!IEOOrg, I LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary JOB TITLE I RESPONSIBILITY NOTE PRINTED1AM'7  
2 (FP-T-SAT-71) I fl Xcf!IEOOrg, I LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary JOB TITLE I RESPONSIBILITY NOTE PRINTED1AM'7
: 5.  
: 5.  
' f" t2 () 6. I!w 5RO 7.
' f" t2 () 6. I!w 5RO 7.
Line 124: Line 124:
1-(, / W) __ 11. ;#Cc/IItei.
1-(, / W) __ 11. ;#Cc/IItei.
S'tAq: _:$_0..;,...7
S'tAq: _:$_0..;,...7
______ Zi7icJ12. 13. 14. 15. NOTES: til."!z<JI.$ ,/));{MA( ..u.... 1>' :::::??r )JUI,z l-J r*t 1  
______ Zi7icJ12. 13. 14. 15. NOTES: til."!z<JI.$ ,/));{MA( ..u.... 1>' :::::??r )JUI,z l-J r*t 1
::;;.--Retention:
::;;.--Retention:
Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.}}
Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.}}

Revision as of 21:06, 28 April 2019

2013 Monticello Nuclear Generating Plant Initial License Examination: Examination Security Agreement (Form ES-201-3)
ML13086A324
Person / Time
Site: Monticello Xcel Energy icon.png
Issue date: 01/28/2013
From: McNeil D R
NRC/RGN-III/DRS/OLB
To:
Shared Package
ML11354A221 List:
References
Download: ML13086A324 (9)
v • d • e


Text

2 *(t XceIEnergy-, MASTER SECURITY AGREEMENT The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment.

1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)

I acknowledge that I have acquired specialized knowledge about the QJtI GP examination(s) scheduled for the date(s) of /-Q?8-13h

=ii/IS as of the date of my signature.

I agree that I will not knowing y any information about these examinations to any persons who haVe not been authorized by an Operations Training Supervisor.

I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration.

I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.

Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee.

Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.

2. Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the examinations administered during the date(s) of IIz'1h! -;;(./13 . From the date that I entered into this security agreement until the completion of examination administration,/1 did not i'nstruct, evaluate, or provide performance feedback to those individuals who were administered these examinations.

PRINTED NAME JOB TITLE / RESPONSIBILITY TNOTE Z ZZf3

@1. M FGs -S iN I JJ£{ UfrliS J.f&Wftt/)

.:J-l-/j 2.

O..:a: In.,j1'" / EAB.'.Z).

h2 V'l'i,oe.t::.

' F 3. /SP'ftlN OPs. /,v!'"r I VCW:>Lofc-"L zh/z-__4. :SOTe., / J_ _ _5.

A-dl}Un -&k 6. J-<vl'i rY\a.A-\l. \ \' I 6)

__ i 7. Retention:

Life of Plant Retain in: Exam File P,ttOf2* MASTER SECURITY AGREEMENT The Master Security Agreement is used for those personnel having both knowledge of Exam Sensitive Material and unrestricted access to Primary and Secondary Containment.

PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE 8. 9. 10; 11. 12. 13. 14. 15. NOTES: Retention:

Life of Plant Retain in: Exam File QF-1071-A,V.

2 (FP-T-SAT-71)

  • P.Of2 LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary
1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)

I acknowledge hat I have acquired specialized knowledge about the J1'IN("l ZCH,3 \\,T examination scheduled for the date(s) of to 2. 'I (:s as of the date of my signature.

I agree that I will not knowingly divulge any information about this examination to any persons who have not been authorized by an Operations Training Supervisor

.. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration.

I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.

Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee.

Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.

2. Post-Examination To the best 9f I1lY knowle ge, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of 'll1(13 -.;) 13 . From the date that I entered into this security agreement until the completion of this examination . administration, I did not instruct, evaluate, or provide performance feedback to those individuals who were administered this examination.

Furthermore, I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination administration.

I further understand that violation of the conditions of this agreement may result in cancellation of the examination and/or enforcement action against the facility licensee or me. PRINTED NAME JOB TITLE / RESPONSIBILITY DATE (2) DATE NOTE 1.

l&-kr L.t.J VWiZ tidJJ. 2. £POS ¥¥&Z;; / 3. (JJf/4111/( 5*G-.t;;1111.1 /tdTy >o.f:;/7vlV("-L

  • 4. PqtA\

5; Qt A 'NM1? q (r; ) .. -;. Retention: Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.

plof2 QF-1071-A,Vo 2 (FP-T-SAT-71) III XcelEnergrJ LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment.

PRINTED NAME -) 7. 8. 9. tlER6 K

10. [;.,'-<,-#O!fY\5JJt
11. if.. -I h .e,' 5. <--"-< 12. 13. 14. '[):;..v i J A r-de/j{X/\
15. NOTES: fo "5R-o . Sf4,) (C(J ,,"0 @ ;/r Ob 7.. DATE NOTE z/I'lioa...

?Ll1jJ) ::J4F43 cZb-13 2 1.co!8 ffb Retention: Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.

  • *
  • __ I QF-1071-02.

Rev. 2 (FP-T-SAT-71) Page 2 of2 III XcelEnefgy T ._. SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment. PRINTED NAME JOB TITLE I RESPONSIBILITY SIGNATURE (1) DATE SIGNATURE (2) DATE NOTE -) 5. Z'b.wQ'cnc/ .N II} I 6. /["k" f2'2J.-eh.i.v .2/f'o -. .

7. ((£.;;c-f R.o
8. *f?o t5j7/rL 9. b6Re.K GutoSS"'"'W Slfta. 5-rl;J 10. t;tv JtclPl5hJt ft; 11,

'5'<-0 ;'--1-0_ . Sf-h 12. I-4urle. 13. Peart.-e. 14. 'i);..vid 1-..0 r/15. 5tbc.z l/t.Gtwo Rt' NOTES: Retention: Life of plant Retain in: Exam tile. Fonn retained in accordance with record retention schedule identified in FP-G-RM-01. OF-1071 Rev. 2 (FP-T-SAT-71)

  • 1.1012 I fl xCiI Energr I LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary
1. Pre-Examination (Review FP-T -SAT -71, Attachment 1 for pre-job briefing requirements)

I acknowledge tbat I have acquired specialized knowledge about the Millie 21)/3 J2r examination scheduled for the date(s) of -"t -1hzas of the date of my signature. I agree that I will not knowingly divulge any information about this examination to any persons who have not een authorized by an Operations Training Supervisor .. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration. I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration. Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.

2. Post-Examination To the best f y knowle ge, I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of I l' I'J -z 13 . From the date that I entered into this security agreement until the completion of this examination administration, I did not Instruct, evaluate, or provide performance feedback to those individuals who were administered this examination.

Furthermore, I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination administration. I further understand that violation of the conditions of this agreement may result in cancellation of the examination and/or enforcement action against the facility licensee or me. PRINTED NAME JOB TITLE / RESPONSIBILITY DATE SIGNATURE...L2) DATE NOTE 1. /i'lcM/2i) SIZO I/l1;/z. 2. 6t:IZ l 2. *1'-*1,3 3. U ..-t:"t: 'SI<O lI./3*/z?9i:4. Zo A-.ri '*11013 Retention: Life of Retain in: Exam Form retained in accordance with record retention schedule identified in --QF-1071 Rev. 2 (FP-T-SAT-71) tl2of2LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted access to Primary and Secondary Containment. JOB TITLE I RESPONSIBILITY DATE NOTE f'D ;2.-7-/3 7. Ji<o /k/z.. -I J 8. SbO .. /O 9. .5rz 0 cJ/.d..!J _ 10. . SilO .y,r/Ilj>

11. 5'9.-. Jc;-d-f /?" k.. "=-12. M2 13.

100.) 2/7b3 14. [;kA-N Sk.>B.M ]: r C4. 15. t.@c,( t N.!.,I\.1oI(;10'l. 1l/2.'1Jlt zla6s NOTES: Retention: Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01. --QF-1071-lev. 2 (FP-T-SAT-71)

  • P.Of2 III Xcel Energy I LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary
1. Pre-Examination (Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)

I acknowledge hat I have acquired specialized knowledge about the 2"/3111#1,1' ILl examination scheduled for the date(s) of /-Z -/ l) 2. I) as of the date of my signature. I agree that I will not knowingly divulge any information about this examination to any persons who have not een authorized by an Operations Training Supervisor .. I understand that I am not to instruct or provide performance feedback to those individuals scheduled to be administered these examinations from this date until completion of examination administration. I also understand that I am not to evaluate individuals scheduled to be administered these examinations from this date until the date of administration. Acting as a simulator booth operator or communicator is acceptable if I do not select the training content or provide direct or indirect feedback to an examinee. Furthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will immediately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.

2. Post-Examination To the best of [y I did not divulge to any unauthorized persons any information concerning the examination administered during the date(s) of 1/2'1 /3 -From the date that I entered into this security agreement until the completion of this examination cJ, 13. . administration:

I did not instruct, evaluate, or provide performance feedback to those individuals who were administered this examination. Furthermore, I agree to NOT discuss any aspects associated with the contents of this examination with ANY examinee until the completion of their examination administration. I further understand that violation of the conditions of this agreement may result in cancellation of the examination and/or enforcement action against the facility licensee or me. PRINTED NAME JOB TITLE / RESPONSIBILITY DATE DATE NOTE 7Zo.., -r;<A t-eD JI$ z/zoA;1. )2. .J 0 f.:r Ct'lMC--t::.<.J (-Lf -rJ .3. P'l_-H-A .. "t-:z. ShL:7 L18//3 dll$ll;) 4. I t/3/WA M zkk Retention: Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.

_012 QF-1071.1ev.

2 (FP-T-SAT-71) I fl Xcf!IEOOrg, I LIMITED SECURITY AGREEMENT The Limited Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have access to Primary and Secondary JOB TITLE I RESPONSIBILITY NOTE PRINTED1AM'7

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' f" t2 () 6. I!w 5RO 7. Dry> \rJ>ll'lLtv:-rt)L J-?-lJ 8. BRIAN _____ J 0, JJ I -.) f5-1j 9. Gr/o Ps '11; 10. Oi3vI J 'E,.;..s?1 OPJ ,..JJ7.-i\lc7..t'- 1-(, / W) __ 11. ;#Cc/IItei. S'tAq: _:$_0..;,...7 ______ Zi7icJ12. 13. 14. 15. NOTES: til."!z<JI.$ ,/));{MA( ..u.... 1>' :::::??r )JUI,z l-J r*t 1

.--Retention

Life of plant Retain in: Exam file Form retained in accordance with record retention schedule identified in FP-G-RM-01.}}

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