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{{#Wiki_filter:VARIOUS CHECKLISTS FOR THE DRESDEN INITIAL EXAMINATION - JUNE 2002
{{#Wiki_filter:VARIOUS CHECKLISTS FOR THE DRESDEN INITIAL EXAMINATION - JUNE 2002


ES-201                                                                                   DRESDEN Examination Securit Agreement Form ES-201-3
DRESDEN ES-201 Examination Securit Agreement Form ES-201-3
: 1.       Pre-Examination I acknowledge that I have acquired specialized knowledge about date of my signature. I agree that I will not knowingly divulge any the NRC licensing examinations scheduled for the week(s) of $,2*7 _-yIl//             z11- as of the information about these examinations to any persons who have by the NRC chief examiner. I understand that I am not to instruct,                                                                                 not been authorized evaluate, administered these licensing examinations from this date until completion or provide performance feedback to those applicants scheduled to be authorized by the NRC.Furthermore, I am aware of the physical                           of examination administration, except as specifically noted below and procedures) and understand that violation of the conditions of thissecurity measures and requirements (as documented in the facility licensee's agreement may result in cancellation of the examinations and/or action against me or the facility licensee. I will immediately report                                                                               an enforcement to facility management or the NRC chief examiner any indications examination security may have been compromised.                                                                                                       or suggestions that
: 1.
: 2.         Post-Examination To the best of my knowledge, I did not divulge to any unauthorized during the week(s) of fa.IU,*, From the date that I entered                   persons any information concerning the NRC licensing examinations into this security agreement until the completion of examination                   administered instruct, evaluate, or provide performance feedback to those applicants                                                                         administration, I did not who were administered these licensing examinations, except as noted below and authorized by the NRC.                                                                                                                     specifically PRINTED NAME             JOB TITLE / RESPONSIBILITY                           SIGNATURE (1)                   DATE       SIGNATURE (2) DATENOTE
Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of $,2*7
: 1.     - _      __            _      r *_.,,                            -,_*o 2 7_*IV_,__.:,.__-T
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: 6.      ._L4~        L ~        -        &=*_**k___**
z11-as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
                                            ------------------------ ¶  _        _-*
: 2.
12.~s~7T 2**                             ---                                                                                             A  ---   --------
Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of fa.IU,*, From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
                                                              -    ---      -                            ------        Lk 31.
PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE (1)
: 5.         --       "W      -   Lo 7-. ....---                                ---------......-------                                                          ---    --      -L---                  -
DATE SIGNATURE (2) DATENOTE
_ L-_                                                        - -       ----- - L-4-----                                             -
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NUREG-1021, Revision 8, Supplement 1 24 of 24
.4
 
(
ES-201DRESDEN Examinatiun Security.
greement
: 1.
Pre-Examination Form ES-201-3 I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of
-* %ýVs of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
2.a To the best of my knowledge, I did not divulge to any unauthoe persons any Information concerning the NRC licensing examinations administered during the week(s) of Z
., From the date that I entered Into this security agreement until he completion of examination administration. I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE (1)
DATE SIGNATURE (2) DATENOTE
: 2.
: 6.
0
: 9.
6.
____f_._
: 11.
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: 12.
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NOTES:
NOTES:
NUREG-1021,         Revision 8, Supplement 1 24 of 24
NUREG-1021, Revision 8, Supplement 1 24 of 24
                                                                                            .4


(                ES-201DRESDEN Examinatiun Security . greement
(
: 1.      Pre-Examination                                                                                                                                    Form ES-201-3 I acknowledge that I have acquired specialized knowledge about the date of my signature. I agree                                                NRC licensing examinations scheduled by the NRC chief examiner. I that I will not knowingly divulge any                                                              for the week(s) of      -* %ýVs of the understand                              information administered these licensing examinationsthat I am not to instruct, evaluate, orabout          these provide        examinations performance          to any persons who have not been authorized by the NRC.Furthermore,              from this date until completion                                      feedback to those applicants scheduledauthorized of examination administration, procedures) and understand that          I am aware  of the physical security measures                                    except as specifically noted below to be action against me or the facility violation of the conditions of this agreement may result in and  requirements      (as documented in the facility licensee'sand licensee. I will immediately report                                    cancellation of the examinations to facility management or the NRC                                      and/or an examination security may have                                                                                          chief examiner any indications enforcement been compromised.                                                                                                      or suggestions that 2.a To the best of my knowledge, during the week(s) of Z          I did not divulge to any unauthoe
DRESDEN ES-201 Examination Security Agreement Form ES-201-3
                                    ., From the date that I entered        persons any Information concerning instruct, evaluate, or provide performance                            Into this security agreement until                  the NRC licensing examinations feedback to those applicants who                                  he completion of examination administration. administered were administered these licensing                                              I did not noted below and authorized by                                                                                                      examinations, except as specifically the NRC.
: 1.
PRINTED NAME              JOB TITLE / RESPONSIBILITY SIGNATURE (1)                      DATE          SIGNATURE (2) DATENOTE 2.
Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of  
: 6.      ;                -----------------                                                        ------
*' -//zctzas of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
: 9.                                                                                          -. -          -.-                0 6 .
: 2.
: 11.                                                                                                              ____f_._      -    -                .        .      .      .
Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of &Zy -g,-
V-,I.I,    ---                  vav-.e****.
From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
                                                                                            ---      ..........          .ft4"..        .    .                1q/-O .-.
PRINTED NAME
                                                                                  /
: 2.
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: 4.
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: 7.
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: 8.
                                                                                                      -- ---                                                      7
: 9.
                                                                                                                                                        ---          X K_.=
: 10.
NOTES:                                                                              .
: 11.
NUREG-1021, Revision 8, Supplement 1                              24 of 24
: 12.
 
13.------
(                                                                                      (
: 14.
DRESDEN ES-201                                                               Examination 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) of *' -//zctzasof the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner 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 NRC licensing examinations administered during the week(s) of &Zy -g,-       From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
PRINTED NAME             JOB TITLE / RESPONSIBILITY                              SIGNATURE (1)                                              DATE                SIGNATURE (2) DATENOTF
: 2.                                        ~~~              o -.          ---                                              -                                                                      ........._ -?-,_..
: 4.                                       -__C-    **          .. . -b"#.-                                                    .. .. ..-. .oo                                                                                    -L _j
                                      -*, *      .- __*_                _-      ,>v                  -              ***_
                                                                                                                    -.---                                --------                't*-:                   t ---  --    - --. :--
                                    ,  .      -,-    -T--        ..              -,,-.        _        - *..        .-  . . -- .      .    .    .**Z--      ,,  -    ------
r*z      "'*"*--
: 7.                                                                                        ---------------                                            ---------                                                --            -  -  ..
8.
: 9.                                         --------------------------
i
: 10.                                                                                                           ----------                                                -        -      -------------
ZW--------                                        ------------
11.
12.
13.------                                                                                                    -----------                      ---                -  ---........                -- - - - - - - - ----  -----    -
14.
15.
15.
JOB TITLE / RESPONSIBILITY SIGNATURE (1)
DATE SIGNATURE (2) DATENOTF
,>v
't*-:
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NOTES:
NOTES:
NUREG-1021, Revision 8, Supplement 1 24 of 24
NUREG-1021, Revision 8, Supplement 1 24 of 24
(


DRESDEN
DRESDEN jI, UI It" I'l yI tAeemlen it Form ES-201-3
                                                                                                                            ,--, , ',,          ,.,jI,                 UI It" I'l yI tAeemlenit                                                                                                                                                        Form ES-201-3
: 1.
: 1.       Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of                                                                                                                                                                                                                                   7abo    as of tthe date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised>,../ @, fl                                                                                                                       /             )P//                                                 6
Pre-Examination 7abo t
: 2.       Post-Examination To the best of my knowledge, I did not divulge to 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 instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised>,../  
PRINTED NAME                 JOB TITLE / RESPONSIBILITY                                                                                                  SIGNATURE (1)                                                                DATE                                    SIGNATURE (2) DATENOTE C---------                                                                                          --------------------------
@, fl  
: 3.                                   ---------------------------                                                                                                                                                                                                                                                                            ----- ---
/  
: 4.                               -- - - - - - - - - - - - - - - - - - ------------------ --------                                                                                                                                                                                                            - - ----------------
)P//
: 5.                                               --- --- - - - -- - - - -- - - -- - - - -- - - --------                                                                                                                          ------ --------------------- ----- ----
6
: 6.                               - - - - - - - - - - - - - - - - - - - - - - - ---------                                                                                                                                          ------ --------------------- ----- ----
: 2.
: 7.                                       --- - - - - - - - - - - - -                                                                      - - - - - - - - - - - - - --------------------                                                  ------                                                                            -    - - - - - - - - -
Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of  
8.-------                          -      -      -      -      -      -      -      -      -      -      -      -    -      -      --              -      -    -      -      -      -      -        -      -    -    -      -      - -- -        --    --
/,
: 9.                               - -          -              -      -    -      -      -    -      -      -    -      -      -    -        -      -      -    -      -      --    -      -      - -      -    -    -      -    -    -    -      --    --      --    --    - ---- -    -    -
From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
: 10.                             -      -        -    -      -      -    -      -      -    -      -      -    -      -      -    -        -      -      -    -        --    -      -        -      -      -    -    -      -      -    - - -    --      -      -
PRINTED NAME
: 11.                                       -- -      -      -      -      -      -      -      -      -      -      -    -      -            -        -      -    -      -      -      -    -        -      -    -    -      -        - - -      --      -    ----- -        -      -    -    -    -    -    -    -      -    -    -      -      -    -  -  -
: 3.
: 12.                                       -      --    -      -      -    -      -      -    -      -      -    -      -      -    -          -      -    -    -      --    -      -        -        -    -    -      -      -    -    --    - - -        -    -    - ----      -    -    -    -    -        -        -      -  -      -      -    -  -  -
: 4.
: 13.                               --          -        -      -      -      -      -      -      -      -      -    -      -      -      -        -      -      -    -      --            -        -      -      -    -    -      - - - -      --    ----- -      -      -        -    -    -    -    -    -    -        -
: 5.
14.
: 6.
: 15.                                                                                                                                                             -    -      -      -      -      --          -      -    -    -      -          -    --    - - -          -      -------      -    -    -    -    --          ----                -      -  ---
: 7.
8.-------
: 9.
: 10.
: 11.
: 12.
: 13.
: 14.
: 15.
NOTES:
NOTES:
JOB TITLE / RESPONSIBILITY SIGNATURE (1)
DATE SIGNATURE (2) DATENOTE C---------
NUREG-1021, Revision 8, Supplement 1 24 of 24
NUREG-1021, Revision 8, Supplement 1 24 of 24


(i                                                                                                                                                                                                               (
(i
DRESDEN ES-201                                                                                       Examination 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) of                                                                                                                                                                                     ben as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.                                                 / J5 e                           -f                       2- J //k3/45
DRESDEN ES-201 Examination Security Agreement Form ES-201-3
* O//
: 1.
2..       Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of,4,.,,..           From the date that I entered into this security agreement until the completion of examination administration. I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of ben as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.  
PRINTED NAME             JOB TITLE / RESPONSIBILITY                                                                    SIGNATURE (1)                                                          DATE                                SIGNATURE (21                                        DATFNCiTr 2.
/
: 3.                                                                                                                                                     -----------------------------
J5 e  
: 4.                                 - - - - - - - - - - - - - - - - - - - - - - - - - - - - -----                                                                                                    - - - - - - - - - - - - - - - -- - -- ----                                                - - --                                    - ---
-f 2-J //k3/45 O//
: 5.                                         - --- - - - -- - - - - - - - - - - - - - -- - - - - - -----
2..
: 6.                                                                                                                                                                                                   - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- -
Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of,4,.,,..
: 7.                                 - - - - - - - - - - - - - - - - - - - - - - - - - - - --- -- - -- - - -- - - - - -
From the date that I entered into this security agreement until the completion of examination administration. I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
: 8.                               -    -    -    -    -    -    -    -    -    -    -    -    -    -      -  -    -    -    -      -    -    -    -    -      -      -      -  -    -      -- - -    --      -    ----- -      -    -    -    -    -    -    -    -    -      -      -      -      -      -    -    -    -
PRINTED NAME
: 9.                               -    -      -    -    -    -    -    -    -    -    -    -    -    -      -  -    -    -      -      -    -    -    -    -      -      -        -    -    -  - -  --    --    -    - - -----    -    -    -    -    -    -    -    -    -      -      -      -      -      -      -      -
: 2.
: 10.                               -    -      -    -    -    -    -    -    -    -    -    -    -    -      -  -    -    -      -      -    -    -    -- -    -      -    - -        -    -          -    -        -    --    --  --    ----- -    -    -    -    -    -      -    -        -          -      -      -      -
: 3.
: 11.                               - -    -    -    -    -    -    -    -    -    -    -    -    -    -        -    -    -      -    -    - - -      -    -      -        -      -    -          - -  --      --      -
: 4.
12.
: 5.
13.
: 6.
: 14.                               - -      -    -    -    -    -    -    -    -    -    -    -    -      -        -    -      -      -    -    -  - -    -      -      -        -    -      -      - - -    -----------                          -    -    -    -        -      -    -        -      -      -      -    -
: 7.
: 15.                                       -    -    -    -    -    -    -    -    -    -    -    -    -        -    -      -      -    -    -    -  - - - ---            -      -  -    -  -    -          -
: 8.
: 9.
: 10.
: 11.
: 12.
: 13.
: 14.
: 15.
NOTES:
NOTES:
NUREG-1021, Revision 8, Supplement 1 24 of 24
JOB TITLE / RESPONSIBILITY SIGNATURE (1)
DATE SIGNATURE (21 DATFNCiTr NUREG-1021, Revision 8, Supplement 1 24 of 24


(,                                                                                                                                                                                                                                                 (
(,
DRESDEN ES-201                                                                                                                       Examinaiion 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) of___ _____                                           as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
DRESDEN ES-201 Examinaiion Security Agreement Form ES-201-3
: 2.       Post-Examination                                                                                                                                                                         !s>.,                   ,CWvY                             --                    j9Z                                                     /-/~.                                           dvc/
: 1.
To the best of my knowled e, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) o ".%t jj .. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of___ _____
PRINTED NAME                 JOB TITLE / RESPONSIBILITY                                                                                                                  SIGNATURE (1)                                                                              DATE                                SIGNATURE (2) DATENOTE
as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
                                                            /W
: 2.
                                                            /d5-77W- C PC /Z.
Post-Examination
2.
!s>.,  
3.
,CWvY j9Z  
: 4.                                 - -          -        -      -      -      -        -      -        -        -      -      -        -        -          -      -      -      -      -        - - -          -        -        -        -      -        -          -        --  - - - - - ----    -    -      -    -    -      -      -    -    -      -    -      -      -      -        -      -      -
/-/~.
: 5.                               --          -        -      -      -      -        -      -        -        -      -      -        -        -          -      -      -      -      -        ----                        -        -        -      -        --          -        ------------------
dvc/
: 6.                                                                                                                                                                                                                                                                                                                                                                             -      --                -        --              -
To the best of my knowled e, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) o ".%t jj.. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
7.
PRINTED NAME
: 8.                                                     -        -      -      -        -      -      -        -      -      -      -          -      -  -      -      -      -      -        -      -      -        -        -        -      -      -        -  - ---    -      -    -- ---------                      -----                            --            ---                    -      --
: 2.
9.
: 3.
: 10.                               -        -      -        -      -      -        -      -      -
: 4.
: 11.                               -      -        -        -      -      -        -      -      -
: 5.
: 12.                                                                                                                                                                                                                                                                                     -                -  - -    -
: 6.
: 13.                                 -  -        -        -      -      -        -      -      -        -      -      -      -        -        -          -      -      -      -        -      -        -      -      -        -        -      -        -            -      - -  - - - - -        - -    -
: 7.
: 14.                                                                   -      -        -      -      -        -      -      -      -          -      --          -      -      -      -        -      -      -        -        -        -----      -      -      -  -        -          -- -      -      -        -        -          -      -      -      -      -          -        -        --              -
: 8.
: 15.                                                                                                         --- -- --            --
: 9.
: 10.
: 11.
: 12.
: 13.
: 14.
: 15.
NOTES:
NOTES:
JOB TITLE / RESPONSIBILITY SIGNATURE (1)
DATE SIGNATURE (2) DATENOTE
/W
/d5-77W-C PC /Z.
NUREG-1021, Revision 8, Supplement 1 24 of 24
NUREG-1021, Revision 8, Supplement 1 24 of 24


(,
DRESDEN ES-201 Examination Security Agreement Form ES-201-3
DRESDEN ES-201                                                                             Examination Security Agreement                                                                                                                             Form ES-201-3
: 1.
: 1.       Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) ofasot.
Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) ofasot.
date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
: 2.       Post-Examination To the best of my knowled *e, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of%,./.ý ,z. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
: 2.
PRINTED NAME               JOB TITLE / RESPONSIBILITY                                                SIGNATU RE (1)                                            DATE                    SIGNATURE (2) DATENOTE 1                           ,___
Post-Examination To the best of my knowled *e, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of%,./.ý,z. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
2.
PRINTED NAME 1
: 3.                               - - - - - - - - - - - - - - - - - - - - - - ------------ ------ ---------------------
: 2.
: 4.                                                                                                                                                                                                                                                 --- -- ----
: 3.
: 5.                               --------------------------------
: 4.
: 6.                                                                                                                                                             ------ --------------------- ----- ----
: 5.
: 7.                                     ----------------                                              -------------------                                              ------ --------------------- ----- ----
: 6.
: 8.                                                                                                                               -------------------                                                                    ------------------
: 7.
: 9.                               -----------------------------------                                                                                                    ------ ------------------- ----- ----
: 8.
10,                             ------------------------------                                                                                            ------ --------------------- -----                                                              ----
: 9.
: 11.                               --    -  -    -  -  -    -    -  -    -    -  -  -    -      -    -    -  -  -    -----                -
10,
: 12.                                                                                                                                                     -  -      -  --      -      -      -    --------
: 11.
: 13.                               --    -    -  -    -  -  -    -    -  -    -    -  -  -      -    -    -  -  -  -      -    -    -    -  -
: 12.
: 14.                                                                                                                                                             -    -    -  --  - - - ----
: 13.
: 15.                               -  -    -  -    -  -  -    -    -  -    -    -  -  -    -  -    -    -    -  -  -    -      -    -      -  -  -    - - - -----
: 14.
: 15.
NOTES:
NOTES:
NUREG-1021, Revision 8, Supplement 1 24 of 24
JOB TITLE / RESPONSIBILITY SIGNATU RE (1)
DATE SIGNATURE (2) DATENOTE NUREG-1021, Revision 8, Supplement 1 24 of 24
(,


(                                                                                                                                                                                                                                                                                                                                                                                                                     (
(
(
DRESDEN rxi.xmrnla~i~n Z-,*Pni Ilrlv Mnr~rl~m~n?
DRESDEN rxi.xmrnla~i~n Z-,*Pni Ilrlv Mnr~rl~m~n?
: 1.       Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) ofi./*/z_77'7/-                                                                                                                                                                                                                                                 z. as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.                                                               *                  ,,6*                                                                             I           !s J3/25                                                     0%/7/Z) o/nY
: 1.
: 2.       Post-Examination To the best of my knowledge I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of-t--.                 From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) ofi./*/z _77'7/- z. as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.  
PRINTED NAME                 JOB TITLE / RESPONSIBILITY                                                                                                              SIGNATURE (1)                                                                              DATE                                  SIGNATURE (2) DATENOTE 2.
,,6*
                                                                                                                                                                                                ------------------------                                                                                ;--A4 ---------
I  
: 3.                                 -- - - - - - - - -7                                                      - - - - - - - - - - - - - -- ----                                                                                  - -- -- - -- --- - -- --- -- -- -- -- --- -- -- --- - - - -- -
!s J3/25 0%/7/Z) o/nY
4._                                 -- - - - - - - - - - - - - -                                                                                                - - - - - --                              - -- --- -- -- --- - -- -- - - -- -- -- -- --- -- -- -- -- - -- -- - -- --
: 2.
Post-Examination To the best of my knowledge I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of-t--.
From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
PRINTED NAME
: 2.
: 3.
4._
5._
5._
6._                             - - - - - - - - - - - - - - --                                                                                                  - - - - - -------------- ------ --------------------- ----- -----
6._
7._                             --        - - - - - - - - - - - - -                                                                                        - - - - - - - ----------                                                                ------ --------------------- ----- -- --
7._
8._                             --        -        -      -      -        -      -        -      -      -      -      -      -        -            -        -      -      -        -      -      -      -      -      -        -      -      -      -    --      - - - - - ----    -    -      -      -      -      -    -      -    -      -      -    -      -    -    -    -  -      -
8._
9._                             -    -        -      -      -        -      -        -      -      -      -      -      -      -        -  -      -        -      -      -        -      -      -      -        -      -        -        -      -- --            --    --  -  - - ---- -    -      -      -      -    -      -    -    ---      -----                          -  -
9._
: 10.                             -    -        -      -      -        -      -        -      -      -      -      -      -      -        -  -      -        -      -      -        -      -      -      -      -      -        -      -      --    --        -    - -  -    -
: 10.
: 11.                             -    -        -        -      -      -        -      -        -      -      -      -      -      -        -    -      -        -      -      -        -      -      -      -      -      -        -      -      --    --        -    --    -    -
: 11.
: 12.                               -      -        -      -      -        -      -        -      -      -      -      -      -        -        -  -        -      -      -        --              -      -      -      -      -        -      -      -      -      --    - -- -      -      -
: 12.
: 13.                               --        -        -      -      -        -      -        -      -      -      -      -      -        -            -        -      -      -        -      -      -      -      -      -        -      -      -              -      - - -    - - - -      --      ----- -        -      -      -    -    -      -      -    -      -    -    -
: 13.
: 14.                               -    -        -      -      -        -      -        -      -      -      -      -      -      -        -  -      -        -      -      - -        -    -          -      -      -        -      -      - -            -      -    -- --        - - -        --    -- ----  -      -    -      -    -    -      -    -    -    -      -
: 14.
: 15.                               -     -         -       -       -       -       -       -       -       -       -       -       -       -         -   -       -       -       -       -       -       -      ---  -    -      -      ---                -              -      -      --            -        -      -        -      --          -      -      -      -        -    -            ---
15.
NOTES:
JOB TITLE / RESPONSIBILITY SIGNATURE (1)
NUREG-1021, Revision 8, Supplement 1                                                                                                                             24 of 24
DATE SIGNATURE (2) DATENOTE
;--A4 ---------
-- - - - - - - - -7 NOTES:
NUREG-1021, Revision 8, Supplement 1 24 of 24


(
DRESDEN ES-201 Examination Security Agreement Form ES-201-3
DRESDEN ES-201                                                                             Examination Security Agreement                                                                       Form ES-201-3
: 1.
: 1.       Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of Z//.         -asof the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to faciility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.                                   ,'.,c,4,,     c'-[
Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of Z//.  
: 2.       Post-Examination                                                             .
-as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to faciility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.  
To the best of my knowllede*j,id not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of                           . the date that I entered into this security agreement until the completion of examination administration, I did not
,'.,c,4,,
                                                      .From instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
c'-[
PRINTED NAME                 JOB TITLE / RESPONSIBILITY                                     SIGNATURE (1)                     DATE               SIGNATURE (2)             DATENOTE 1                                                                                       . .........
: 2.
4.5----------------------           3 ---
Post-Examination To the best of my knowllede*j,id not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of  
: 87.                  ----
..From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
                                          ------------ ~~------------------------------------ ---------------------------
PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE (1)
10.
DATE SIGNATURE (2)
11.
DATENOTE 1
3 ---
4.5---------------------- -- - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- - -
: 87.
~~------------------------------------
: 10.
11------------------------------------------
11------------------------------------------
: 11.
12.-..
12.-..
13.
: 13.
14.
: 14.
NOTES:
NOTES:
NUREG-1021, Revision 8, Supplement 1 24 of 24
NUREG-1021, Revision 8, Supplement 1 24 of 24
(


(                                                                               (                                                                                              (
(
DRESDEN ES-201                                                         Examination SecurityAgreement                                                               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) of                               /       as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised. /<e,/                 e   o1                 //-c/-44,ie      ,.-,        43
DRESDEN ES-201 Examination SecurityAgreement Form ES-201-3
: 2.       Post-Examination To the best of my knowledge, I did not divulge to 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 instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
: 1.
PRINTED NAME             JOB TITLE / RESPONSIBILITY                    SIGNATURE (1)                      DATE          SIGNATURE (2)          flATI:nT-*T
Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of  
: 1. &#xfd;DL-       1-.,,MQ:Zpq.l
/
: 2.                                                           - - - - ----
as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.  
                                                                        - -- - - - -11'-                                  V 3.
/<e,/
4.
e o1 44,ie
: 5.                                                                                           - ----------- - -------------
//-c/-
6.
4 3
7.
: 2.
: 8.                               -----------------------------                                                      ----------------------- ----- -----
Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of  
9.
. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
10.
PRINTED NAME
: 11.                                                                                                                                                             - -- --
: 1. &#xfd;DL-1-.,,MQ:Zpq.l
: 12.                                                                                       --------------------------
: 2.
: 13.                                         -- -- - -- - - - -  - - --  -  -  -  -  -- -  -  -    ---- --- --
: 3.
: 14.                                                                                                                   -    -    -- -  -  -  -  -  -  -  -  -  -  -  -    --  -
: 4.
15.
: 5.
: 6.
: 7.
: 8.
: 9.
: 10.
: 11.
: 12.
: 13.
: 14.
: 15.
NOTES:
NOTES:
NUREG-1021, Revision 8, Supplement 1 24 of 24
JOB TITLE / RESPONSIBILITY SIGNATURE (1)
DATE SIGNATURE (2) flATI:nT-*T
-- - - - -11'-
V NUREG-1021, Revision 8, Supplement 1 24 of 24
(


(                                                                                                                                                                               (                                                                                                                                                                                                                        (
(
(
DRESDEN ES-201 Examination Security Agreement Form ES-201-3
DRESDEN ES-201 Examination 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) as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.                                                                                                                                                                 12-1/ 1                         C j',                 '.
: 1.
: 2.       Post-Examination To the best of my knowledge, I did not divulge to 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 t, did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.
PRINTED NAME                 JOB TITLE / RESPONSIBILITY                                                                                                                      SIGNATURE (1)                                                                              DATE                                SIGNATURE (2) DATENOTE
1 2-1/ 1 j',
: 2.   - W 3.
C
7 -
: 2.
: 4.                                   -    -      -      -      -      -        -        -        -        -        -        -        -        -        -  -      -        -        -      -        -        -
Post-Examination To the best of my knowledge, I did not divulge to 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  
: 5.                                                                                                                                                                                                                                                                                                                                                                                   -      -      ---      -
, t did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
: 6.                                                                                                                               ----          --            -  --          --          --          -      --          --          -      --          --          --      -        --      ------      ------        ---------                                    -----
PRINTED NAME
7.------------------                                                                                                                                                                                                                                                                                                                                                                                        --
: 2. - W 7 -
: 8.                                                     ----------------------------------                                                                                                                                                                                                                                                                                  --            -    --        -
: 3.
: 9.                                 --        -      -      -      -      -        -        -        -        -      -          -      -        -            -      -        -        -      -      --                -      -      -        -      -      -------      -
: 4.
: 10.                                                                                                       ----
: 5.
: 11.                               ---------------
: 6.
: 12.                               --------------------------------
7.------------------
: 13.                               ---------------
: 8.
: 14.                               -    -      -      -      -      -        -        -      -        -      -        -        -        -        --          -        -        -      -        -        -      -      -        -
: 9.
: 15.                               --        -      -      -      -      -        -        -        -        -      -          -      -        -            -      -        -        -      -        ---            -
: 10.
: 11.
: 12.
: 13.
: 14.
: 15.
NOTES:
NOTES:
                                                                                                  -----------------------------                            ~~~~   --          -        -        -      -      -      -        -      -      -        -      -      -        --          -            -        ----        -    --------
JOB TITLE / RESPONSIBILITY SIGNATURE (1)
DATE SIGNATURE (2) DATENOTE
~~~~
NUREG-1021, Revision 8, Supplement 1 24 of 24
NUREG-1021, Revision 8, Supplement 1 24 of 24
(


(                                                                                (
(
DRESDEN ES-201                                                       Examination Security Agreement                                               Form ES-201-3
DRESDEN ES-201 Examination 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) of &#xfd;             -L     .as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised. /<ui~                         of J       /. S-,tc'<,7
: 1.
: 2.       Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of &#xfd;. - Z,-       From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of &#xfd;  
PRINTED NAME             JOB TITLE / RESPONSIBILITY                       SIGNATURE (1)           DATE       SIGNATURE (2)   DATENOTE 2.
-L  
                                                                                                      - - -4          - -                      --              ,
.as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised. /<ui~
3.
o f J  
: 4.     ----------------------------------------
/.
3 ---- ------ ---------            ---------------------------
S-,tc'<,7
6.5.     - -- ------ --------------                                    ---------------------------
: 2.
7.------------------ -----------------------------                            -- - - - - - - - - - -                                          ----- ----
Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of &#xfd;. -Z,-
: 8.                                                                                                                                             ----- ----
From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.
: 9.                                       ~~~---
PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE (1)
: 10. 12.------------------    -----------------------------              ---------------------------        ------ --- ----------------- ----- ----
DATE SIGNATURE (2) DATENOTE
13.
: 2.
14.1       -------------------------------------------
: 3.
15.
: 4.
3 ----
6.5.
7.------------------
: 8.
: 9.  
~~~---
12.------------------
: 10.
14.1
: 13.
: 15.
NOTES:
NOTES:
NUREG-1021, Revision 8, Supplement 1 24 of 24
NUREG-1021, Revision 8, Supplement 1 24 of 24
(


ES-301                                               O;erating Test Quality Checklist                                 Form ES-301-3 tyateof SQ,6-5                                                                 Examination--61/             Operating Test Numberv,,             1, Initials
ES-301 O;erating Test Quality Checklist Form ES-301-3 SQ,6-5 tyateof Examination--61/
: 1. GENERAL CRITERIA a     b"       ce
Operating Test Numberv,,
: 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 function distribution)           , 140      "
1, Initials
: b.         There this during  is noexamination day-to-day repetition between this and other operating                                   1.40   !:(.1 tests to be administered c         The operating test shall not duplicate items from the applicants' audit test(s)(see Section D.1.a).     ,.1     "
: 1. GENERAL CRITERIA a
: d.         Overlap lim its .,, with the written examination and between operating test categories is within acceptable           0 *
b" ce
: e.         It appears that the operating test will differentiate between competent and less-than-competent           ,
: a.
applicants at the designated license level.
The operating test conforms with the previously approved outline: changes are consistent with sampling requirements (e g. 10 CFR 55 45. operational importance, safety function distribution) 1, 40
: b.
There is no day-to-day repetition between this and other operating tests to be administered during this examination 1.40 !:(.1 c
The operating test shall not duplicate items from the applicants' audit test(s)(see Section D.1.a).  
,.1
: d.
Overlap with the written examination and between operating test categories is within acceptable lim its.,,
0 *
: e.
It appears that the operating test will differentiate between competent and less-than-competent applicants at the designated license level.
: 2. WALK-THROUGH (CATEGORY A & B) CRITERIA
: 2. WALK-THROUGH (CATEGORY A & B) CRITERIA
: a.         Each JPM includes the following, as applicable:
: a.
Each JPM includes the following, as applicable:
* initial conditions
* initial conditions
* initiating cues
* initiating cues
* references and tools, including associated procedures
* references and tools, including associated procedures
* reasonable and validated time limits (average time allowed for completion) and specific                                               I designation ifdeemed to be time critical by the facility licensee
* reasonable and validated time limits (average time allowed for completion) and specific designation if deemed to be time critical by the facility licensee  
                            . specific performance criteria that include:                                                             r'A.,   -'              =
. specific performance criteria that include:
                                  - detailed expected actions with exact criteria and nomenclature
r'A.,  
                                  - system response and other examiner cues
=  
                                  - statements describing important observations to be made by the applicant
- detailed expected actions with exact criteria and nomenclature  
                                  - criteria for successful completion of the task
- system response and other examiner cues  
                                  - identification of critical steps and their associated performance standards
- statements describing important observations to be made by the applicant  
                                  - restrictions on the sequence of steps, if applicable
- criteria for successful completion of the task  
: b.         the prescripted questions in Category A are predominantly open reference and meet the criteria in Attachment 1 of ES-301.                                                             i4.e
- identification of critical steps and their associated performance standards  
: c.         Repetition from operating tests used during the previous licensing examination is within acceptable limits (30% for the walk-through) and do not compromise test integrity.                       ,
- restrictions on the sequence of steps, if applicable
: d.         At least 20 percent of the JPMs on each test are new or significantly modified.                         A/vY               __
: b.
a.
the prescripted questions in Category A are predominantly open reference and meet the criteria in Attachment 1 of ES-301.
: 3. SIMULATOR (CATEGORY C) CRITERIA The associated simulator operating tests (scenario sets) have been reviewed in accordance with Form ES-301-4 and a copy is attached.                                                                      4
i4.e
: c.
Repetition from operating tests used during the previous licensing examination is within acceptable limits (30% for the walk-through) and do not compromise test integrity.
: d.
At least 20 percent of the JPMs on each test are new or significantly modified.
A/vY
: 3. SIMULATOR (CATEGORY C) CRITERIA
: a.
The associated simulator operating tests (scenario sets) have been reviewed in accordance with
[:1*
[:1*
Printed Name / Signature                                           Date
Form ES-301-4 and a copy is attached.
: a. AuthorNAA                                       0T7UZ           aIP5
4 Printed Name / Signature Date
: a. AuthorNAA 0T7UZ aIP5
: b. Facility Reviewer(*)
: b. Facility Reviewer(*)
: c. NRC Chief Examiner (#)                         A2iVzi,//(
: c. NRC Chief Examiner (#)
                                                                ,                                /Yk,.
A2i Vzi
: d. NRC Supervisor 6711               __"I NOTE:     ' The facility signature is not applicable for NRC-developed tests.
(  
                          # Independent NRC reviewer initial items in Column "c;" chief examiner concurrence required.
/Yk,.  
23 of 26       NUREG-1021, Revision 8, Supplement I Exam Submittal
,//
: d. NRC Supervisor 6711
__"I NOTE:  
' The facility signature is not applicable for NRC-developed tests.  
# Independent NRC reviewer initial items in Column "c;" chief examiner concurrence required.
23 of 26 NUREG-1021, Revision 8, Supplement I Exam Submittal I


ES-301                               Transient and Event Checklist                         Form ES-301-5 OPERATING TEST NO.: ILT 01-1 Applicant           Evolution     Minimum                 Scenario Number Type               Type         Number
ES-301 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO.: ILT 01-1 Applicant Evolution Minimum Scenario Number Type Type Number
______ILT-N-1               ILT-N-2 ILT-N-3 Reactivity           1               1           2       2 Normal           1               2           1"       1 RO Instrument!         4             3*-4/       4, 5*/   4*,6/
______ILT-N-1 ILT-N-2 ILT-N-3 Reactivity 1
Component                           5, 6*       3, 6*   3, 5*
1 2
_Major               1               7           7       7 RO in position as ANSO Reactivity         1               1           2       2 Normal           0                 2           0       0 As RO           Instrument           2               4/           4/     6/
2 Normal 1
Component                             5           3       3 Major           1                 7           7       7 SRO-I Reactivity         0                 1           2       2 Normal           1               2           1       1 As SRO           Instrument/         2               3,4/         4, 5/   4,6/
2 1"
Component                           5, 6         3, 6     3, 5 Major           1                 7           7       7 Reactivity         0 Normal           1               No SRO-U Candidates SOU         Instrument /         2                       for IL T01-1 I C o m p on en t 1 F Major           1 Instructions: (1)      Enter the operating test number and Form ES-D-1 event numbers for each evolution type.
1 RO Instrument!
(2)      Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.4.d) but must be significant per Section C.2.a of Appendix D.
4 3*-4/
(3)      Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant' competence count toward the minimum requirement.
4, 5*/
4*,6/
Component 5, 6*
3, 6*
3, 5*
_Major 1
7 7
7 RO in position as ANSO Reactivity 1
1 2
2 Normal 0
2 0
0 As RO Instrument 2
4/
4/
6/
Component 5
3 3
Major 1
7 7
7 SRO-I Reactivity 0
1 2
2 Normal 1
2 1
1 As SRO Instrument/
2 3,4/
4, 5/
4,6/
Component 5, 6 3, 6 3, 5 Major 1
7 7
7 Reactivity 0
Normal 1
No SRO-U Candidates SOU Instrument /
2 for IL T01-1 I C o m p o n e n t 1
F Major 1
Instructions:
Author:
Author:
NRC Reviewe r:
NRC Reviewe (1)
Enter the operating test number and Form ES-D-1 event numbers for each evolution type.
(2)
Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.4.d) but must be significant per Section C.2.a of Appendix D.
(3)
Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant' competence count toward the minimum requirement.
r:
NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal
NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal


ES-301                         Transient and Event Checklist                     Form ES-301-5 OPERATING TEST NO.: ILT 01-1 Instructions: (1)  Enter the operating test number and Form ES-D-1 event numbers for each evolution type.
ES-301 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO.: ILT 01-1 Instructions:
(2)  Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.4.d) but must be significant per Section C.2.a of Appendix D.
(3) Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count toward the minimum requirement.
Author:
Author:
NRC Reviewe r:
NRC Reviewe (1)
Enter the operating test number and Form ES-D-1 event numbers for each evolution type.
(2)
Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.4.d) but must be significant per Section C.2.a of Appendix D.
(3)
Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count toward the minimum requirement.
r:
NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal
NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal


ES-301                                    Competencies Checklist                               Form ES-301-6 SRO PosiL#
Competencies Checklist Form ES-301-6 Comply With and Use Procedures (1)
QR6-RO-U 3-I8            o          2, NSO4/S* t #RO-U 27-8plicant kZORO-I/SRO-U  # 3 Position SCENARIO                                          ANSO Position Competencies             ILT-N-1                          SCENARIO ILT-N-2                                      SCENARIO ILT-N-1    IILT-N-2 ILT-N-1      ILT-N-2 t____        5, 7, 8 5,
Competencies Understand and Interpret Annunciators and Alarms Diagnose Events and Conditions Understand Plant and System Response Operate Control Boards (2)
Understand and Interpret                                         7, Annunciators and Alarms             3-8          3-8        1, 2, 4,    2-4, 7-8    3, 6, 7, 8      1, 5-8 3-8          3-8              8 1, 2, 4,      2-4, 5,    3, 6, 7, 811, Diagnose Events                                                                                           5-8 and Conditions 5,7,8          7-8 Understand Plant and System Response                 1-8          1-8          1-8      2-4, 5,        3-8        1, 5-8 7-8 Comply With and Use Procedures (1)                  1-8          1-8        1, 2, 4,    2-4, 7-8    3, 6, 7, 8      1, 5-8 5, 7,8 Operate Control Boards (2)                           N/A          N/A        1, 2, 4,    2-4, 7-8    3, 6, 7, 8    1, 5-8 7,8 Communicate and Interact With the Crew               1-8          1-8          1-8        2-4, 5,      1, 3-8      1, 4-8 7-8 Demonstrate Supervisory Ability (3)                         1-8          1-8          N/A          N/A          N/A          N/A Comply With and Use Tech. Specs. (3)                 4            4        aInNA NcA          NaA          NfA Notes:
Communicate and Interact With the Crew Demonstrate Supervisory Ability (3)
ification compliance for an RO.
Comply With and Use Tech. Specs. (3)
Notes:
(1) Includes Technical Spec (2) Optional for an SRO-U.
(1) Includes Technical Spec (2) Optional for an SRO-U.
(3) Only applicable to SROs Instructions:
(3) Only applicable to SROs 3-I8 2, 4 t # 2 7-8plicant
# 3 QR6-RO-U
/S*
RO-U kZORO-I/SRO-U t____
5, 7, 8 SRO PosiL o
NSO Position ANSO Position SCENARIO SCENARIO SCENARIO ILT-N-1 ILT-N-2 ILT-N-1 IILT-N-2 ILT-N-1 ILT-N-2 3-8 3-8 1, 2, 4, 2-4, 7-8 3, 6, 7, 8 1, 5-8 5,
7, 8
3-8 3-8 1, 2, 4, 2-4, 5, 3, 6, 7, 811, 5-8 5,7,8 7-8 1-8 1-8 1-8 2-4, 5, 3-8 1, 5-8 7-8 1-8 1-8 1, 2, 4, 2-4, 7-8 3, 6, 7, 8 1, 5-8 5, 7,8 N/A N/A 1, 2, 4, 2-4, 7-8 3, 6, 7, 8 1, 5-8 7,8 1-8 1-8 1-8 2-4, 5, 1, 3-8 1, 4-8 7-8 1-8 1-8 N/A N/A N/A N/A 4
4 NcA NaA NfA aInNA ification compliance for an RO.
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 every applicant.
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:
Author:
NR C R e v ie we r:                   ,__
N R C R e v ie w e r:
_ _ _ _ _ _ _ _ _ _  1 NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal
1 NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal ES-301


ES-301                             Competencies Checklist                         Form ES-301-6 Instructions:
ES-301 Competencies Checklist Form ES-301-6 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 every applicant.
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:
Author:
NRC Reviewer:                 Ar/*           //         A NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal
NRC Reviewer:
Ar/* //
A NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal


ES-301 Oh                               Form ES-301-6 Understand and Annunciators   andInterpret                                                    .
ES-301 Oh Form ES-301-6 Understand and Interpret Annunciators and Alarms 1,3-9 5-9 1, 3, 4, 7-9 Diagnose Events and Conditions 3-9 5-9 3, 4, 7-9 Understand Plant and System Response 1-9 2,4-9 1,3,4, 7-9 Comply With and Use Procedures (1) 1-9 2, 5-9 1, 3, 4, 7-9 Operate Control Boards (2)
Alarms   1,3-9                     5-9                 1, 3, 4, 7-9 Diagnose Events and Conditions                 3-9                     5-9               3, 4, 7-9 Understand Plant and System Response             1-9                   2,4-9                 1,3,4, 7-9 Comply With and Use Procedures (1)             1-9                   2, 5-9               1, 3, 4, 7-9 Operate Control Boards (2)                     NA                     2,n5-9               1,3,4, 7-9 Communicate Interact With theandCrew        1-9                   2, 4-9               1, 3, 4, 7-9 Demonstrate Ability (3)   Supervisory      1-9                     NIAN/
NA 2,n5-9 1,3,4, 7-9 Communicate and Interact With the Crew 1-9 2, 4-9 1, 3, 4, 7-9 Demonstrate Supervisory Ability (3) 1-9 NIAN/
Comply Use Tech.With Specs.
Comply With and l Use Tech. Specs. (3)N/NA Notes:
and (3)N/NA l
Notes:
(1) Includes Technical Specification compliance for an RO.
(1) Includes Technical Specification compliance for an RO.
(2) Optional for an SRO-U.
(2) Optional for an SRO-U.
Line 355: Line 557:
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.
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:
Author:
NRC Reviewer:                             '"/       A NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal
NRC Reviewer:  
'"/
A NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal


ES-403                               Written Examination Grading                     Form ES-403-1 Quality Checklist
ES-403 Written Examination Grading Form ES-403-1 Quality Checklist
[Facility:   Dresden U2/U3             Date of Exam: 6/14/2002             Exam Level: RO/SRO Initials Ifi.m fl .pcriptfinn                              a       b             c
[Facility: Dresden U2/U3 Date of Exam: 6/14/2002 Exam Level: RO/SRO Initials Ifi.m fl  
: 1.     Clean answer sheets copied before grading                                                   l,____
.pc riptfinn a
: 2.     Answer key changes and question deletions justified and documented
b c
: 3.     Applicants' scores checked for addition errors (reviewers spot check > 25% of examinations)
: 1.
: 4.     Grading for all borderline cases (80% +/- 2%) reviewed in detail                                                             tr7     l"
Clean answer sheets copied before grading l,____
: 5.     All other failing examinations checked to ensure that grades are justified
: 2.
: 6.     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
Answer key changes and question deletions justified and documented
: a. Grader                                           7,'911,
: 3.
: b. Reviewer(*)                                                                           7_____,_____-____-___
Applicants' scores checked for addition errors (reviewers spot check > 25% of examinations)
: c. NRC Chief Examiner (*)               6             //   -                            7/&#x17d;     ,'2
: 4.
: d. NRC Supervisor (*)               ./"'*       /   /-"
Grading for all borderline cases (80% +/- 2%) reviewed in detail tr7 l"
(*)     The facility reviewer's signature is not applicable for examinations graded by the NRC; two independent NRC reviews are required.
: 5.
5 of 5     NUREG-1021, Revision 8, Supplement 1}}
All other failing examinations checked to ensure that grades are justified
: 6.
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 7,'911,
: b. Reviewer(*)
7_____,_____-____-___
: c. NRC Chief Examiner (*)
6  
//
7/&#x17d;,'2
: d. NRC Supervisor (*)  
./"'*  
/  
/-"
(*)
The facility reviewer's signature is not applicable for examinations graded by the NRC; two independent NRC reviews are required.
5 of 5 NUREG-1021, Revision 8, Supplement 1}}

Latest revision as of 16:21, 16 January 2025

Various Checklists for the Dresden Initial Examination - June 2002
ML022200523
Person / Time
Site: Dresden  Constellation icon.png
Issue date: 06/03/2002
From: Otten M
Exelon Generation Co
To:
Office of Nuclear Reactor Regulation
References
50-237/02-301, 50-249/02-301, ES-403-1 NUREG-1021, Rev 8
Download: ML022200523 (20)


Text

VARIOUS CHECKLISTS FOR THE DRESDEN INITIAL EXAMINATION - JUNE 2002

DRESDEN ES-201 Examination Securit 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) of $,2*7

_-yIl//

z11-as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner 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 NRC licensing examinations administered during the week(s) of fa.IU,*, From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) DATENOTE

1.

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NUREG-1021, Revision 8, Supplement 1 24 of 24

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ES-201DRESDEN Examinatiun Security.

greement

1.

Pre-Examination Form ES-201-3 I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of

-* %ýVs of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2.a To the best of my knowledge, I did not divulge to any unauthoe persons any Information concerning the NRC licensing examinations administered during the week(s) of Z

., From the date that I entered Into this security agreement until he completion of examination administration. I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) DATENOTE

2.
6.

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6.

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NOTES:

NUREG-1021, Revision 8, Supplement 1 24 of 24

(

DRESDEN ES-201 Examination 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) of

  • ' -//zctzas of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner 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 NRC licensing examinations administered during the week(s) of &Zy -g,-

From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME

2.
4.
7.
8.
9.
10.
11.
12.

13.------

14.

15.

JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) DATENOTF

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NOTES:

NUREG-1021, Revision 8, Supplement 1 24 of 24

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DRESDEN jI, UI It" I'l yI tAeemlen it Form ES-201-3

1.

Pre-Examination 7abo t

I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) of as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised>,../

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2.

Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of

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From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME

3.
4.
5.
6.
7.

8.-------

9.
10.
11.
12.
13.
14.
15.

NOTES:

JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) DATENOTE C---------

NUREG-1021, Revision 8, Supplement 1 24 of 24

(i

(

DRESDEN ES-201 Examination 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) of ben as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

/

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2..

Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of,4,.,,..

From the date that I entered into this security agreement until the completion of examination administration. I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

NOTES:

JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (21 DATFNCiTr NUREG-1021, Revision 8, Supplement 1 24 of 24

(,

(

DRESDEN ES-201 Examinaiion 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) of___ _____

as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2.

Post-Examination

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To the best of my knowled e, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) o ".%t jj.. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

NOTES:

JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) DATENOTE

/W

/d5-77W-C PC /Z.

NUREG-1021, Revision 8, Supplement 1 24 of 24

DRESDEN ES-201 Examination 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) ofasot.

date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

2.

Post-Examination To the best of my knowled *e, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of%,./.ý,z. From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME 1

2.
3.
4.
5.
6.
7.
8.
9.

10,

11.
12.
13.
14.
15.

NOTES:

JOB TITLE / RESPONSIBILITY SIGNATU RE (1)

DATE SIGNATURE (2) DATENOTE NUREG-1021, Revision 8, Supplement 1 24 of 24

(,

(

(

DRESDEN rxi.xmrnla~i~n Z-,*Pni Ilrlv Mnr~rl~m~n?

1.

Pre-Examination I acknowledge that I have acquired specialized knowledge about the NRC licensing examinations scheduled for the week(s) ofi./*/z _77'7/- z. as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

,,6*

I

!s J3/25 0%/7/Z) o/nY

2.

Post-Examination To the best of my knowledge I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of-t--.

From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME

2.
3.

4._

5._

6._

7._

8._

9._

10.
11.
12.
13.
14.

15.

JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) DATENOTE

--A4 ---------

-- - - - - - - - -7 NOTES:

NUREG-1021, Revision 8, Supplement 1 24 of 24

DRESDEN ES-201 Examination 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) of Z//.

-as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to faciility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

,'.,c,4,,

c'-[

2.

Post-Examination To the best of my knowllede*j,id not divulge to 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 instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2)

DATENOTE 1

3 ---

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87.

~~------------------------------------

10.

11------------------------------------------

11.

12.-..

13.
14.

NOTES:

NUREG-1021, Revision 8, Supplement 1 24 of 24

(

(

(

DRESDEN ES-201 Examination SecurityAgreement 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) of

/

as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

/<e,/

e o1 44,ie

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4 3

2.

Post-Examination To the best of my knowledge, I did not divulge to 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 instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME

1. ýDL-1-.,,MQ:Zpq.l
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

NOTES:

JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) flATI:nT-*T

-- - - - -11'-

V NUREG-1021, Revision 8, Supplement 1 24 of 24

(

(

(

DRESDEN ES-201 Examination 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) as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised.

1 2-1/ 1 j',

C

2.

Post-Examination To the best of my knowledge, I did not divulge to 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

, t did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME

2. - W 7 -
3.
4.
5.
6.

7.------------------

8.
9.
10.
11.
12.
13.
14.
15.

NOTES:

JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) DATENOTE

~~~~

NUREG-1021, Revision 8, Supplement 1 24 of 24

(

(

DRESDEN ES-201 Examination 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) of ý

-L

.as of the date of my signature. I agree that I will not knowingly divulge any information about these examinations to any persons who have not been authorized by the NRC chief examiner. I understand that I am not to instruct, evaluate, or provide performance feedback to those applicants scheduled to be administered these licensing examinations from this date until completion of examination administration, except as specifically noted below and authorized by the NRC.Furthermore, I am aware of the physical security measures and requirements (as documented in the facility licensee's procedures) and understand that violation of the conditions of this agreement may result in cancellation of the examinations and/or an enforcement action against me or the facility licensee. I will immediately report to facility management or the NRC chief examiner any indications or suggestions that examination security may have been compromised. /<ui~

o f J

/.

S-,tc'<,7

2.

Post-Examination To the best of my knowledge, I did not divulge to any unauthorized persons any information concerning the NRC licensing examinations administered during the week(s) of ý. -Z,-

From the date that I entered into this security agreement until the completion of examination administration, I did not instruct, evaluate, or provide performance feedback to those applicants who were administered these licensing examinations, except as specifically noted below and authorized by the NRC.

PRINTED NAME JOB TITLE / RESPONSIBILITY SIGNATURE (1)

DATE SIGNATURE (2) DATENOTE

2.
3.
4.

3 ----

6.5.

7.------------------

8.
9.

~~~---

12.------------------

10.

14.1

13.
15.

NOTES:

NUREG-1021, Revision 8, Supplement 1 24 of 24

(

ES-301 O;erating Test Quality Checklist Form ES-301-3 SQ,6-5 tyateof Examination--61/

Operating Test Numberv,,

1, Initials

1. GENERAL CRITERIA a

b" ce

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 function distribution) 1, 40

b.

There is no day-to-day repetition between this and other operating tests to be administered during this examination 1.40 !:(.1 c

The operating test shall not duplicate items from the applicants' audit test(s)(see Section D.1.a).

,.1

d.

Overlap with the written examination and between operating test categories is within acceptable lim its.,,

0 *

e.

It appears that the operating test will differentiate between competent and less-than-competent applicants at the designated license level.

2. WALK-THROUGH (CATEGORY A & B) CRITERIA
a.

Each JPM includes the following, as applicable:

  • initial conditions
  • initiating cues
  • references and tools, including associated procedures
  • reasonable and validated time limits (average time allowed for completion) and specific designation if deemed to be time critical by the facility licensee

. specific performance criteria that include:

r'A.,

=

- detailed expected actions with exact criteria and nomenclature

- system response and other examiner cues

- statements describing important observations to be made by the applicant

- criteria for successful completion of the task

- identification of critical steps and their associated performance standards

- restrictions on the sequence of steps, if applicable

b.

the prescripted questions in Category A are predominantly open reference and meet the criteria in Attachment 1 of ES-301.

i4.e

c.

Repetition from operating tests used during the previous licensing examination is within acceptable limits (30% for the walk-through) and do not compromise test integrity.

d.

At least 20 percent of the JPMs on each test are new or significantly modified.

A/vY

3. SIMULATOR (CATEGORY C) CRITERIA
a.

The associated simulator operating tests (scenario sets) have been reviewed in accordance with

[:1*

Form ES-301-4 and a copy is attached.

4 Printed Name / Signature Date

a. AuthorNAA 0T7UZ aIP5
b. Facility Reviewer(*)
c. NRC Chief Examiner (#)

A2i Vzi

(

/Yk,.

,//

d. NRC Supervisor 6711

__"I NOTE:

' The facility signature is not applicable for NRC-developed tests.

  1. Independent NRC reviewer initial items in Column "c;" chief examiner concurrence required.

23 of 26 NUREG-1021, Revision 8, Supplement I Exam Submittal I

ES-301 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO.: ILT 01-1 Applicant Evolution Minimum Scenario Number Type Type Number

______ILT-N-1 ILT-N-2 ILT-N-3 Reactivity 1

1 2

2 Normal 1

2 1"

1 RO Instrument!

4 3*-4/

4, 5*/

4*,6/

Component 5, 6*

3, 6*

3, 5*

_Major 1

7 7

7 RO in position as ANSO Reactivity 1

1 2

2 Normal 0

2 0

0 As RO Instrument 2

4/

4/

6/

Component 5

3 3

Major 1

7 7

7 SRO-I Reactivity 0

1 2

2 Normal 1

2 1

1 As SRO Instrument/

2 3,4/

4, 5/

4,6/

Component 5, 6 3, 6 3, 5 Major 1

7 7

7 Reactivity 0

Normal 1

No SRO-U Candidates SOU Instrument /

2 for IL T01-1 I C o m p o n e n t 1

F Major 1

Instructions:

Author:

NRC Reviewe (1)

Enter the operating test number and Form ES-D-1 event numbers for each evolution type.

(2)

Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.4.d) but must be significant per Section C.2.a of Appendix D.

(3)

Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant' competence count toward the minimum requirement.

r:

NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal

ES-301 Transient and Event Checklist Form ES-301-5 OPERATING TEST NO.: ILT 01-1 Instructions:

Author:

NRC Reviewe (1)

Enter the operating test number and Form ES-D-1 event numbers for each evolution type.

(2)

Reactivity manipulations may be conducted under normal or controlled abnormal conditions (refer to Section D.4.d) but must be significant per Section C.2.a of Appendix D.

(3)

Whenever practical, both instrument and component malfunctions should be included; only those that require verifiable actions that provide insight to the applicant's competence count toward the minimum requirement.

r:

NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal

Competencies Checklist Form ES-301-6 Comply With and Use Procedures (1)

Competencies Understand and Interpret Annunciators and Alarms Diagnose Events and Conditions Understand Plant and System Response Operate Control Boards (2)

Communicate and Interact With the Crew Demonstrate Supervisory Ability (3)

Comply With and Use Tech. Specs. (3)

Notes:

(1) Includes Technical Spec (2) Optional for an SRO-U.

(3) Only applicable to SROs 3-I8 2, 4 t # 2 7-8plicant

  1. 3 QR6-RO-U

/S*

RO-U kZORO-I/SRO-U t____

5, 7, 8 SRO PosiL o

NSO Position ANSO Position SCENARIO SCENARIO SCENARIO ILT-N-1 ILT-N-2 ILT-N-1 IILT-N-2 ILT-N-1 ILT-N-2 3-8 3-8 1, 2, 4, 2-4, 7-8 3, 6, 7, 8 1, 5-8 5,

7, 8

3-8 3-8 1, 2, 4, 2-4, 5, 3, 6, 7, 811, 5-8 5,7,8 7-8 1-8 1-8 1-8 2-4, 5, 3-8 1, 5-8 7-8 1-8 1-8 1, 2, 4, 2-4, 7-8 3, 6, 7, 8 1, 5-8 5, 7,8 N/A N/A 1, 2, 4, 2-4, 7-8 3, 6, 7, 8 1, 5-8 7,8 1-8 1-8 1-8 2-4, 5, 1, 3-8 1, 4-8 7-8 1-8 1-8 N/A N/A N/A N/A 4

4 NcA NaA NfA aInNA ification compliance for an RO.

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 every applicant.

Author:

N R C R e v ie w e r:

1 NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal ES-301

ES-301 Competencies Checklist Form ES-301-6 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 every applicant.

Author:

NRC Reviewer:

Ar/* //

A NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal

ES-301 Oh Form ES-301-6 Understand and Interpret Annunciators and Alarms 1,3-9 5-9 1, 3, 4, 7-9 Diagnose Events and Conditions 3-9 5-9 3, 4, 7-9 Understand Plant and System Response 1-9 2,4-9 1,3,4, 7-9 Comply With and Use Procedures (1) 1-9 2, 5-9 1, 3, 4, 7-9 Operate Control Boards (2)

NA 2,n5-9 1,3,4, 7-9 Communicate and Interact With the Crew 1-9 2, 4-9 1, 3, 4, 7-9 Demonstrate Supervisory Ability (3) 1-9 NIAN/

Comply With and l Use Tech. Specs. (3)N/NA Notes:

(1) Includes Technical Specification compliance 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 every applicant.

Author:

NRC Reviewer:

'"/

A NUREG-1021, Revision 8, Supplement 1 Rev 1 Exam Submittal

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

[Facility: Dresden U2/U3 Date of Exam: 6/14/2002 Exam Level: RO/SRO Initials Ifi.m fl

.pc riptfinn a

b c

1.

Clean answer sheets copied before grading l,____

2.

Answer key changes and question deletions justified and documented

3.

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

4.

Grading for all borderline cases (80% +/- 2%) reviewed in detail tr7 l"

5.

All other failing examinations checked to ensure that grades are justified

6.

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 7,'911,
b. Reviewer(*)

7_____,_____-____-___

c. NRC Chief Examiner (*)

6

//

7/Ž,'2

d. NRC Supervisor (*)

./"'*

/

/-"

(*)

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

5 of 5 NUREG-1021, Revision 8, Supplement 1