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{{#Wiki_filter:NRC FORM 591M PART 1                                                                                             U.S. NUCLEAR REGULATORY COMMISSION
{{#Wiki_filter:SAFETY INSPECTION REPORT AND COMPLIANCE INSPECTION
  (07-2012)
NRC FORM 591M PART 1
  10 CFR 2.201
U.S. NUCLEAR REGULATORY COMMISSION
                                    SAFETY INSPECTION REPORT AND COMPLIANCE INSPECTION
(07-2012)
1. LICENSEE/LOCATION INSPECTED                                                         2. NRC/REGIONAL OFFICE
10 CFR 2.201
   Princeton Community Hospital                                                         Region 1
1. LICENSEE/LOCATION INSPECTED
  12th Street Extension                                                                 2100 Renaissance Blvd
2. NRC/REGIONAL OFFICE
  Princeton, WV 24740                                                                   Suite 100
REPORT NUMBER(s)    
                                                                                        King of Prussia, PA 19406-2713
Princeton Community Hospital
REPORT NUMBER(s) 2021001
12th Street Extension
3. DOCKET NUMBER(S)                                 4. LICENSE NUMBER(S)                                       5. DATE(S) OF INSPECTION
Princeton, WV 24740
  030-10772                                          47-16307-01                                                03/04/2021 though
Region 1
                                                                                                                  4/6/21
2100 Renaissance Blvd
LICENSEE:
Suite 100
  The inspection was an examination of the activities conducted under your license as they relate to radiation safety and to compliance with the
King of Prussia, PA 19406-2713
  Nuclear Regulatory Commission (NRC ) rules and regulations and the conditions of your license. The inspection consisted of selective examinations of
2021001
  procedures and representative records, interviews with personnel, and observations by the inspector. The inspection findings are as follows:
4.
        1. Based on the inspection findings, no violations were identified.
LICENSE NUMBER(S)
  o     2. Previous violation(s) closed.
3.
  o      3.The violations(s), specifically described to you by the inspector as non-cited violations, are not being cited because they were self-identified,
DOCKET NUMBER(S)
        non-repetitive, and corrective action was or is being taken, and the remaining criteria in the NRC Enforcement Policy, to exercise discretion, were
47-16307-01
        satisfied.
030-10772
                          Non-cited violation(s) were discussed involving the following requirement(s):
5. DATE(S) OF INSPECTION
  o     4. During this inspection, certain of your activities, as described below and/or attached, were in violation of NRC requirements and are being
03/04/2021 though  
        cited in accordance with the NRC Enforcement Policy. This form is a NOTICE OF VIOLATION, which may be subject to posting in accordance
4/6/21
        with 10 CFR 19.11. (Violations and Corrective Actions)
LICENSEE:
                                                                  Statement of Corrective Actions
The inspection was an examination of the activities conducted under your license as they relate to radiation safety and to compliance with the  
  I hereby state that, within 30 days, the actions described by me to the Inspector will be taken to correct the violations identified. This statement of
Nuclear Regulatory Commission (NRC ) rules and regulations and the conditions of your license. The inspection consisted of selective examinations of  
  corrective actions is made in accordance with the requirements of 10 CFR 2.201 (corrective steps already taken, corrective steps which will be taken,
procedures and representative records, interviews with personnel, and observations by the inspector. The inspection findings are as follows:
  date when full compliance will be achieved). I understand that no further written response to NRC will be required, unless specifically requested.
 
            TITLE                                 PRINTED NAME                                           SIGNATURE                                         DATE
1. Based on the inspection findings, no violations were identified.
LICENSEE'S                        Sherri Snead, Director of Imaging
o
REPRESENTATIVE
2. Previous violation(s) closed.
NRC INSPECTOR                     Robin Elliott
3.The violations(s), specifically described to you by the inspector as non-cited violations, are not being cited because they were self-identified,
                                                                                                                                                        4/7/21
non-repetitive, and corrective action was or is being taken, and the remaining criteria in the NRC Enforcement Policy, to exercise discretion, were
                                  Donna Janda                                                                         Digitally signed by Donna M.
satisfied.
BRANCH CHIEF
Non-cited violation(s) were discussed involving the following requirement(s):  
                                                                                            Donna M. Janda            Janda
o
                                                                                                                      Date: 2021.04.27 16:06:42 -04'00'
o
NRC FORM 591M PART 1 (07/2012)                                                                                                                                  Page 1 of 1
4. During this inspection, certain of your activities, as described below and/or attached, were in violation of NRC requirements and are being
cited in accordance with the NRC Enforcement Policy. This form is a NOTICE OF VIOLATION, which may be subject to posting in accordance
with 10 CFR 19.11. (Violations and Corrective Actions)
I hereby state that, within 30 days, the actions described by me to the Inspector will be taken to correct the violations identified. This statement of  
corrective actions is made in accordance with the requirements of 10 CFR 2.201 (corrective steps already taken, corrective steps which will be taken,  
date when full compliance will be achieved). I understand that no further written response to NRC will be required, unless specifically requested.
TITLE
PRINTED NAME
SIGNATURE
DATE
Statement of Corrective Actions
Sherri Snead, Director of Imaging
Robin Elliott
Donna Janda
LICENSEE'S
REPRESENTATIVE
NRC INSPECTOR
BRANCH CHIEF
NRC FORM 591M PART 1 (07/2012)
Page 1 of 1
4/7/21
Donna M. Janda
Digitally signed by Donna M.  
Janda  
Date: 2021.04.27 16:06:42 -04'00'
}}
}}

Latest revision as of 03:59, 16 March 2025

Princeton Community Hospital, NRC Form 591M Part 1, Inspection Report 03010772/2021001
ML21118A067
Person / Time
Site: 03010772
Issue date: 03/04/2021
From: Robert Elliott
NRC Region 1
To:
Princeton Community Hosp
References
IR 2021001
Download: ML21118A067 (1)


See also: IR 07200202/2010001

Text

SAFETY INSPECTION REPORT AND COMPLIANCE INSPECTION

NRC FORM 591M PART 1

U.S. NUCLEAR REGULATORY COMMISSION

(07-2012)

10 CFR 2.201

1. LICENSEE/LOCATION INSPECTED

2. NRC/REGIONAL OFFICE

REPORT NUMBER(s)

Princeton Community Hospital

12th Street Extension

Princeton, WV 24740

Region 1

2100 Renaissance Blvd

Suite 100

King of Prussia, PA 19406-2713

2021001

4.

LICENSE NUMBER(S)

3.

DOCKET NUMBER(S)

47-16307-01

030-10772

5. DATE(S) OF INSPECTION

03/04/2021 though

4/6/21

LICENSEE:

The inspection was an examination of the activities conducted under your license as they relate to radiation safety and to compliance with the

Nuclear Regulatory Commission (NRC ) rules and regulations and the conditions of your license. The inspection consisted of selective examinations of

procedures and representative records, interviews with personnel, and observations by the inspector. The inspection findings are as follows:

1. Based on the inspection findings, no violations were identified.

o

2. Previous violation(s) closed.

3.The violations(s), specifically described to you by the inspector as non-cited violations, are not being cited because they were self-identified,

non-repetitive, and corrective action was or is being taken, and the remaining criteria in the NRC Enforcement Policy, to exercise discretion, were

satisfied.

Non-cited violation(s) were discussed involving the following requirement(s):

o

o

4. During this inspection, certain of your activities, as described below and/or attached, were in violation of NRC requirements and are being

cited in accordance with the NRC Enforcement Policy. This form is a NOTICE OF VIOLATION, which may be subject to posting in accordance

with 10 CFR 19.11. (Violations and Corrective Actions)

I hereby state that, within 30 days, the actions described by me to the Inspector will be taken to correct the violations identified. This statement of

corrective actions is made in accordance with the requirements of 10 CFR 2.201 (corrective steps already taken, corrective steps which will be taken,

date when full compliance will be achieved). I understand that no further written response to NRC will be required, unless specifically requested.

TITLE

PRINTED NAME

SIGNATURE

DATE

Statement of Corrective Actions

Sherri Snead, Director of Imaging

Robin Elliott

Donna Janda

LICENSEE'S

REPRESENTATIVE

NRC INSPECTOR

BRANCH CHIEF

NRC FORM 591M PART 1 (07/2012)

Page 1 of 1

4/7/21

Donna M. Janda

Digitally signed by Donna M.

Janda

Date: 2021.04.27 16:06:42 -04'00'