ML15216A116

2015 Monticello Nuclear Generating Plant Initial License Examination Form ES-201-3

ML15216A116
Person / Time
Site:	Monticello
Issue date:	06/05/2015
From:	McNeil D R NRC/RGN-III/DRS/OLB
To:	Northern States Power Co
References
Download: ML15216A116 (9)

Text

i QF-1071-0*1 'JV. 2 (FP-T-SAT-7 1) j fl Xcel Energ y-\ MASTER SECURITY AGREEMENT l:'P f 2 ---= T he M as t e r Security Agr ee m ent i s used for t hose personnel having both knowledge of Exam Sens itiv e Mate ri al and unr estric t e d access to Pr imary and Secon da ry Containment.

1. Pr e-Examination (Review FP-T-SAT-71 , Attach ment 1 for pre-job briefi n g re qu i remen t s) ! ackno w ledge t ha t I h a ve acq uire d specia li zed knowledge about the 2015 MNGP I LT NRC exam i nation scheduled for t he date of 06-01-15. As of the da te of my signature, I agree that I will not knowingly divulge any information about these examinat i ons to any persons who have not bee n authoriz ed by an Operat ions Train i ng Supervisor. I understand that I am not to instruct or provide performance feedback to t hose i ndividuals scheduled to be administere d these examinations from this date until completion of examination administrat i on. I also understand t ha t I a m not to evaluate indiv i du als schedu led to be adm i nistered these examinations from this date until the date of adm i nist r ation. Act i ng as a simulato r bo ot h operator or commu nica tor is acceptable i f I do not select the training con t ent or provide d ir ect or i ndirect feedback to an exa mi nee. Furthermore , l am awa re of t he physica l security measures and requirements (as documented in NSPM procedures) and u n d ers tan d that vio ia t ion of th e conditions o f th is ag r eemen t may result in cancellation of the examinations and/or an enforcement action aga i nst m y facility o r me. ! w ill immedia tel y report to the E xa m Pro ject Manager any i ndications or suggestions that examinat i on sec u r ity may h a ve bee n compromised.

2. Post-Exami nati on To the best o f my knowled ge , I did n ot divu lg e to any unauthorized persons any information concerning the exam in ations ad min i s ter ed dur in g the dat e(s) of . From th e date that I entered into th i s security agreement until the comp l et i on of exam i nat i on ad m ini stration , i did not instruct, ev a luate , or provide performance feedback to those individua l s who were administered these exa m inatio ns. Retention:

Li fe of Plant Re tai n in: Exam Fi le SIGNATURE (!) DATE NOTE (,-15-!5 --

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6/15/15 tdt'S"h5'-I ,. 'I ---

QF-1071-0. 2v. 2 fF P-T-SAT-71\

________ . I '(! Xcel Energ y-/ I ' MASTER SECURITY AGREEMENT T he Master Secur i ty Agre e me nt i s use d for those personne l having both know l edge of Exam Sens i t i ve Material and u nrestricted access to P ri ma ry and Seco nd a r y C o ntainment.

8. 9. 10. i 1. 12. 1 3. 14. 15. NOTES: PRINTE D NAME \ t .)Lf'C 7 .k Ls OA Re t ention: Li fe of Pl ant Re t a i n in: Exam File JOB T I T LE I RE S PO NSIB I LIT Y S I GNATURE (1) 9¥74 S I GNA T URE (2) D AT E N O TE t/l s/15 QF-1071 '2 v. 2 (F P-T-S J\T-71) f2 i '(l Xcel Energy-LIMITED SECURITY AGREE MENT \ ---**-------*--------*----------' The Li m i ted Secur it y Agre e ment i s used for t hose personnel having limited k nowledge of Exam Sens i tiv e Material but do not have unre s t ricte d access t o Primary an d Seconda r y Containment.

1. Pre-E xamination (Review FP-T-S A T-7 1, Attachment 1 for pre-job briefing requirements)

I ackn o w le d ge that I have a cquired specialized k nowledge about the 2015 MNGP IL T NRC examination scheduled f o r the date o f 06-01-15. A s of th e d at e o f m y signa tu r e , I agree that I will not know ingly divulge any i nformation a bou t this examination t o any per sons who h a ve not been auth oriz ed by an Operat i ons T r aining Superv i sor .. I und e rst and that I am not to i ns tr uct o r prov ide p erf ormance f eedbac k to those i nd i viduals s che du le d to be administered these exami nat ions fro m this date until completion of examination adm i nist ra tion. l also understan d tha t I am not to ev a l uate i nd i viduals scheduled to be administered these examinations from this date until the date o f adm inis t rat ion. Acting as a simulato r bo o t h operato r o r communicator is acceptable if I do not select the training con t ent or provide di r ect or indirect feedback to an exam i nee. Furth e r more , I am aware of t he phys ica l security measures and requirements (a s documented i n NSPM procedures) and under s tand that v iolat ion of t he c o nditions of this agreement may result in cancellation of the examination and/or an enforcement action against my facility or me. I w i ll im me d iately report to the Exam Project Manager any indications or suggestions that examination security may ha ve be en compromised. 2. Po s t-E xam i na ti on 1. ,., L. 3. 4. 5. To the b e st of m y know l edge , I did not divulge to any unauthorized persons any information concerning the exa m i nation adm i ni s t ered dur i ng the d a t e(s) o f . From the date that I entered into this security agreement until the completio n of this exam inat i on adminis trat i o n, i did not instruct, evaluate , or provide performance feedback to those individuals who were adm i nistered t h is exam i nation. F u rt h e r mo r e , I agree t o NOT discuss any aspects associated with the contents of this examinat i on with ANY examinee until the completion o f t he ir ex aminatio n admin i stration.

I further understand that violation of the conditions of this ag r eement may result in cancellation of the exam i n ati on a n d/or enforcemen t action again st t he facility l i censee o r me. Ret e nti o n: Life o f p la n t Retain in: Exam file Form reta ined in a c cordance with record reten tion schedule identified i n FP-G-RM-01.

QF-1Q7*i-Oi , (FP-T-SAT-71) I fl Xcel Energy-I LIMITED sEcuR1TY AGREEMENT

• -*----1 The Limit ed Sec ur ity Agreement is used for those personnel having lim i ted knowledge of Exam Sensit i ve Ma terial but do not have unre str i cted acce s s to Primary and Secondary Cont ainmen t. 6. 8. S. j\ PRINTAD N,AME 1 t_ t, v e ,-;I I Sc:-crn-Do \/vQ 10.

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15. _ _/{ 6fll _ _/lf-Low NOTES: Ret e n tio n: Life of pia nt Re t ain i n: Exam file JOB TITLE S& O /JOJ' Form r etained in accordance with record retent i o n schedule ide n tified in FP-G-RM-01. DATE ll/;o/, 1 f D ATE NOTE tRlut/t{'

---r r1 /f 5. <Pl1c,}1 r---(,,*tJ.*IS' ?/(f!1r-__

v. 2 (FP-T-SA T-71) Paf, .

>f 2 LIMITED SECURITY AGREEMENT The limited Security Agreement is used for those personne l having limited knowledge of Exam Sensitive Material but do not have unrest rict ed ac cess to Primary and Secondary Containment.

1. Pr e-Examination

{Review FP-T-SAT-71, Attachment 1 for pre-job briefing requirements)

I acknowledge that I have acquired specialized knowledge about the 2015 MNGP ILT NRC examination scheduled for the date of 06-01-15.

As of the date of my signature, I agree that I will not knowingly divulge any information about this examination to any persons who have n o t been authorized by an Operations Training Supervisor

.. I unde r stand that I am not to instruct or provide performance feedback to those indiv i duals sch eduled to be administered these examinations from this date until complet io n of examinat i on administrat i on. I also understand that I am not t o evaluate individuals scheduled to be administered these examinations from this date until the date of administration.

Acting as a simulator boo th operator or communicator is acceptable if I do not select the training content or provide direct or i ndirect feedbac k to an examinee. Furth ermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) a n d understand that violati on of th e conditions of this agreement may result in cancellation of the examination and/or an enforcement act i on against my faci l ity or me. I will imm ediately report to the Exam Project Manager any indications or suggestions that exam i nat i on security may h a v e been compromised. 2. Post-E xamination To the best of my knowledge, I did* not divulge to any unauthorized persons any info rmation concern i ng the exam i nat ion administered du ri ng the date(s) of_ . From the date that I entered into this security agreement unt il the completion of this examinat i on a dministration, f did not instruc t. evaluate, or provide performance feedback to those individuals who were administered this exam inatio n. Furthermore, I agree to NOT discuss any aspects associated with the contents of this examina ti on with ANY examinee until the comp l e ti on of t heir examination administration. J further understand that violation of the conditions of this agreement may result in cancellation of the examination and/or enforcement a0ion against the facility licensee or me. R etention:

Life of plant R etain in: Exam file F orm retained in accordance with record retention schedule identified in FP-G-RM-01. i I I I I I I I I I I I I I I I I I I I QF-1071-C

.;v. 2 (F P-T-SAT-7 1) I fl Xcel Energy I LIMITED SECURITY AGREEMENT T he Li mi t ed Security Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted a cce s s to Primary and Secondary Containment.

1. Pr e-E xamination (Rev i ew FP-T-S AT-71 , Attachment 1 for pre-job briefing requirements)

I ackn owledge t h at I have acquired speci alized knowledge about the 2015 MNGP IL T NRC examination scheduled for the date of 06-01-15. As of t h e date of my signature, I agree t hat I will not knowingly divulge any information about this examination to any persons who have not been au th o r i zed by an Op e rat ions Training Supervisor

.. I understand that I am not to instruct or provide performance feedback to those individuals sch e d uled to be adm i nistered these examinations from this date until completion of examination administration.

I also understand that I am no t to e va l uate i ndividuals scheduled to be admin i stered these examinations from this date until the date of admin i stration. Acting as a simulator bo oth o perator or communic a tor is a cceptable if I do not select the training content or prov i de direct or indirect feedback to an examinee.

Fu rthermore, I am aware of the physical security measures and requirements (as documented in NSPM procedures) and understand that viol a t ion o f the conditions of thi s ag r eement may result in cancellation of the examination and/or an enforcement action against my facility or me. I will i m med i ate l y report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.

2. Po st-Exam i nation 1. 2. To the best of my k n owledge, I did n ot divulge to any unauthorized persons any information concerning the examination administered during the da te (s) of . From the date that I entered into this security agreement until the completion of this exam i nation ad m i n i stration , I d i d not i nstruct , ev a luate , or provide performance feedback to those individuals who were administered this examination. Furth ermore , I agree to NOT discuss any aspects associated with the contents of th i s examination with ANY examinee until the completion of the ir examination administration.

I further understand that violation of the conditions of this agreement may result in cancellation of the ex amination and/or enforce men t ac t ion aga i ns t the facility licensee or me. P RINTED NAME JOB TITLE I RESPONSIBILITY

JC PG V\ Ks <Ro je s Sr \n

________

3_ _____ .........

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______

5. JOA"

<1 Ao ------------Retenti on: Li fe of plant R et a in in: Exam file Fo rm retai ned in acco r dance with record retention schedule identified in FP-G-RM-01.

Q F-1 071-02, .. c v. 2 (F P-T-SAT-7 1) Pag f2 LIMITED SECURITY AGREEMENT The li m it ed Security Agreement i s use d for those personnel having limited knowledge of Exam Sensitive Material but do not have unrestricted a c cess to Primary and Secondary Containment.

6. 7. 8. 9. P RINTED NAME f)ofliv...

6 A1 lf Ic;J uxPr J crz JS l) NE I ,_l 0 12. ,/r/ ,./!vb I tv" c1 13. Bllt.MV W.aeNttr ;:

NOTES: R e tention: Life of plant R e tai n in: Exam file JOB TI TLE I RESPONSIBILITY S v(o .SRO NlJ clew Btirli (Jr trrlt:VYL DPS IMS:n i u.(:fr:,:.,;L F o r m r eta i ne d in accordance with record retention schedule i dentified in FP-G-RM-01.

'--------.,..--*-----*---

• Xcel.Enerav-i

,,P.J I LIMITED SECURITY AGREEMENT The Limited Secu1ity Agreement is used for those personnel having limited knowledge of Exam Sensitive Material but .. do not have access to Primary and . . . 1. Pre-Examination

{Review FP-T .SAT-71, Attachment 1 for r:ire-job briefing requirements)

I acl<novvledge that i have acquired specialized knowledge about the 2015 MNGP !LT NRC examination scheduled for the date of 06-01-15.

As of the date of my signature, l agree that I v1m no!"khowingiy"divufge any° information about this examination to any persons who have not been authorized by an Operations Training Supervisor

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

r also uffderstand that 1 am, !!Pt to evaluate individuals scheduled to be administered these examinations from this date until the date of administration.

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

Furthermore, l am aware of the physical security measures and req.uirements (as documented in NSPM procedures) and understand that violation of the conditions of this agre-ement may result in cancellation of the examination and/or an action against myfac!lity or me. ! 'NiH lmmedlately report to the Exam Project Manager any indications or suggestions that examination security may have been compromised.

2. P,:ist-Examination

4. To the of my knowledge, l did not divulge to any unauthorized persons any information concerning the examination administered during the date( s) of** . From the date that I, entered into this security agreement until the completion qf this examination administration, ! did not instruct, evaluate, or provide performance feedback to those individuals who were admii:iistered this examination.

Furtherrr:ore, l agree to NOT d!scuss any aspects associated wtth the contents of this examination vvith ANY examlnee completion of their examlnation administration.

l further understand that violation of the et,)nditions of this agreement may result in cancellation of the examlnation and/or enforcement action against the facility licensee or me. PRINTED N/;,,ME ,JOB TITL.E I RESPONS!BIUTY DATE NOTE t>Atc 1 _.,iv) ..-\<--. .,.,, , 1 It,,,,.'\[_;.,

• VlrJ

.. R.r;tentlon:

Life of ulant Retaln ir;: Exam \*ne Fom1 retain$d in accordance v.tith record retention schedule identified in F?-G-Rl\li-01.

QF-'i0/1-02, .. ..;v. 2 (F P-T-SAT-71) Pa g f 2 LIMITED SECURITY AGREEMENT The Limi t e d Se cu rity Agreeme n t i s u sed for those personnel having limited knowledge of Exam Sensitive Material but do not have u nres t ricted access t o Pr i m a ry a n d Se c ondary Conta i nment. PR I NT E D NA M E 6. \)S.,O._E,\(

7. r)_o(lrr-..

6Allf ie;JElA+-l NOTES: Rete nt i on: Life of p l a n t R e ta in in: E x a m fi l e J OB TI TL E I RESPONSIBILITY 12.o Sr<.o Form ret a ined in a cc ord a n ce w i th r ecord reten ti o n schedule identified in FP-G-RM-01. SIGNATURE (2) DATE NOTE