SEWS 8.2.2 MOV (1 of 4) Sheet 1 of \_\_\_\_\_\_

+------------------------------------+----------------+---------------+
| **SCREENING EVALUATION WORK SHEET  |                |               |
| (SEWS)**                           |                |               |
+------------------------------------+----------------+---------------+
| **Equipment ID No.:**              | **Equipment    |               |
|                                    | Class:         |               |
|                                    | Motor-Operated |               |
|                                    | Valves**       |               |
+------------------------------------+----------------+---------------+
| Equipment description:             |                |               |
+------------------------------------+----------------+---------------+
| Equipment Location: Bldg.          | Floor El.      | Room,         |
|                                    |                | Row/Col.      |
+------------------------------------+----------------+---------------+
| Manufacturer, model, etc.:         |                |               |
+------------------------------------+----------------+---------------+
| Smallest pipe diameter attached to |                |               |
| valve:                             |                |               |
+------------------------------------+----------------+---------------+
| Pipe centerline to top of motor    |                |               |
| actuator length:                   |                |               |
+------------------------------------+----------------+---------------+
| Valve material:                    | Yoke material: |               |
+------------------------------------+----------------+---------------+
| Weight:                            |                |               |
+------------------------------------+----------------+---------------+
| Drawing No.:                       | Performance    |               |
|                                    | Category:      |               |
+------------------------------------+----------------+---------------+
| ***Functionality Requirement***    |                |               |
+------------------------------------+----------------+---------------+
| q Contact Lead Relay Reviewer to   |                |               |
| determine if item contains         |                |               |
| Essential Relays                   |                |               |
|                                    |                |               |
| q For components whose function or |                |               |
| structural integrity is required,  |                |               |
| complete all sections of this      |                |               |
| form.                              |                |               |
|                                    |                |               |
| q For all other components, only   |                |               |
| anchorage evaluation is required.  |                |               |
+------------------------------------+----------------+---------------+
| ***Seismic Capacity vs. Demand     |                |               |
| (Chapter 5)***                     |                |               |
+------------------------------------+----------------+---------------+
| 1\. Seismic Capacity based on:     |                |               |
|                                    |                |               |
| q Reference Spectrum               |                |               |
|                                    |                |               |
| q GERS                             |                |               |
|                                    |                |               |
| q Existing documentation           |                |               |
|                                    |                |               |
| 2\. Elevation where equipment      |                |               |
| receives seismic input             |                |               |
|                                    |                |               |
| Seismic Demand Spectrum (SDS)      |                |               |
| based on:                          |                |               |
|                                    |                |               |
| q In-structure response spectrum   |                |               |
| (IRS) per DOE-STD-1020             |                |               |
|                                    |                |               |
| q Other in-structure response      |                |               |
| spectrum (determine appropriate    |                |               |
| experience data                    |                |               |
|                                    |                |               |
| scale factor)                      |                |               |
|                                    |                |               |
| q Design basis earthquake (DBE)    |                |               |
| per DOE-STD-1020                   |                |               |
|                                    |                |               |
| q Other                            |                |               |
|                                    |                |               |
| Scale Factor (SF) Experience Data  |                |               |
| Factor (F~ED~)                     |                |               |
|                                    |                |               |
| Does capacity exceed demand? Y N U |                |               |
|                                    |                |               |
| Reference:                         |                |               |
+------------------------------------+----------------+---------------+
| ***Caveats (Section 8.2.2)***      |                |               |
+------------------------------------+----------------+---------------+
| *Reference Spectrum* (Identify     |                |               |
| with an asterisk (\*) those        |                |               |
| caveats which are met by intent    |                |               |
| without meeting the specific       |                |               |
| wording of the caveat rule and     |                |               |
| explain the reason for this        |                |               |
| conclusion in the COMMENTS section |                |               |
| below)                             |                |               |
+------------------------------------+----------------+---------------+
| 1\. Equipment is included in       |                |               |
| earthquake experience equipment    |                |               |
| class Y N U N/A\                   |                |               |
| 2. No cast-iron body Y N U N/A\    |                |               |
| 3. No cast-iron yoke Y N U N/A     |                |               |
+------------------------------------+----------------+---------------+

SEWS 8.2.2 MOV (2 of 4) Sheet 2 of \_\_\_\_\_\_

+------------------------------------+---------------------------------+
| **SCREENING EVALUATION WORK SHEET  |                                 |
| (SEWS) (Cont.)**                   |                                 |
+------------------------------------+---------------------------------+
| **Equipment ID No.:**              | **Equipment Class:              |
|                                    | Motor-Operated Valves**         |
+------------------------------------+---------------------------------+
| Equipment description:             |                                 |
+------------------------------------+---------------------------------+
| ***Caveats (Cont.)***              |                                 |
+------------------------------------+---------------------------------+
| 4\. Mounted on 1-inch diameter     |                                 |
| pipe or larger Y N U N/A\          |                                 |
| 5. Centerline of pipe to operator  |                                 |
| within restrictions or yoke can    |                                 |
| take\                              |                                 |
| static 3g load Y N U N/A\          |                                 |
| 6. Actuator and yoke not braced    |                                 |
| independently from pipe Y N U N/A\ |                                 |
| 7. Have you looked for and found   |                                 |
| no other adverse concerns? Y N U   |                                 |
| N/A\                               |                                 |
| \                                  |                                 |
| Is the intent of all the caveats   |                                 |
| met for Reference Spectrum? Y N U  |                                 |
| N/A                                |                                 |
+------------------------------------+---------------------------------+
| *GERS* (Identify with an asterisk  |                                 |
| (\*) those caveats which are met   |                                 |
| by intent without meeting the      |                                 |
| specific wording of the caveat     |                                 |
| rule and explain the reason for    |                                 |
| this conclusion in the COMMENTS    |                                 |
| section below)                     |                                 |
|                                    |                                 |
| (Note that GERS for this class     |                                 |
| apply to [only]{.underline} motor  |                                 |
| operator and its connection to     |                                 |
| valve; valve itself and valve/pipe |                                 |
| interface are [not]{.underline}    |                                 |
| covered.)                          |                                 |
+------------------------------------+---------------------------------+
| 1\. Equipment is included in       |                                 |
| generic seismic testing equipment  |                                 |
| class Y N U N/A                    |                                 |
|                                    |                                 |
| 2\. Meets all Reference Spectrum   |                                 |
| caveats Y N U N/A                  |                                 |
|                                    |                                 |
| 3\. Use amplified spectrum of      |                                 |
| piping system and valve at         |                                 |
|                                    |                                 |
| valve/operator interface Y N U N/A |                                 |
|                                    |                                 |
| 4\. Motor axis is horizontal Y N U |                                 |
| N/A                                |                                 |
|                                    |                                 |
| 5\. Valve and operator will not    |                                 |
| impact surrounding structures and  |                                 |
|                                    |                                 |
| components Y N U N/A               |                                 |
|                                    |                                 |
| 6\. Motor controls remotely        |                                 |
| located Y N U N/A                  |                                 |
|                                    |                                 |
| 7\. If valve has side mounted      |                                 |
| actuator attached to secondary     |                                 |
| reducer,                           |                                 |
|                                    |                                 |
| seismic brackets are used          |                                 |
|                                    |                                 |
| 8\. Manufactured by Limitorque or  |                                 |
| Rotork                             |                                 |
|                                    |                                 |
| 9\. Any loose or missing           |                                 |
| valve-to-operator bolts are        |                                 |
| tightened or replaced              |                                 |
|                                    |                                 |
| (tightness check not required)     |                                 |
|                                    |                                 |
| Is the intent of all the caveats   |                                 |
| met for GERS? Y N U N/A            |                                 |
+------------------------------------+---------------------------------+
| ***Anchorage (Chapter 6)***        |                                 |
+------------------------------------+---------------------------------+
| 1\. Type of anchorage:             |                                 |
|                                    |                                 |
| q expansion anchor                 |                                 |
|                                    |                                 |
| q cast-in-place bolt or headed     |                                 |
| stud anchor                        |                                 |
|                                    |                                 |
| q cast-in-place J-bolt             |                                 |
|                                    |                                 |
| q grouted-in-place bolt            |                                 |
|                                    |                                 |
| q welds to embedded steel on       |                                 |
| exposed steel                      |                                 |
|                                    |                                 |
| q lead cinch anchors               |                                 |
|                                    |                                 |
| q Other                            |                                 |
|                                    |                                 |
| q N/A (no further anchorage        |                                 |
| considerations)                    |                                 |
|                                    |                                 |
| 2\. Appropriate characteristics    |                                 |
| for anchorage type checked         |                                 |
|                                    |                                 |
| (size, location, equipment         |                                 |
| characteristics) Y N U             |                                 |
|                                    |                                 |
| 3\. Gap at threaded anchor less    |                                 |
| than 1/4 inch Y N U N/A            |                                 |
|                                    |                                 |
| 4\. Base stiffness and no          |                                 |
| significant prying action          |                                 |
| requirements met Y N U             |                                 |
+------------------------------------+---------------------------------+

SEWS 8.2.2 MOV (3 of 4) Sheet 3 of \_\_\_\_\_\_

+-----------------------------------+----------------------------------+
| **SCREENING EVALUATION WORK SHEET |                                  |
| (SEWS) (Cont.)**                  |                                  |
+-----------------------------------+----------------------------------+
| **Equipment ID No.:**             | **Equipment Class:               |
|                                   | Motor-Operated Valves**          |
+-----------------------------------+----------------------------------+
| Equipment description:            |                                  |
+-----------------------------------+----------------------------------+
| ***Anchorage (Cont.)***           |                                  |
+-----------------------------------+----------------------------------+
| 5\. Equipment base strength and   |                                  |
| structural load path adequate Y N |                                  |
| U                                 |                                  |
|                                   |                                  |
| 6\. Embedment steel and pads      |                                  |
| requirements met Y N U N/A        |                                  |
|                                   |                                  |
| 7\. Embedment length requirements |                                  |
| met Y N U                         |                                  |
|                                   |                                  |
| 8\. Anchor spacing requirements   |                                  |
| met Y N U                         |                                  |
|                                   |                                  |
| 9\. Edge distance requirements    |                                  |
| met Y N U                         |                                  |
|                                   |                                  |
| 10\. Concrete strength            |                                  |
| requirements met Y N U            |                                  |
|                                   |                                  |
| 11\. Concrete crack requirements  |                                  |
| met Y N U                         |                                  |
|                                   |                                  |
| 12\. Equipment with essential     |                                  |
| relays requirements met Y N U N/A |                                  |
|                                   |                                  |
| 13\. Installation adequacy        |                                  |
| requirements met Y N U N/A        |                                  |
|                                   |                                  |
| 14\. No other concerns Y N U      |                                  |
|                                   |                                  |
| Does anchorage capacity exceed    |                                  |
| demand? Y N U                     |                                  |
|                                   |                                  |
| Reference:                        |                                  |
+-----------------------------------+----------------------------------+
| ***Interaction Effects (Chapter   |                                  |
| 7)***                             |                                  |
+-----------------------------------+----------------------------------+
| 1\. Soft targets free from impact |                                  |
| by nearby equipment               |                                  |
|                                   |                                  |
| or structures Y N U N/A           |                                  |
|                                   |                                  |
| 2\. If equipment contains         |                                  |
| sensitive essential relays,       |                                  |
| equipment free                    |                                  |
|                                   |                                  |
| from all impact by nearby         |                                  |
| equipment or structures Y N U N/A |                                  |
|                                   |                                  |
| 3\. Attached lines have adequate  |                                  |
| flexibility Y N U N/A             |                                  |
|                                   |                                  |
| 4\. No collapse of overhead       |                                  |
| equipment, distribution systems,  |                                  |
|                                   |                                  |
| or masonry walls Y N N/A          |                                  |
|                                   |                                  |
| 5\. Equipment is free from        |                                  |
| credible and significant          |                                  |
|                                   |                                  |
| seismic-induced flood and spray   |                                  |
| concerns Y N U N/A                |                                  |
|                                   |                                  |
| 6\. No credible seismic-induced   |                                  |
| fire concerns Y N N/A             |                                  |
|                                   |                                  |
| 7\. No other "two over one"       |                                  |
| concerns as defined in            |                                  |
| DOE-STD-1021 Y N N/A              |                                  |
|                                   |                                  |
| 8\. No other concerns Y N U N/A   |                                  |
|                                   |                                  |
| Is equipment free of interaction  |                                  |
| effects? Y N U                    |                                  |
+-----------------------------------+----------------------------------+
| ***Comments***                    |                                  |
+-----------------------------------+----------------------------------+
|                                   |                                  |
+-----------------------------------+----------------------------------+

SEWS 8.2.2 MOV (4 of 4) Sheet 4 of \_\_\_\_\_\_

+-------------------------------+-----------------------------+-------+
| **SCREENING EVALUATION WORK   |                             |       |
| SHEET (SEWS) (Cont.)**        |                             |       |
+-------------------------------+-----------------------------+-------+
| **Equipment ID No.:**         | **Equipment Class:          |       |
|                               | Motor-Operated Valves**     |       |
+-------------------------------+-----------------------------+-------+
| Equipment description:        |                             |       |
+-------------------------------+-----------------------------+-------+
| ***Comments (Cont.)***        |                             |       |
+-------------------------------+-----------------------------+-------+
| Screening Walkdown(s):        |                             |       |
|                               |                             |       |
| [Date]{.underline}            |                             |       |
| [Time]{.underline} [Team      |                             |       |
| Members]{.underline}          |                             |       |
+-------------------------------+-----------------------------+-------+
| ***Recommend Resolution***    |                             |       |
+-------------------------------+-----------------------------+-------+
| q Maintenance action:         |                             |       |
|                               |                             |       |
| q Further evaluation:         |                             |       |
|                               |                             |       |
| q Retrofit design:            |                             |       |
|                               |                             |       |
| q Other:                      |                             |       |
|                               |                             |       |
| q No further action required. |                             |       |
| Equipment is seismically      |                             |       |
| adequate.                     |                             |       |
+-------------------------------+-----------------------------+-------+
| All aspects of the            |                             |       |
| equipment\'s seismic adequacy |                             |       |
| have been addressed.          |                             |       |
|                               |                             |       |
| Evaluation by: Date:          |                             |       |
|                               |                             |       |
| (All team members)            |                             |       |
+-------------------------------+-----------------------------+-------+