Page of

NRC FORM 361N

(07-28-2023) 

U.S. NUCLEAR REGULATORY COMMISSION

OPERATIONS CENTER 

NON-POWER REACTOR (NPR) 

EVENT NOTIFICATION 

WORKSHEET 

APPROVED BY OMB: NO. 3150-0238 EXPIRES: 07/31/2026

NRC FORM 361N (07-28-2023)

Estimated burden per response to comply with this voluntary collection request: 30 minutes. The information provided will be used for 

evaluation of licensee event description, facility status and for input to the public website. Send comments regarding burden estimate to the 

FOIA, Library, and Information Collections Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, or by 

email to Infocollects.Resource@nrc.gov, and and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0238), Attn: 

Desk Officer for the Nuclear Regulatory Commission, 725 17th Street NW, Washington, DC 20503; email: oira_submission@omb.eop.gov. 

The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting 

or requiring the collection displays a currently valid OMB control number.

EN #

NRC OPERATIONS TELEPHONE NUMBERS: PRIMARY - 301-816-5100 or 800-532-3469ǂ, BACKUPS - [1st ] 301-951-0550 or 800-449-3694ǂ, 

[2nd] 301-415-0550 and [3rd] 301-415-0553. ǂLicensees who maintain their own ETS are provided these telephone numbers. 

FAX - 301-816-5151, EMAIL - hoo.hoc@nrc.gov

Notification Time Facility or Organization Name of Caller Call Back #

Event Time & Zone Event Date Power/Mode Before Power/Mode After

Reactor Type Max Power Max Pulse Pulse Inserted During Event?

EVENT CLASSIFICATIONS

GENERAL EMERGENCY GEN/AAEC

SITE AREA EMERGENCY SIT/AAEC

ALERT ALE/AAEC

UNUSUAL EVENT UNU/AAEC

SAFEGUARDS EVENT (73 App G) 

MATERIAL/EXPOSURE 

INFORMATION ONLY NNF

OTHER UNSPECIFIED REQMT. (see last column)

REPORTABLE CONDITION (Varies by facility TS)

TS Deviation ADEV

TS Required S/D ASHU

RPS Actuation (scram) ARPS

Offsite Notification APRE

Degraded Condition ADEG

Unanalyzed Condition AUNA

Specified System Actuation AESF

Safe S/D Capability AINA

Control of Rad Release AINC

Accident Mitigation AIND

Offsite Medical AMED

Loss Comm/Asmt/Response ACOM

Invalid Specified System Actuation AINV

SUSPICIOUS ACTIVITY

SECURITY EVENT

OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)

NONR

 NONR

Description (Include: System affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continue on Page 2) 

NOTIFICATIONS YES NO WILL 

BE

HQ NPR STAFF

STATE(s)

LOCAL

OTHER GOV AGENCIES

Anything Unusual or not understood? Yes (Explain above) No

Did all systems function as required? Yes No (Explain above)

Mode of operation until corrected (if applicable) 

Estimate for restart date:

MEDIA/PRESS RELEASE Additional Information continued on next page? Yes No
Page of

NRC FORM 361N

(07-28-2023) 

U.S. NUCLEAR REGULATORY COMMISSION

NON-POWER REACTOR (NPR) OPERATIONS CENTER 

EVENT NOTIFICATION WORKSHEET (Continued) 

NRC FORM 361N (07-28-2023)

EN #

RADIOLOGICAL / CHEMICAL RELEASES: CHECK OR FILL IN APPLICABLE ITEMS (specific details/explanations should be covered in event description)

Event Description (Include: Systems affected, actuations and their initiating signals, causes, effect of event on plant, actions taken or planned, etc.) (Continued from Page 1) 

 Liquid Release Gaseous Release Unplanned Release Planned Release Ongoing Terminated

 Monitored Unmonitored Offsite Release T.S. Exceeded RM Alarms Areas Evacuated

 Personnel Exposed or Contaminated Offsite Protection Actions Recommended *State release path in description

Release Rate (Ci/sec) % T.S. Limit HOO Guide Total Activity (Ci) % T.S. Limit HOO Guide

Noble Gas 0.1 Ci/sec 1000 Ci

Iodine 10 μCi/sec 0.01 Ci

Particulate 1 μCi/sec 1 mCi

Liquid (excluding 

tritium and dissolved 

noble gas)

10 μCi/min 0.1 Ci

Liquid (tritium) 0.2 Ci/min 5 Ci

TOTAL ACTIVITY

List of Safety Related Equipment not Operational