NRC FORM 361

(07-28-2023) 

U.S. NUCLEAR REGULATORY COMMISSION

OPERATIONS CENTER 

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

REACTOR PLANT EVENT 

NOTIFICATION WORKSHEET 

NRC FORM 361 (07-28-2023)

Page of

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 Unit Name of Caller/Title Call Back #

Event Time & Zone Event Date Power/Mode (At Time of Event) Power/Mode (At Time of Notification)

EVENT CLASSIFICATION 1-HR. NON-EMERGENCY 10 CFR 50.72(b)(1)

GENERAL EMERGENCY 

SITE AREA EMERGENCY 

ALERT 

UNUSUAL EVENT 

50.72 NON-EMERGENCY

PHYSICAL SECURITY (73.71) 

MATERIAL/EXPOSURE 

FITNESS FOR DUTY 

GEN/AAEC

SIT/AAEC

 ALE/AAEC

UNU/AAEC

 (see next columns)

DDDD

B????

 HFIT

 TS Deviation 

(i) TS Required S/D 

(iv)(A) ECCS Discharge to RCS 

(iv)(B) RPS Actuation (scram) 

(xi) Offsite Notification 

(ii)(A) Degraded Condition 

(ii)(B) Unanalyzed Condition 

(iv)(A) Specified System Actuation

(v)(A) Safe S/D Capability 

(v)(B) RHR Capability 

(v)(C) Control of Rad Release 

(v)(D) Accident Mitigation 

(xii) Offsite Medical 

(xiii) Loss Comm/Asmt/Response

Invalid Specified System Actuation 

ADEV

4-HR. NON-EMERGENCY 10 CFR 50.72(b)(2)

ASHU

ACCS

 ARPS

APRE

8-HR. NON-EMERGENCY 10 CFR 50.72(b)(3)

ADEG

 AUNA

AESF

 AINA

AINB

 AINC

 AIND

 AMED

 ACOM

AINV

60-DAY OPTIONAL 10 CFR 50.73(a)(1)

 

OTHER UNSPECIFIED REQUIREMENT (IDENTIFY)

NONR

NONR

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

OTHER UNSPECIFIED REQMT. (see last column)

INFORMATION ONLY NNF

NOTIFICATIONS

NRC RESIDENT

YES NO WILL 

BE

STATE(s)

LOCAL

OTHER GOV AGENCIES

MEDIA/PRESS RELEASE

Anything Unusual or not understood?

Did all systems function as required?

Mode of operations until corrected (if applicable) 

 Yes (Explain above) No

 Yes No (Explain above)

Additional Information continued on next page? Yes No
NRC FORM 361

(07-28-2023) 

U.S. NUCLEAR REGULATORY COMMISSION

OPERATIONS CENTER 

REACTOR PLANT EVENT NOTIFICATION WORKSHEET (Continued) 

NRC FORM 361 (07-28-2023)

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EN #

 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

Plant Stack Condenser/Air Ejector Main Steam Line SG Blowdown Other

RAD Monitor 

Readings

Alarm Setpoints

% T.S. Limit (If 

applicable)

RCS OR SG TUBE LEAKS: CHECK OR FILL IN APPLICABLE ITEMS: (specific details/explanations should be covered in event description)

Location of the Leak (e.g., SG #, valve, pipe, etc.)

Leak Rate Units: gpm/gpd T. S. Limits Sudden or Long-Term Development

Leak Start Date Time

Coolant Activity 

and Units:

Primary Secondary

List of Safety Related Equipment not Operational

RADIOLOGICAL 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)