Appendix 10 Instructions for Completing ORR Forms

DOE-HDBK-3012-96

APPENDIX 10

INSTRUCTIONS FOR COMPLETING ORR FORMS

ORR ASSESSMENT FORM 1

OBJECTIVE:

CRITERIA:

CRITERION MET

DATE: 6/ 4/96

YES

OBJECTIVE: (2 spaces) Copy the Objective from the Implementation Plan.

Criterion: (2 spaces) Copy the criterion as written in the Implementation Plan.

Records Reviewed:

o(F4) Cite a specific document (number, title, rev.)

o(F4) Cite next document, etc.

Interviews Conducted:

o(F4) Use title, do not use name (use site identifer, as site will respond)

Shift Performance Evolution:

o(F4) Provide description of activity observed. Use N/A if not applicable

Discussion of Results:

Record Review: (2 spaces) Discuss the record review or write None, if not applicable.

Interviews: (2 spaces) Discuss the interviews or None if not conducted.

Shift Performance: (2 spaces) Discuss the shift performance observed or write None, if not applicable.

Conclusion:(2 spaces) Tie together discussion of key points resulting in your conclusion. State whether the

criterion was met.

Issue(s):

o(F4) Write a brief, full sentence description of each issue. This should be an exact match of the title on

the Form 2. Cite all Form 2s associated with this criteria. If no Form 2s were generated under this criteria,

write NONE.

APPENDIX 10-1