Appendix 10 Sample ORR Assessment Form 1

DOE-HDBK-3012-96

APPENDIX 10

SAMPLE ORR ASSESSMENT FORM 1

FUNCTIONAL

OBJECTIVE EP.2, Rev. 2

CRITERIA MET

AREA: EP

DATE: June 4, 1996

YES

NO X

PAGE NO. 2

OBJECTIVE: A baseline compliance status review of DOE Orders 5500.1B, 5500.2B, 5500.3A has been

performed. Noncompliance items have been addressed.

Criteria

All noncompliance issues are adequately addressed by DOE approved compliance schedule approvals

(CSA) or exemptions. The CSAs include an adequate technical basis and schedule for attaining compliance.

(DP-AP-202)

Compensatory measures that are specified in the CSAs are adequately implemented. (DP-AP-202)

Approach

Record Review: Review order compliance packages for the listed orders, including all applicable CSAs and

Interviews: For orders that are not fully implemented, interview management personnel to ensure they are

aware of this noncompliance and action necessary to fully implement the order requirements.

Shift Performance: Where appropriate, observe the implementation of any specified compensatory

measures within the facility to determine their effectiveness.

Records Reviewed:

5500.1B-STCS-93-016

5500.1B-CSA-94-123, Rev.1

5500.2B-CSA-93-072

5500.3A-CSA-93-005

5500.3A-CSA-93-006

5500.3A-CSA-93-024

5500.3A-CSA-93-001, Rev. 2

5500.7B-STCS-93-010

5500.7B-STCS-93-015

5500.3A-CSA-93-007A

5500.3A-CSA-94-127

APPENDIX 10-2