[별지 제3호서식]

THE INTERNATIONAL NUCLEAR EVENT SCALE (INES)
EVENT RATING FORM (ERF) to be sent to : IAEA, WAGRAMERSTRASSE 5, P.O.BOX 100, A-1400 VIENNA, AUSTRIA TELEX:1-12645, CABLE:INATOM VIENNA, FACSIMILE:43 1 2309723, TELEPHONE:43 1 2360 2685
EVENT TITLE														EVENT DATE
RATING	RATING DATE		BELOW SCALE		ON SCALE							SAFETY ATTRIBUTE	DEGR. DEFENCE □ IN-DEPTH ON-SITE IMPACT □ OFF-SITE IMPACT□
				0	1	2	3	4	5	6	7
COUNTRY				FACILITY NAME								FACILITY TYPE
ASPECTS OF SIGNIFICANCE TO THE PUBLIC : ACCIDENT □ INCIDENT □ DEVIATION □ RADIOACTIVE RELEASES OFF-SITE RADIOACTIVE RELEASES ON-SITE WORKERS INJURED BY RADIATION WORKERS INJURED PHYSICALLY PLANT SAFETY IS UNDER CONTROL THE EVENT REPORTED IS A DISCOVERY OF A DEFICIENCY BY ROUTINE SURVEILLANCE A PRESS RELEASE WAS MADE ( IF YES, PLEASE ATTACH IT )															YES NO □ □ □ □ □ □ □ □ □ □ □ □ □ □
SHORT DESCRIPTION OF THE EVENT : *
CONTACT PERSON FOR FURTHER INFORMATION					NAME : ADDRESS : Nuclear Safety and Security Commission, Saemunan-ro, Jongno-gu, Seoul, KOREA PHONE : 82-2-397-7281～88 FAX : 82-2-397-7292
* PLEASE ATTACH ADDITIONAL INFORMATION ON JUSTIFICATION OF THE EVENT RATING AND DIFFICULTIES ENCOUNTERED, IF NEED