Corrective Actions

01 Dec 14

From: HM1 (FMF/SW/AW) Jakarta D. Crafton
To: HMC (SS) Richard Tapia

Subj: ORSE REPORT ON CORRECTIVE ACTIONS Ref: (a) NAVMED P-5055, Radiation Health Protection Manual (b) NAVSEA S9213-33-MMA-000/(V), Radiological Controls For Ships (c) NAVSEA TW120-AAPRO-10, Nuclear Weapons Radiological Controls Program (d) NAVMED P-117, Manual of the Medical Department (e) COMSUBLANT/COMSUBPACINST 6470.5, Submarine Radiation Health Manual (f) BUMEDNOTE 6470, dtd 16 Jun 2003

1. The following is a listing of all corrective actions noted during recent ORSE from 08 Aug 2014.

2. The below are all the areas audited with the corrective actions listed below:

Discrepancy
Root Cause
Corrective Action
The MDR did not have a process in place to audit records, no way to prove that records were being audited upon completion of Radiation Medical Examinations.
MDR did not utilize ref (e) to audit records upon completion of Radiation Medical Examination.
MDR will utilize ref (e) upon completion of Radiation Medical Examination to properly audit health records.
E5418 – Block 23 did not indicate the level of training for the physician (UMO, RAM, or RHI).
MDR did not utilize ref (e) to audit records upon completion of Radiation Medical Examination.
MDR will utilize ref (e) upon completion of Radiation Medical Examination to properly audit health records.
P1135 – Incomplete information pertaining to the Examining Facility.
MDR did not utilize ref (e) to audit records upon completion of Radiation Medical Examination.
MDR will utilize ref (e) upon completion of Radiation Medical Examination to properly audit health records.
W7909 and H3324 – Missing exposures, corrections made, but were made incorrectly on multiple occasions.
MDR did not utilize ref (e) to audit records of NAVMED 6470/10.
MDR will utilize ref (e) upon completion of NAVMED 6470/10 to properly correct health records.
P1135 –