Differing Professional Opinion (DPO) Submittal Form

Survey Questions

Do you believe this issue involves a risk of imminent danger that would warrant an immediate stop work or a shutdown?
Yes No

1. What is the issue?

2. What is your recommended action?

3. What could happen if there is no change?
(Note: Include a sound technical basis for the issue.)

4. Which technical experts would you recommend to be included on the panel to review the DPO?

5. What should we read to help us resolve the issue?

6. What else have you tried to resolve the issue (review and comments, discussions with technical personnel and management, local DPO processes, etc.) and what were the results?

This DPO involves (select the applicable entry)
National Nuclear Security Administration (NNSA) facility
Office of Science (SC) hazard category 1, 2, or 3 nuclear facility
SC facility or activity other than a hazard category 1, 2, or 3 nuclear facility
Office of the Under Secretary nuclear facility
Office of the Under Secretary for Nuclear Security nuclear facility other than NNSA
All other DOE facilities

Contact Information

Name:

Email:

Organization:

Relationship to DOE:

Phone Number:

Complete mailing address:

Best way to contact you for additional information:

Certification

I certify that the above information is true

Security

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