Québec Self-Certification Form Québec Self-Certification Form EOP-001-2.1 — Emergency Operations Planning Registered Entity: (Must be completed by Registered Entity) Régie Identification Number: (Must be completed by Registered Entity) Function(s) Applicable to Self-Certification: Balancing Authorities – BA; Transmission Operators – TOP Reporting Period: April 1, 2015 to December 31, 2015 Québec Self-Certification Form Form Version: QSelfCert_EOP-001-2.1b_v1EN Revision Date: October 2015 Page 1/4 Québec Self-Certification Form Disclaimer This Self-Certification Form was developed by Northeast Power Coordinating Council Inc. (NPCC) to facilitate a registered entity’s self-certification with this Reliability Standard and its appendix specific to Quebec. Contact information of the person submitting the Self-Certification: Name: _____________________________________________ Contact information of the person NPCC should contact for supplemental information regarding this Self-Certification: Email: _________________________________ Name: ___________________________________ Phone: _________________________________ Québec Self-Certification Form Form Version: QSelfCert_EOP-001-2.1b_v1EN Revision Date: October 2015 Page 2/4 Québec Self-Certification Form Reliability Standard effective date in Québec: April 1, 2015 Self-Certification Summary Table Requirement R2 R3 R4 R6 ☐ ☐ ☐ ☐ Compliant Yes ☐ Yes ☐ Yes ☐ Yes ☐ No No No No Non-Compliances Fill out a Non-Compliance Report for each Non-Compliance in the reporting period. Copy and paste the blank report below as required. Non-Compliance Report If the Non-Compliance was not previously reported, complete all the sections. If the Non-Compliance was previously reported, identify here (Non-Compliance # and date): then, update the mitigation section if required and complete the mitigation status section. Identification and description section of the Non-Compliance: Identify the requirement: Please provide the function(s) applicable to the Non-Compliance: Date the Non-Compliance was discovered: Beginning date of Non-Compliance: End or expected end date of Non-Compliance: Is the Non-Compliance still occurring? ☐ Yes ☐ No Provide a detailed description and cause of the Non-Compliance: Québec Self-Certification Form Form Version: QSelfCert_EOP-001-2.1b_v1EN Revision Date: October 2015 Page 3/4 Québec Self-Certification Form Potential impact to the electric power transmission system: Provide detailed description of potential impact to electric power transmission system: Actual impact to the electric power transmission system: Provide detailed description of actual impact to the electric power transmission system: Additional Comments: Mitigation Section: Provide description of mitigation activities: Provide details of measures to prevent recurrence: Mitigation Status Section: Are mitigation activities in progress or completed? ☐ Yes ☐ No Date mitigation activities (including activities to prevent recurrence) are expected to be completed or were completed: Québec Self-Certification Form Form Version: QSelfCert_EOP-001-2.1b_v1EN Revision Date: October 2015 Page 4/4