05000259/FIN-2013011-04
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Finding | |
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| Description | The team identified a Green, self-revealing non-cited violation (NCV) of Technical Specification (TS) 5.4.1, Procedures. The team determined that BFNs clearance and tagging application related to the planned A2 residual heat removal service water (RHRSW) pump maintenance was not properly applied and verified as required by TVA Corporate Procedures NPG-SPP-10.2, Rev. 5, Clearance Procedure to Safely Control Energy, and NPG-SPP-10.3, Rev.1, Verification Program. Two BFN assistant unit operators (AUOs) closed and danger tagged the A1 RHRSW pump manual discharge valve instead of the required A2 RHRSW pump discharge valve on May, 6, 2013. Upon starting the A1 RHRSW pump, control room alarms provided the operators indication of a system problem, and in the course of responding to the alarm, the operators noted the danger tag. The tags were removed and the pump was declared inoperable to fill and vent the system prior to returning it to an operable status. This issue was entered in to the corrective action program as PER 722859. The performance deficiencies were reasonably within BFNs ability to foresee and correct. This Finding was more than minor because it was associated with the human performance attribute which occurred when the AUOs closed and tagged the wrong RHRSW pump discharge valve. The AUOs errors adversely affected the Mitigating System cornerstone objective of ensuring the availability, reliability, and capability of the RHRSW and RHR systems that respond to initiating events to prevent undesirable consequences. The team determined that this Finding was of very low safety significance (Green) because it did not represent an actual loss of safety function or safety systems out of service for greater than the TS allowed outage time. The team determined that this Finding had a cross-cutting aspect in the area of Human Performance, Work Practices, because BFN AUOs did not use self-checking and peer checking human error prevention techniques to prevent the inadvertent closure and danger tagging of the A1 RHRSW pump manual discharge valve instead of the required A2 RHRSW pump valve during the application of a tagging clearance. |
| Site: | Browns Ferry  |
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| Report | IR 05000259/2013011 Section 4OA4 |
| Date counted | Jun 30, 2013 (2013Q2) |
| Type: | NCV: Green |
| cornerstone | Mitigating Systems |
| Identified by: | Self-revealing |
| Inspection Procedure: | IP 95003 |
| Inspectors (proximate) | C Even C Moore E Guthrie J Eargle J Heinly R Skokowski |
| Violation of: | Technical Specification - Procedures Technical Specification |
| CCA | H.12, Avoid Complacency |
| INPO aspect | QA.4 |
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Finding - Browns Ferry - IR 05000259/2013011 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Browns Ferry) @ 2013Q2
Self-Identified List (Browns Ferry)
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