05000263/FIN-2012004-02
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Finding | |
|---|---|
| Title | Bus 12 Lockout Caused by Inadequate Work Plan |
| Description | A finding of very low safety significance was self -revealed on September 25, 2012, when a reactor scram occurred during planned testing of the 2R to Bus 12 local (switchgear cubicle A201) and remote (control room panel C-08) ammeter switches. As a result of the sites failure to effectively plan the work activity, the performance of the testing resulted in the lockout of Bus 12, and loss of 12 reactor feedwater pump and the 12 recirculation pump. During the ensuing plant transient, a main turbine trip occurred, followed immediately by a reactor scram, when reactor water level reached the Reactor Water Level Hi Hi setpoint (+48 ). The licensee entered this issue into their CAP and is performing root cause evaluations to further evaluate the post-scram reactor water level control and the ineffective work planning associated with development of the work order used to conduct the testing. The inspectors determined that the most significant causal factor associated with the performance deficiency was associated with the cross-cutting area of Human Performance, having resources components, and involving aspects associated with procedures and work packages are available and adequate to assure nuclear safety H.2(c). The inspectors determined that the licensees failure to develop and implement work documents which adequately tested the 2R to Bus 12 ammeter switches was a performance deficiency because it was the result of the failure to meet a requirement or standard; the cause was reasonably within the licensees ability to foresee and correct; and should have been prevented. The inspectors screened the performance deficiency per IMC 0612, Power Reactor Inspection Reports, Appendix B, and determined that the issue was more than minor because it impacted the procedural quality attribute of the Initiating Events Cornerstone objective to limit the likelihood of those events that upset plant stability and challenge critical safety functions during shutdown as well as power operations. The inspectors applied IMC 0609, Appendix A, The SDP for Findings At-Power, to this finding. The inspectors evaluated the issue under the Initiating Events Cornerstone, and utilized Exhibit 1, Initiating Events Screening Questions, to screen the finding. Under Section B, Transient Initiators, the inspectors answered No to the question Did the Finding cause a reactor trip AND the loss of mitigation equipment relied upon to transition the plant from the onset of the trip to a stable shutdown condition? and determined the finding to be of very low safety significance. |
| Site: | Monticello  |
|---|---|
| Report | IR 05000263/2012004 Section 4OA3 |
| Date counted | Sep 30, 2012 (2012Q3) |
| Type: | Finding: Green |
| cornerstone | Initiating Events |
| Identified by: | Self-revealing |
| Inspection Procedure: | IP 71153 |
| Inspectors (proximate) | K Riemer M Phalen K Stoedter S Thomas P Voss S Bell |
| CCA | H.7, Documentation |
| INPO aspect | WP.3 |
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Finding - Monticello - IR 05000263/2012004 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Monticello) @ 2012Q3
Self-Identified List (Monticello)
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