05000263/FIN-2013003-01
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Finding | |
|---|---|
| Title | Inadvertent Mispositioning of Instrument Air Valve and Loss of Spent Fuel Pool Cooling |
| Description | A finding of very low safety significance and an associated non-citied violation was self-revealed for the sites failure to implement the requirements of FP-OP-SC-01, Status Control, when, on April 23, 2013, a valve in the instrument air system was mispositioned as a result of site personnels failure to review high traffic scaffold access points for equipment bump hazards. Specifically, scaffold plan reviewers failed to ensure that components susceptible to inadvertent mispositioning were identified and protected in accordance with FP-OP-SC-01 and TS 5.4.1, Procedures. As a result, an instrument air valve located near a scaffold ladder was inadvertently bumped, which led to the loss of instrument air to the reactor and turbine buildings, and the loss of the spent fuel pool cooling system, a system being used to provide cooling to the fully offloaded core in the spent fuel pool. Corrective actions included restoration of instrument air, installation of protective barriers for the affected instrument air valve, and revision of the site scaffold control procedure to ensure scaffold positioning would be reviewed postconstruction by operations for bump hazards. The inspectors determined that the issue was more than minor because it impacted the configuration control shutdown equipment lineup attribute of the Initiating Events Cornerstone and affected the cornerstones objective to limit the likelihood of events that upset plant stability and challenge critical safety functions during shutdown as well as power operations. In addition, it impacted the Barrier Integrity attribute of configuration control to maintain functionality of the spent fuel pool cooling system and affected the cornerstones objective to provide reasonable assurance that physical design barriers (fuel cladding, reactor coolant system, and containment) protect the public from radionuclide releases caused by accidents or events. Using IMC 0609 Appendix G for shutdown operations, the inspectors determined that the finding had very low safety significance because it did not adversely affect core heat removal, inventory control, power availability, containment control, or reactivity guidelines. The inspectors determined that this finding was cross-cutting in the Human Performance, work control area, and involved aspects associated with planning work activities by incorporating risk insights and jobsite conditions. |
| Site: | Monticello |
|---|---|
| Report | IR 05000263/2013003 Section 1R13 |
| Date counted | Jun 30, 2013 (2013Q2) |
| Type: | NCV: Green |
| cornerstone | Initiating Events |
| Identified by: | Self-revealing |
| Inspection Procedure: | IP 71111.13 |
| Inspectors (proximate) | K Riemer S Thomas J Tapp P Voss I Hafeez S Bell M Ziolkowski |
| Violation of: | Technical Specification - Procedures Technical Specification |
| CCA | H.5, Work Management |
| INPO aspect | WP.1 |
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Finding - Monticello - IR 05000263/2013003 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Monticello) @ 2013Q2
Self-Identified List (Monticello)
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