05000272/FIN-2012004-01
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Finding | |
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| Title | Inadvertent Injection of Auxiliary Feedwater Into the 23 Steam Generator |
| Description | A self-revealing Green NCV of TS 3.7.1.2.a, Auxiliary Feedwater System, was identified because the 23 steam generator flow control valve from the 21 AFW pump opened unexpectedly during the in service test of the 21 AFW pump on July 5, 2012. PSEG determined that the air supply to the valve was incorrectly isolated during previous surveillance testing, which caused the valve to fully open when the 21 AFW pump was started and prevented operators from closing it using the valve control switch in the control room. This alignment directed full flow from the 21 AFW pump to the 23 SG during performance of the surveillance test, which adversely affected level control for that SG and required operators to declare the 21 AFW pump inoperable. PSEG entered the issue into the CAP as notification 20566493. The performance deficiency is more than minor because it is associated with the Mitigating Systems cornerstone attribute of equipment performance and affected the cornerstone objective of ensuring the availability, reliability, and capability of systems that respond to initiating events to prevent undesirable consequences (i.e. core damage). Using IMC 0609, Appendix A, The Significance Determination Process for Findings at Power, the inspectors determined that the finding was of very low safety significance (Green) because the system maintained the ability to inject water into each of the steam generators. Senior Risk Analyst review determined that the valve failure to close is not modeled in sequences which could lead to core damage. The inspectors determined that this finding has a cross-cutting aspect in the area of human performance, work practices, because PSEG did not adequately communicate expectations regarding human error prevention techniques H.4(a). Specifically, as required by the sites human performance error prevention technique procedures, flagging and robust barriers were not used in a situation where multiple similar components existed within close proximity to each other. This resulted in the isolation of the air regulator valve for valve 23AF21, which resulted in inoperability of the 21 AFW pump. |
| Site: | Salem  |
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| Report | IR 05000272/2012004 Section 1R22 |
| Date counted | Sep 30, 2012 (2012Q3) |
| Type: | NCV: Green |
| cornerstone | Mitigating Systems |
| Identified by: | Self-revealing |
| Inspection Procedure: | IP 71111.22 |
| Inspectors (proximate) | D Schroeder J Schoppy R Nimitz A Burritt P Mckenna A Turilin |
| CCA | H.12, Avoid Complacency |
| INPO aspect | QA.4 |
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Finding - Salem - IR 05000272/2012004 | |||||||||||||||||||||||||||||||||||||
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Finding List (Salem) @ 2012Q3
Self-Identified List (Salem)
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