05000298/FIN-2011008-04
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Finding | |
|---|---|
| Title | Failure to Revise Unclear Work Instructions |
| Description | The inspectors identified a noncited violation of Technical Specification 5.4.1, for a failure to comply with procedures described in Regulatory Guide 1.33, Appendix A. Specifically, the licensee failed to implement procedures and a work order instruction that required the work order to be returned to work planners and revised if the original work scope is changed or a problem is encountered. This directly contributed to three instrumentation and control technicians receiving an unexpected radiation dose. A site stand down was held to discuss the lessons learned from the event. This was entered into the licensees corrective action program as Condition Report CR-CNS-2011-4428. The finding was more than minor because it is associated with the human performance attribute of the Occupational Radiation Safety Cornerstone and affected the cornerstone objective to ensure the adequate protection of the worker health and safety from exposure to radiation from radioactive material during routine civilian nuclear reactor operation. The inspectors evaluated this finding using Inspection Manual Chapter 0609, Appendix C, Occupational Radiation Safety Significance Determination Process. The inspectors determined that the finding is of very low safety significance (Green) because it was not associated with ALARA planning or work controls, there was no overexposure, there was no substantial potential for an overexposure, and the licensees ability to assess dose was not compromised. The finding has a crosscutting aspect in the decision making component of the human performance area because the licensee did not use conservative assumptions in decision-making. Specifically, the licensee did not validate the assumptions made when considering the change in work scope. |
| Site: | Cooper  |
|---|---|
| Report | IR 05000298/2011008 Section 4OA5 |
| Date counted | Jun 30, 2011 (2011Q2) |
| Type: | NCV: Green |
| cornerstone | Or Safety |
| Identified by: | NRC identified |
| Inspection Procedure: | IP 93812 |
| Inspectors (proximate) | B Tharakan D Overland V Gaddy |
| Violation of: | Technical Specification |
| CCA | H.14, Conservative Bias |
| INPO aspect | DM.2 |
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Finding - Cooper - IR 05000298/2011008 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Cooper) @ 2011Q2
Self-Identified List (Cooper)
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