05000313/FIN-2010005-05
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Finding | |
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| Title | Failure to Use Human Performance Tools Results in Two Turbine Building Roof Fires |
| Description | The inspectors documented a self-revealing finding for contract roofers failing to use human performance tools, per Procedure EN-HU-102, Human Performance Tools, Revision 5, while performing hot work activities on Arkansas Nuclear Ones turbine building roof which resulted in two fires. Specifically, contractors committed human performance errors during activities by not performing self- and peer-checks, or demonstrating a questioning attitude which resulted in a fire on September 17 and again on November 18, 2010. These issues were entered into the corrective action program as Condition Reports CR-ANO-1-2010-3231, CR-ANO-C-2010-2428, and CR-ANO-C-2010-2978. The failure to use human performance error prevention tools as specified in Procedure EN-HU-102, Human Performance Tools, Revision 5, was a performance deficiency. The performance deficiency was determined to be more than minor because it was associated with the protection against external activities attribute of the Initiating Events Cornerstone, and affected the cornerstone objective to limit the likelihood of those events that upset plant stability during power operations, and therefore a finding. Using Inspection Manual Chapter 0609.04, Phase 1 Initial Screening and Characterization of Findings, the finding was determined to be of very low safety significance because the finding did not contribute to both the likelihood of a reactor trip and the likelihood that mitigation equipment or function would not be available. The finding was determined to have a crosscutting aspect in the area of human performance, associated with work practices, in that the licensee failed to ensure supervisory and management oversight of work activities, including contractors, such that nuclear safety is supported. Specifically, the licensee failed to provide adequate oversight of the roofing contractor to prevent fires. |
| Site: | Arkansas Nuclear  |
|---|---|
| Report | IR 05000313/2010005 Section 4OA3 |
| Date counted | Dec 31, 2010 (2010Q4) |
| Type: | Finding: Green |
| cornerstone | Initiating Events |
| Identified by: | Self-revealing |
| Inspection Procedure: | IP 71153 |
| Inspectors (proximate) | A Fairbanks A Sanchez D Jones G Guerra J Cherubini J Clark J Larsen J Rotton P Frechette P Prescott R Latta R Schmitt T Burns |
| CCA | H.2, Field Presence |
| INPO aspect | LA.2 |
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Finding - Arkansas Nuclear - IR 05000313/2010005 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Arkansas Nuclear) @ 2010Q4
Self-Identified List (Arkansas Nuclear)
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