05000397/FIN-2015004-01
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Finding | |
|---|---|
| Title | Incorrect Electrical Component Operated During Maintenance |
| Description | The inspectors reviewed a self-revealing non-cited violation of Technical Specification 5.4.1.a, Procedures, for the licensees failure to implement Work Order 02048855 during maintenance on a safety-related power panel. Specifically, the licensee operated an incorrect electrical disconnect, E-DISC-7AA-6A. Further, upon realization of the error, maintenance personnel re-energized the E-DISC-7AA-6A circuit without understanding the effects of that action. As a result of this incorrect component operation, the division 1 emergency diesel generator was rendered inoperable. As an immediate corrective action, the licensee stopped all associated maintenance and restored the division 1 emergency diesel generator to operable status by performing the standby alignment procedure. The licensee entered this issue into their corrective action program as Action Request 337018. The failure to implement Work Order 02048855 during maintenance on a safety-related power panel was a performance deficiency. This performance deficiency was more than minor, and therefore a finding, because it adversely affected the configuration control attribute of the Mitigating Systems Cornerstone objective of ensuring the capability of systems that respond to initiating events to prevent undesirable consequences. Using Inspection Manual Chapter 0609, Attachment 04, Initial Characterization of Findings, and Appendix A, The Significance Determination Process (SDP) for Findings At-Power, Exhibit 2, Mitigating Systems Screening Questions, dated June 19, 2012, the inspectors determined the finding was of very low safety significance (Green) because the finding did not represent a loss of safety function, did not represent an actual loss of function of a single train for greater than its technical specification allowed outage time, and did not represent an actual loss of function of one or more non-technical specification equipment for greater than 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />. The inspectors determined the finding had a cross-cutting aspect in the area of human performance associated with the avoid complacency component because the licensee failed to recognize and plan for the possibility of mistakes, latent issues, and inherent risk, even while expecting successful outcomes including implementing appropriate error reduction tools. Specifically, the maintenance staff failed to follow the sites error prevention tool process and operated the incorrect component. |
| Site: | Columbia  |
|---|---|
| Report | IR 05000397/2015004 Section 1R04 |
| Date counted | Dec 31, 2015 (2015Q4) |
| Type: | NCV: Green |
| cornerstone | Mitigating Systems |
| Identified by: | Self-revealing |
| Inspection Procedure: | IP 71111.04 |
| Inspectors (proximate) | D Bradley G Kolcum J Groom R Lantz S Hedger S Janicki |
| Violation of: | Technical Specification - Procedures Technical Specification |
| CCA | H.12, Avoid Complacency |
| INPO aspect | QA.4 |
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Finding - Columbia - IR 05000397/2015004 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Columbia) @ 2015Q4
Self-Identified List (Columbia)
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