05000440/FIN-2015004-03
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Finding | |
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Title | Failure to Properly Implement System Operating Instructions to Restore RHR B to Service |
Description | A finding of very low safety significance and an associated NCV of Technical Specification (TS) 5.4.1, Procedures, was self-revealed on November 4, 2015 when operators failed to follow procedures and caused an increase in level of the suppression pool. Specifically, during the process of recovering the B RHR system in accordance with system operating instruction SOIE12, Residual Heat Removal System, the operators failed to follow an If/Then statement and did not isolate the alternate keep-fill system prior to starting the RHR pump to sweep voids into the suppression pool. This resulted in the condensate transfer system remaining lined up to B RHR train and transfer of an estimated 15,000 gallons of condensate water to the suppression pool. The resultant increasing suppression pool level caused a suction swaps for both HPCS and RCIC to the suppression pool. The licensee took immediate actions to suspend the evolution, restored the suppression pool level to the middle of the acceptable band, and restored the suction sources for HPCS and RCIC to the condensate storage tank. A human performance event response investigation was conducted and the operating crew was remediated. The issue was entered into the licensees CAP as CR 201515089. The operators failure to follow the procedure was a performance deficiency that was determined to be more than minor; and thus a finding, because it was associated with the Mitigating Systems Cornerstone attribute of equipment performance and adversely affected the cornerstone objective to ensure the availability, reliability, and capability of systems that respond to initiating events to prevent undesirable consequences. The finding was determined to be of very low safety significance because it did not represent an actual loss of function of one or more non-TS trains of equipment designated as high safety-significance in accordance with the licensees Maintenance Rule Program for greater than 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br />. This finding has a cross-cutting aspect in the area of problem identification and resolution, problem resolution, because the licensee had not solved a similar issue in third quarter of 2015 that involved the same contributing factors of poor maintenance supervision, inadequate pre-job briefs and poor shift management oversight. |
Site: | Perry ![]() |
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Report | IR 05000440/2015004 Section 4OA2 |
Date counted | Dec 31, 2015 (2015Q4) |
Type: | NCV: Green |
cornerstone | Mitigating Systems |
Identified by: | NRC identified |
Inspection Procedure: | IP 71152 |
Inspectors (proximate) | B Dickson B Kemker G Hansen J Nance K Kolaczyk M Bielby M Marshfield P Lee T Go |
Violation of: | Technical Specification - Procedures Technical Specification |
CCA | P.3, Resolution |
INPO aspect | PI.3 |
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Finding - Perry - IR 05000440/2015004 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Perry) @ 2015Q4
Self-Identified List (Perry)
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