05000440/LER-1991-001, :on 910101,delta Flow High RWCU Isolation Occurred While Attempting to Shift Flow from Pump B to Pump A.Caused by Personnel Error.Control Room Operator Counseled & Event Will Be Discussed During Training

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:on 910101,delta Flow High RWCU Isolation Occurred While Attempting to Shift Flow from Pump B to Pump A.Caused by Personnel Error.Control Room Operator Counseled & Event Will Be Discussed During Training
ML20066J969
Person / Time
Site: Perry FirstEnergy icon.png
Issue date: 01/31/1991
From: Hegrat H
CENTERIOR ENERGY
To:
Shared Package
ML20066J967 List:
References
LER-91-001, LER-91-1, NUDOCS 9102050164
Download: ML20066J969 (3)
v • d • e


LER-1991-001, on 910101,delta Flow High RWCU Isolation Occurred While Attempting to Shift Flow from Pump B to Pump A.Caused by Personnel Error.Control Room Operator Counseled & Event Will Be Discussed During Training
Event date:
Report date:
4401991001R00 - NRC Website
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On January 1, 1991 at 1935, while attempting to shift Reactor Vater Cleanup (RWCU) system flow from the B pump to the A pump, a Delta-Flow high RWCU isolation occurred.

At the time of discovery, the Plant was in Operational Condition 2 (Startup).

Reactor Pressure Vessel (RPV) temperature was 170 degrees Fahrenheit and reactor pressure was atmospheric. The Operator started the A RWCU pump for t 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> run and secured the B RWCU pump. RWCU flow dropped off considerably and the B RWCU pump was restarted approximately 3 minutea later. The A RWCU pump was then secured. A Delta-Flow Righ RWCU isolation occurred within 1 minute because of flow imhalances within the RWCU system resulting from this evolution. Upon investigation, it was discovered that the A RWCU pump discharge valve was closed.

RWCU flow was then properly re-established in accordance with System Operattng Instruction S01-033, " Reactor Water Cleanup System",

using tlie B RWCU pump.

The root cause of this event was personnel error, inattention to detail, by the Control Room Operator. The operator started the A RWCU pump without first verifying that the pump discharge valve had been opened.

The corrective actions taken f or this event include counseling the operator involved and discussing the event during Operator requei ification training.

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=cs-.mvenm On January 1, 1991 at 1935, while attempting to shif t Reactor Water Cleanup (RWCU) {CE] system flow f rem the B pijmp [P) to thu A pump, a Delta Flow-High RWCU isolation occurred. At the time of discovery, the Plant was in Operational Condition 7 (Startup). Reactor Pressure Vessel {RPV) temperature was 170 degrees Fahrenheit and reactor pressure was atmospheric.

A work order was written on Decenber 18, 1990, to drain and flush the A RWCU pusp l

bearing housing as required to clean the housing. Out-of-Service tags were htmg on the A FWCU pump breaker, the breaker fuses, the control switch and the discharge valve on December 19, 1990, to allow the Operations and Maintenance personnel flexibility in running the pump following the drain amd flush oporations Out-of-Service tags are used to provide control over the operation

.f a component in situations like this when personnel safety is not in jeopardy, but control is desired.

On January 1,1991 the Control Room Operator was requested t', start the A pump j

for a 24 hour2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> run.

The operator started the A RWCU pump at 1928 and secured the B RWCU pump 27 seconds later af ter obserring what appeared to be normal flow and

' discharge pr. essure.

RWCU flow dropped off considerably when the B RWUU pump was secured and the B RUCU pump was restarted approximately 3 minutes later. The A Rk'CU pump was then secured. A Delta Flow-High RWCU ioolation occurred within 1 minute becanoe of flow imbalances within the RWCU system resulting from this evolution. Upon investigation, it was discovered that the A RWCU pump discharge b

valve was closed.

RWCU flow was then propurly re eotablished in accordance with Syotem Operating Instruction, S01-033, " Reactor Water Cleanup Cystem", using the B RWCU pump.

Because the purap has no minimum flow racirculation capability and heceuse the pump was run sgainst shutoff head for approximately 3 minutes, an engineering 3

evaluation-was performed to dt.termine the future operobility of the pump. The bearing housing was flushed again, and the puup was run for 48 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br />, The peinp was declared fully operational on Janunry 8, 1991.

The root cause of this event was personnel error, inattention to detail, by the Control Room Operator. System Operating Instruction (S01-G33), " Reactor Water Cleanup System" requires that a valve lineup be perNined prior to starting up i.

the system. Although 'the valve lineup wn wrent at the time of the ever'., the Out-of-Service tags hung for thin evolution modified the valve lineup l>y allowing the' maintenance Person in Charge to control the openjng and closing of the A RWCU putap discharge valve as needed to perform the drain and flunh evolutions. When Out-of-Service tags.are used, the Control Room operator is solely responsible for the actual pump and valve manipulations to ensure that proper lineups are maintained for the existing operating conditions.

In this case, the operator was handed the tagout which identified the A RWCU pump control switch, the pump breaker, the breaker fusas and the pump discharge valve as being under maintenance control and he was given permission to operate these components as necessary under their tags to condact the pump retest.

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position of the A RVOC pump discharge valve prior to statting the pump. The discharge valve 4a1 e osed.

The RWCU systen is nied to control reactor water chemistry, control reactor water bl inventory during sta tup ind shutdown, and minimire temperature gradients when recirculation pump: C i nat operating. The RWCU differentir1 flow instrumentation is pat-of the Leak Detection System (IJ) and in conjunction with the Nuclear Steam Suppa ' Shutof f (NSS!,. system is designed to isolate RWCU flow Jn the event of a line 5 eta i'n the system. The Leak Detection System compares t

RCD sur f 9n flow wit's he / scharge flow and generates an isolation signal when high de itial flor xists for a duration of greater than 45 seconds.

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f ferent.a1 flow situation existed in this insto a resulting in a trip r. '.a.m of W U syntem flow for a short period of time.

'l W-loss of RWCU riow uid not have a significant offeet on plant chemist ry cont rol Eiitionally, Lt.- RWCU isolation function performed as designed to isolate the,no:t on a Delta Flow 'iigh signal. Therefore, this event is not considered safety ni p ficant.

Previous RWCU is tatM i caused by high dif ferential flow have been disunf red (see LER's99-025. 89-034,90-008 cnd 90-022).

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were attri Nttable M perst.nel error.

The correct tve actions take s for this event include counseling t'ie Operatet involved and discussing tht. event during Operator requalification training, Energy Industry Identification System Codes are identified in the text as IXX).

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