ML020950191

Preliminary Root Cause Investigation Form Con-Ed SL1 Investigation & LER

ML020950191
Person / Time
Site:	Indian Point
Issue date:	03/21/2002
From:	Division Reactor Projects I
To:	Consolidated Edison Co of New York
References
FOIA/PA-2002-0184, FOIA/PA-2003-0379, FOIA/PA-2003-0388
Download: ML020950191 (22)

Text

U-lk P 0

L

&16, m4 43 Z ojaý U.S. NUCLEAR REGULA INDIAN POINT 2 NUctý OFFICE FACSIMILE TO:

11N THlE OFFICE~ VI-:

DZ TrI rFCOPY NO.:

NUMOER OF P GES TRANSMITrTED INCLUDING' l-1 FOJ

RM:

3

/*

2 BILL RAYMOND, SENIOR RESJDGENTI IN-ECTOR PCI-I AI3IGHOR ST. RFPSIflEN'T INSPECTrOR ROSEMARY MAR< riN. SE-CRCTARY Q0

)0

0) QW000000000 0

0000000.0 00 IO04;

)00 00)0 0 09 j 0 000 Q00 0 NIW P.O. oox 69 BUCHIANANs, NY 10511

(!J14) 730J-9300 OF-FICE (SA1')

/39-0350 FAX

RootCausp Statement No. I Eauioment Res nnn-n Operators were hampered or delayed by Inoperable and/

e.g.,

U

'4

Ic

High pressure condenser dump valve controller 4110

• MS-1-24 main steam'isolation valve

$ Steam jet air ejector pressure control valve A

Islolation valve seal water system l&e1Jc.76 s

<1U 29TSU, roceeding to cold shutdown took approximately 23 hour6 (actual) instead

§T 1fihor3"(Ideal), and included 8 hours9.259259e-5 days <br />0.00222 hours <br />1.322751e-5 weeks <br />3.044e-6 months <br /> during which flow into 24SG from t RCS-.

Factual Bai:,S.

AA Fact Dale 1-. Operator placed thc steam dump controller in pressure 2-15.00 mode end in the automatic mode thls would put IX in the coan of the pa sure tranemittor

2. With the steam dump r.ontrol In automatic, as the secondaty side preseure docreaseed, there would be a decrease in the controlle' output corresponding with a dw ee In cteam 0ow

3.

hi.ftmanager-stled he only noticed one lght on ste*m dups durIN Gvant.

4. Pressurizer pressure master controller failed to tun spraye open wvh~n in Proc*dure for deprreurizetion of Res to match RCS pressure with ruptured Ateam generator pressure. Individual spray controllers wcrc pieced in marnual ond olosdd. Master controller did not respond agqaJr) until next shifl.

5. High pressure steom dumps controller opened erid closed about 25% at a lime controlling pressure in "batchcs" not S

resp.onding prope ly. Controller wai placed in manual.

6.

On 311100, special tes*ng wae conducted on valve PCV 1137 (24SG Atmo. Stcam Dump) and lbt associaled instrument control kop Testing was performed by M&C under tost no. P-MI -183 nd VATS under wmrkonder no. NP 00- li~i he "Otng rV ui A

c~nsisntr dats and cub aluntiy a tr 1'.

7 m"

7. SaseO onc-'t'ing descrbed in CR# 200001468. addlt hivestigation and testing was performed on.C-449 lopated i th CCR in panel FBF, This t3ting resulted in finding PC0449 malfunciloning. OQwraded.g1=itrs pre suspected. I&C acrion requcsts have been generated (see references) to inspect contfolleis rind repLace

',celi.ors, or Pntire controller.

Time

'2100 Source Operator slie~men t.

System description SM Interview CR 200001214 CR 200001215 CR 20 01468 CR 200001628 3/16/00 Jýý zv.

Fact

8. I&C compleled work pa ckage for WONU 00-14448 for the RHR temp recorder being out or collbrobon. When *he recorder was returned and placed I/s the inlet temp teads 102F and theoutlet ternp is re2ding 1021,-. The Came tempa am read by GAS are inlet 102F outlet 86F using the Oame inputs this shows that there Is a debta Temp of 16F whicA ic not refleated on the chtart recorder

-&36 which is used for Tave indication when RHR is US-- S~o though the PMT foil R-636 patses, per the I&C work packege. due to It being within its tolerance this is not eceptable to operations as a norm. Reference CR 2000D1537, which indlcates the same problem where the IndlcAtd values push the operator Into a workaround wher6 none existed beforc. The rsolution is to either narrow the ae_.pable bWnd and or calibrate the inUkation wfth the actuaf input instead of tylng them separtoly.

9.. 24*SG pressure contiued to decrease and level In 24 SG continued to f*ncrease.

~64 Date ITime'I Source

.~hl~~-

JCR23+/-5z 2-16-00 1

4

=l.

Opeot-. instructid to Isolate MST.4 2-15-00 20:23 A.O.I. 1-2

11. CCR secured AFW flow to 24 SIG 2-15-00 20:25 A.O.I. 1-2

13. OIer~rex;cmplaealisplafing224 SIG 2-15-00 2-0:34 AOl, 1-0

14. 24 SfG prescure reached 1023 peig 2-16-00 20:59" Plant data

16. Gamma isotopic analyses or water obtained from Main CR 200001118 Steam Trap 23, the Drains Collection Tank, and the hotwoet$ indicate the presence of radio-gas dissolved in the w-ere'. The relative concentration of the rdio-gas jr.

highest In Main Steam Trap 23 with the hotwell having the least activity. These. dlfferPrK.Pce In ro~ncentr'atlons may uggest that there is some leak by MS-I.24.

18. Wilh no ofh.r soufrce of cooling present, the 24 SG Plant data prescure decre3se could only hovc been caused by leakaoe past the shut main steam stop valve, MS-1-24.

/

17. OE from Palo Verde and GInna dIscust;cd long pcriod of OE time to cooldown affected sg,usIngp akfill methoix.

18, A cool dlown of the p4ant was started per step Se of ES-3.1 2-15-00 23:36 C3 3.1 to brind the system Into a cold shutdown condition.

19. The cool down was stopped when condenser vacuum was 2-16-00 00:05 Operator logs lost due to book firng ooFtc stoenm jet air electors (6JAE).

20. As st*am pressure changed (lowered) In the main header Plant data with the plant cool down, the supply prcssuro to the SJAE changed as well, and steam snpply pressure di upped below'the point where the SJAE could elticiently remove non-condensable gases from the main condenser.

t-I Plant data

_21, M21n Conr.nsoer vacuum was re-ectablished.

22. Cooldown had been continued on the steart, generator 2tms0pherics. Condenser vacuum was cubcequcntly restored about an hour later. The loss of condenser vacuum may be attributed to the steam suppiy to the sjae' to bc in monuel on the bypass.' WO 94-69637 for pcv1222 (steam -supply to sJae.) had b.een cnanceled duw to pending retirament This should be re-evalusted.

2 16 00 01:1 15 iosl-2-16-00 0812 CR 200000984 Pil 3/16/00

")_'1

• JPI t"l

• ,-t I}

2-16 00 01.tR VnHn.* Innm 17

Fact

23. Vacuum was restored to the main condensers, and primary plant temperature m2intenance was rcturned to the Gteen). dumps 24 The IVSWS is tv on 3 containment phase "A isolation signal. This type of signal Closer selected vapor containment penetraWn valves to prevent potential contomination from leaving the Gantainm*nt after an accicierm.

25. The IVSWS then plaec premurinzed water from ft own

£elawAter tank botwelln the paired containment is&-aion vatfes. The purpose of this is to ensure that if any potentl V9VQ leak1aGe did ocour, tho IVSWS water would leak into the leakage Oath. and ensure no contamination release

occurred,

26. W*icnl the manual safety injection occurred, this also caured alcontainment phase *A' irolation.

27. 8eYeral valves sealed with VSWS water in the Component Cooling Water Systeni(CCW) for the Reactor Coolant Pumps ere not Isolated by a phase 'A" Lisoation signal. They are itolated by o phase 48' containment ikal;Uon signal.

28. There was no phase "8" demand slg'na present or reuired duuinthis event

29. The 6VSWS seal water flowed info Mhe open CCW coniairnment Isoladon valves and from therc into the CCW system. This flpw required periodic IVSWS lank refaln0 as IoN as me system Is actuated.

30. Opeiator found the Isolation Valve Seal Wale Tank to be empty on 02/11600. He attemptaod to fill tne tank and it subsequenty omptled again. The Control Room uperalor noticed that the Component Cooling Surge tank level had Increased a cop.espondinq amount.

31. The operators took guidance from the POP 3.1 to re3lign the Isolaton Valve Seal Water system for normal o

bio y a Ihe switches to Close.

37 On 2/10 BdVO c02:20, IVSW LCO entored for tank being empty entered TS 3.0.1. Exited alt 9 05 as tank parameters were restored.

Other QeUj m;nt aspues identified durina tI a

"i

33. Pressurizer Master controller broke in the full open

34. Observed eeated tomperature (approximately 80F) in the AFP room on 2/16 witti the motor-driven Dumprn in servioe.

35. The wintrtczbon Plan for the AFP room covered the fresh air inlet t,., the room and raised the fan thermostat ettings.

26-e 2-16-00 Time 08:b2 Source Plant Log Systam description Sysewpm i

dectr cption 2-15-00 21:04 1 Plant da-t System description System devuription Operator

,ca&tment 2-17-00 CJ3:40 CR 200001026 POP3.1 2-17-00 05:17 CR 200001033 2-1(6.0 08:15 Operator ded 2-17-00 10:30 i CR 200001051 3116/00 18

Faet

36. Woo' had bon pl o

the venU atlon louvers tor Iho ABFP room (east side w-u to few rag. volve area). SOP

.1

.5-wiirte'aUon calls for wood lo be plaUd over louvers on tMe east side wall to prevent oold afr intrusion into the feed.ragl velve ar6. With tft ABFPa in service for an e

fd*ed Vime during the SGTR eve t, it wae reported (hat the ABFP Moom was ge90ng warm. The wood to Ihe ABFP room Iouver wa" SubSeQuenly removed to allow cooling of the ABrP roomr with the pumpe operating. The wood Wa, then ref12d to restore what was assumed to be proper wlntenation conrguratn. The quection arises as to Whelher placement of the wood Is appropriale for ABFP e P no.a' P event suCh s th e SGTR.

37 While perfomIng tube rupture reooveryacg, operator noted. thesc eomalles; 21 RCP lgh vitrations - 14 mfl S23 RCP seef return less lhan 0.2 gpm for approximately 2 minutes.

Prossurier mraster controller PC-456K did not wor, in

manual,

• e DLfM.*lgrr came u'i after22 RCP wa secured.

_I*'h indi Ilu

8. The iwo Ic true wh light in for valve 9.56G lnot

.o, W e 5ýdi not w r iliwmlgnate. This problem was fo Midring the reactor

39. Tho bo iý true kh

for valve 1788 will not illuminate.

Problem fbu du tho manual reactor tri f 40. Te two i6 tue lights far valve 1 I will not illuminate.

Problem 166n4 di 1' The manual reactor torl

41. Tbe twn Is true rd indicatng I glfor FCV-437fwil not iutnine.

blern fobUd durina manual rearlor trip.

42 The two is true whitp Indicating iHht for PCV-1216 will not llumlrfe, Problem found dur the mantiol reactor tp,

43. The two 4i5rue red indicatIng tight for PCV-1229 wUl not iuum~neteG. P oblem found durtMn the manual rEctor trip.

44. The two Is tue red indiceting Nght for SOV.35tg will not illuminate Problam fou d dud o the manual reactor tri

46. The is true white indicating u9gt for HC-VSA will not W*umhiate. Problem found dud the manual rpactor tri

46. The two, is true white Indlcalig light for HC.IV3A will not llumulrnte. Problem found djrng the manual reactor td.

47 The two Is true 1,d

'indicatin lgh for SOV-3421 will not ipumnlna2.

Problem found ddu, the manual reactr trip.

48. The SJAE

• ischarg.

Isolatio, va"ve was low to close.

This occurred ouri Phose A Con~tainment isolation.

49. Excees L-etdown CCW Isolaion Valve 793 Con trol lrjicatn5 Circuit is blowmig fuses. There Is currently no indiatbon, of valve position or par-el SG and Panel SN in tte CCR Please Invefti atn 3r*a rc D

3/16/00 19

Fact

50. The lire alarm for Zone 1, 23 RCP was received al pprofdmaGtly 0300 this moMing. I was directed by the CRS to invetigat, the alarm in Ule VC. No visible fire was Obsevcd. On further investlgaion. I noticed tat what I believe.is the third detector In series on 93' cdevotion of 23 RCP pLtvorm w,* blinking, and the other two detectors were not. I believe th ceuse of th 21arm waC 3 faully

.3/1-6100 20

k vt\\

The plant Ios ocus on the need to reduce RCS pressure and temperature as directed in ES?3.1. Th1fre were distractions that Included communicafion problems with the TSC, confllotiru boron concentration values at turnover, conflicting procedural requiterments regrding RCS pressure limitations to RHR, insufficient quid closure of the 822 valves, and the performance of PT -V14 to enter OPS. As a result, "proceeding to cold s'hutdown took approximately 23 hours2.662037e-4 days <br />0.00639 hours <br />3.80291e-5 weeks <br />8.7515e-6 months <br /> during whirh during, C

~time there was addl~on'iLfow from the RCS into 24 §G.

factual B~asis; aw-to tL Z WLu exct 4eve and requirin!

wa6 stopped for SL-1 team review showed the sequencing procedurally logical.

5 Prioto fte m*nu-l S). the OCR operators determined that POP 3.3 would need a TPC to allow cooldowo to proceed while boron concentration did not comply with RCS-4. Changing plant oonditions obviated th need for thV TPC.

6. On 2/15/00 the station P.xpertonced a Steam Generator Tube Rupture in Steanm Generntor 24. The. plant expcrie'noed a Safely Ihjecdlon Which reulted ien aVerage oooldown rate in thpe tactor cool tGmperature of approximately 103 Fthr at 2131 ln'l-oop 3.

Tech Spec 3,1B.

1.8 tes he reactor coolant temperature and pressure and system heatup and.ooldown rates (with the oxception of 1he pressurfzer)

ý7 averaged over one hour shafl be limited in acordanco with Figurc 3.0.6-1 and Figure 311.B-2 for the service period up to 21.63 effective full-power yp.ars. The-.

heatup or cooldown haell not exceed 100 FiiC". On 2116100 2t 1255 ac thc plant continued te cooldown pioc..ss the Auxiliary Spray valve wa3 open allowing water from the Regenerant Heat Exchanger to flow In the Spray Line. 1 lie tWmpeorture difference between the Spray Line and the Pressurizer steam space ab indicaled by the Plant Information System (PI) was 322 F. Tpeh Spec 3.1.8,5 states 'ThA prescurizor heatup and cooldown rates averaged over onec hor shall not exceed 100 F/hr and 200 F/hr, respectively. The spre all not be 1ised If th atemp ftr"re difference between the presurker ir gr thian 320 F.'"

Archived logs, OAD23 notes 3/16/00 21

7.

Once 24 SIG Was Isolated and MSIV-1-24 closed, the AOI has opa.iatlons usG CR2

'POP4.3 to cool-down. The POP is fore normal AhuWown and requires 0lnlmnum-srwuddw boron concentrm(on per graph KCS-4 to be met prior to ctoolg down. With A tube 192k, it's imperative that the cool-down be establimhed ind pressure reduced to stop the primary to secondary leak Boron was bf~ng 2dddd to the RCt through charging to ensure the limits per RCS-4 would be met as sOon as posslple, but delaying the cool-down unIl this point was reached would reultsin filling 24 S/G fhrther and risk lifting the atmospheic rellef valve.

The cool-down was startd with SM approval prior to reaching the RCS-4 limit for boron. The cool, down and depres-suri7ation wars required to prevent 2A S/G from filling fuither. As the cooldown WaS begun, pressurizer level dropped due to a rapid cooldown of the RCS system. This resulted In the need for a manual SI duo to Pressuizer level approaching 9 %. I hir returned the operatnrs to E-0, then into E-3. whtere the requiemonts to meel RCS-4 prior to gtarting the cool down.ire not required. Boron was contlnuously added to ensure we would meot RCS-4 requirnements. RGS-4 was verified In ES-3.1. laltr in the EOP procedures S.

In the course of trying to establish RHR, the operators found CCW valvas 822A & Open B wete.still open as a result of the safety in)ection thai had occurred eadler, but stale.

copuld not fAnd procdural guidAnce (o close the valves.

9.

Nelfhe E-3 ior SOP-RHR 4.2.1 contain a step to ra-position *t*se valves as Con required if an SI has occurred. By omparison, tile NYPA version of E-3 includes

SOP, 1a stn to close the 87MA&B v2ave if an SI hes occurred.

NYPt

10. i is--c*

kn-o~

ge amnong'the upeimors ttt RHR flow control valves HCV.

638 and 640 do adt fully Isolate RHR flow when cosed. This condition created a need to general. a TPC to allow the clos*se of tha 747 valve to isolate RHR flow if needed.

11. F.nEglr revislons of the operting procedures did address the concerns identified In SeER 9-0W. Indusry Steam Generator Tube Leak Evenis

12. SL-1 ttam review of PT-V14 Identified adequate controls over the positioning of MOV-535 and 536.

13. 'RIis dieh normal cool down system used to bring the plant to cold shutdown (lcsfthan 200 F) and maintain core cooling when in cold shut down.

14. Step 9 of ES-3.1 requires RCS pressure to be less than 300 peig and RCS temperature less than 350 F prior to pl3cing the Residual Heat Removal (RHR) syWtem In sgnvile. Stop 9 said that when 1hese conditions were met, to place the RHR dystcm In service pe. Standard Operating Procedure (SOP) 4 2.1 "Residual Heat Removal Svswm."

16. SOP 4.2.1, Step 2.5. requires RCS pressure to be less. than or equal to 460 psig to, place RHR in service.

15. SOP 1.'Regctor Coolant PurND Startup and Shutdown" step 2.10. requires 1hAt me*eolor coolant pumps be tripped it RCS pressure drops bpeluw 350 pcig.

17. hi order to moot Me more restritive RCS pressure limite or ES-3.1 for RHR operation, the raactor conlant pumps would have to be secured prior to placing RHR in s.rvice. Reactor coolant pump operallun iK required for normal pressure control of the reactor' coolant system. Securing the Reactor Coolant Pumps would remove normal prersure control and require the use of alternate pressurizer i2\\sorav via the charalna cumos for ores.vJre control.

1.8,,~henm S3.1 was revised to change ROG pressure ftom 400 to 300 peig, In Dcc skL 1.9.9, a V&V w9e not performed since the change was considered to be admlnis.trfve.

19. When FS 3.1, Backflll from Steam Generalor. was entered from step 44 of E-3, 24 RCP wes In servlce.

affec proc 30001024 rnent Ed E-3, 1.2.1,

k E-3 ived logo

, review of ted Idures V14, Archived A.~sfemn SOP 4.2.1 SOP 1.3 SOP 1.3 rSC Log 4

1%

22 Fact S.....

k ".

i]

-+

=*

[

TSC Log F&LI Scumse 3116100

i, fFact Source

20. o*ntinuationof ES-3.1 was delayed for 1 hour1.157407e-5 days <br />2.777778e-4 hours <br />1.653439e-6 weeks <br />3.805e-7 months <br /> and 26 minutes while relief was Attachment A oug'from Westinghouse to allow initiation of RHR with RCS pressure between Sequence of 380 nd 400:pSl..

events

21. This prbcedural conflict was not Identified during simulator training prior to the event

2. The vlue of R'CS pressure required by NYPA's IP3 ES-3.1 procedure is 400 NYPA ES-3.1 psig. This value is supportedby the Westinghouse Owners Group Emergency and WOG Reo ss Gui delines, guidelines

23. At 08:52 Westinghouse was contacted via a conference call between Eric Frantz CR 200001012 Rich Ptokopvich, and Jeff Stukus. M.Mfliler and W. Durr provided the Westinghouse personnel with current unit conditions as well as procedural information. Upon coming to an understanding of the situation Westinghouse concun..d that for the given plaint conditions it is just as safe to use the normal prinary s stem set onts to place RHR in service

24. A Fax was received from Westinghouse providing documentation of the c,,a r

CR 200001012 a*.e.emintioned conference call conclusion at 11:44 AM wc

(

25. 0 23 operator statements ate silent on Intiation of cooldown.

OAD23 forms 26 On 02(16/00, during the cooldown of the Reactor Coolant System per Emergency CR 200001025 Operating Procedure ES 3.1 Post SGTR Cooldown. it was determined that the Technidal Specification required Reactor Coolant System Overpressure Protection System. would have to be considered inoperable at less than the required Reactor Coolant System temperature of 305 degrees. The system is inoperable at present due to the Inadequate size of the nitrogen supply to the Pressutizer Power Operated Relief Valves and the two required surveillance tests not having been performed. To comply with Technical Specifications, the Reactor Coolant System tempetature, pressure, and level are required to be opetated In accordance with graph 3.1.A-2. This also requires that the three Safety liJectlon Pumps and two of the Charging Pumps be de-energized. This was determined to. be acceptabl, while operating within the Emergency operating Procedures, as at this point In the procedures, the Safet Injection sIgnal hýs been reseL the Safety Injection pumps were secured, and re-initiation of Safety Injection requires the operator to manually start equipment as necessary.

The Safety Injection pumps switches and Charging Pump switches3 were, placed In Pullout and Caution Tags were applied to comply with Technical SSpecifications. _

27. TO] 2651(and SOp-1.2) state ";if actual hot calibrated and actual cold calibrat-ed CR 200001164 pressurizer levels are not withih,15 percent... ' Graph RCS 3A that would be used to determine "actual hot calibrated" level, does not have a line for conditions below 300 degrees. It would be helpful If a fine for 70 degrees could be added to graph ROS 3A.

2*8. During the coo~ldOwn and depressurization associated with 24 Steam Generators CR200001236 tube leak, operators were e'ncumbered by the fact that the OPS system was not operable, It has always been our practice to defer OPS testing until just prior to a cold shutdown outage. Without testing, OPS can not be considered operable.

Tech Specs limit the number of energized Charging Pumps and restricts the Pressurizer level arid temperature. This is an operator work-around when an

..unan)ticip~ated cooldown is required, 3/16/00 23

Contributintg Cause 2 Lea( vs. Rupture Flow Rates Preparations, procedutes, and training focused on either a gradually increasing leak (3

-J 50 gpd) or a gross SG tube rupture (-400 gpm). As a result, operators were not fully piepared to. identify and respond to the smaller volum-rJphe that occurred (-100 gprn).

Fattual Basis:

Fact Date

[1.

Opera*or training has mainly been on large break SGTR

.scenarios. There has been little small break training rvded.

2. :After the plant trip, the Watch Engineer stated, the leak

'had substantially decreaed, elimina
tng any indications to

¶irin ate an Si sIgnal, f*3.] Operators initiated a cool down In accordance witht POP S3.3 cool down requirements, resulting in loss of SPresS~urier le el.

4.* Dn 2/15/00 the station experiefcedl a Steam Generator 2-15-00 Tube eRupture In Steam Generator 24. The plant experienced a Safety Injection, which resulted in an average looadown rathheath reactor cool temperature of approximately 103 F/hr at2131 in Loop 3.

,Tech Spec 3.1.B.1 states "The reactor coolant temperature and pressure and system heatup and coOldOwn rates (with the exception of the pressurizer) averaged over one hour Shall be limited in accordance with l igure 3.i.S-1 and Figure 3.1.8-2 for the service periodf up to 21.63 effectve full-power years. The heatup or cooldowrl shall not exceed 100 F/hr". On 2/1 6/00 at 1255 as the plant continued the cooldown process the Auxiliary 3

Spray valve Was open allowing water from the Regenerent reet Exchanger to flow to the Spray Line. The 4 temperature difference between the Spray Line and the TuPressurIner steam space as indicated by the Plant Infor 'lna en System (PI) was 322 F.

Tech Spec 3.1.a.5 states "Tee pressurizer heatup and cooldown rates averaged over one hour shall not exceed 100 F/hr and 200

Tlht, respectively. The spray shall not be used if the

• temperature difference between the pressurizer and the sc,*

'fluid is reater than 320 F."

5.

RO stated he had started a Cooldown with the Steam

.Dums 3n.autoatic in the 3ressure mode.

t6.

RO stated that the other RO on the shift commented on t ca on stro ller beln o in auto verses bein 2

in manual.

7. Tae RO stated that lie wanted to operate the controller in aut y

bevause it was designed to operate as such.

8. Durng thea cooldown pressurizer level slowly decreased to approximate 9% at whic e time the Control Room Spruprisor CRS directed him RO to manuali initiate SI.

-9. The RO st yt_

that the steam dumps ha2e a histoe 3of etrra c "T pr)a i

n.

10. Theoperators have never taken SGTR training through the point of establishinau RHR coolingi 3 /1 6/00 24 Source Various license holders Watch Engineer statement Plant data 2131 j1CR200001575 Operator interview Operator Interview Operator interview Operator Interview Operator interview

Fact Date Time Source i1. Existing simulator scenarios do not progress through ES Interview of 3;1 to the point that a transition to RHR Is made, S.Dzadik

12. The conflict between ES-3.1 and SOP 4,2.1 regarding the Interview of RCS pressure requirement to enter RHR was not identified S.Dziadik during simulator training.

13. During the plant cooldown and transition onto Residual CR 200001015 Heat Removal certain procedural Inadequacies were uncovered. SOP 4.1.2 Residual Heat Removal System

-Operation assumes that the system Is being placed Into service from a normal, isolated condition. However, this proCedure was entered from Emergency Operating Procedure ES 3.1 which is used following a Safety Injection. The Safety Injection opens 822 A & S.

Component Cooling to the RHR Heat Exchangers. The procedure should address either starting point and allow for only a single heat exchanger to be lined up to CCW.

Later, we secured the only operating Reactor Coolant Pump. This necessitates using Auxilliary Spray from the Charging Pumps for pressure control. It was found that if Aux. Spray is used with a normal Spray Valve partially open, pressure control Is ineffective and Surge Line temperature is affected. The procedure (SOP 1.4 Pressurizer Pressure'Controi)andlor training should address closing all normal spray valves prior to usIng Aux.

Spray to maximize Its effectiveness.

14. Late.entry-During the ALERT on 2116/00 the POM CR 20001384 directed that the OPS OSC Coordinator prepare a contingency plan and Procedure to transfer the contents of 24 Steam Generator to the Unit I Waste Collection Tank

11. This activity was lead by a Spare FSS with support from NPOB and a Generation Support procedure writer. A TPC and -a planned flow path were prepared by the Team and reviewed with the POM. The POM authorized the line up of the'equipment required to implement the plan with the exception of three valves to provide an isolation path, The intent was to be prepared to Implement a contingency action inoaseThe transfer beCame necessary to protect the integrity, of 24 Steam Generator. The TPC was not SNSC approved at the time of the valve line up contrary to AO.1 00 and OAD-27. 'Prior to the actual transfer of 24 Steam Generator, after the ALERT was terminated, the procedure change was approved. Please assign to GS to provide further documentation; assign FYIs to Recovery Plan Manager (John Curry), Emergency Preparedness a,d NS&L.,.

\\4 j.-

A 3/16/00 25

Co*trilbuiina Cause 2 Loakeenina Central Coitrol Room and Emergency Response.Organization log-keeping

('

performance during the event was below prevailing industry practices. As a result, I

event reconstruction was difficult, which interfered with evaluating adequacy of Emergency Response Organization response and support, identifying "lessons to be learned" anO developing corrective actions.

The team dig! not determine whether log keeping met applicable legal requirements.

Log keeping practices during previous EP exercises were reportedly similar to those this event. CorrectiVe actions for a number of ERO performance weaknesses, I

including log keeping, had been initiated but not completed prior to this event.

b Similar weaknesses were noted in the Central Control Room (CCR) log keeping. OAD 3, "Plant Surveillance and Log Keeping" specifies a number of operator actions and evolutions that must be logged. Some of the more significant requirements include plant chemistry and. radiological data, significant events which could affect plant operation, and :conversations with System Operators.

"Standards and expectations for Operations Personnel" require narrative logbooks to be chronological, accurate written histories of plant operations that are legal documents that contain an accurate history of plant operations.

,Factual Basis; Fact Date Time Source "1. Archive Operator Log did not include declaration of the 2/15/00 1929 Arcbived ALERT.

Operator Log 2,

Archive Operator-Log did not Include logging notification of 2/35/00 2007 Arcbived ALERT to NRC, State. Local agencies.

..Operator Log 3.. Control Ro6m Chemistry Log did not Include several Boron 2/15/00 many CCR Chernistry samples that the Watch Chemist log indicates were Log, Watch reported to the. CCR.

Chemist Log 4,

Archiye Operator Log did not log start time of first 2/15/00 2047 Archived

cooldown, Operator Log, Handwritten Logs

5.

Time when first cooldown rate was increased was not 2/15/00 2108 Archived logged.

.Operator Log

6.

R6e-establlshment of auxiliary feed to 24 SIG at 2024 was 2/15/00 2024 Arcbived not log~ged. -

Operator Log 7,

Reason for loss of condenser vacuum was not logged.

2/16/00 0005 Archived Operator Log r8 Start of TPersonnel Accountability" was not logged.

T/15/00 Archived Operator og "9. Initial results of accountability (i.e., not all persons 2/15/00 Archived acocunted for were not accurately lo ged.

Operator Log

10. Emergency Response Organization log keeping 2115-EP Manager performance during t6is event was consistent with ERP

.16/00 discussion log keeping performance during EP exercises.

3/16/00 26

ý1 L;)-

Fact Date Time Source I I. The EOF did not maintain an Emergency Director Log that 2/15-Initial EP documented ED decisions and direction.

16/00 package of 2/22/00.

Additional EP records on 3/300.

Discussion with EP Manager.

I. The TSC POM Log did not adequately document POM 2/15-TSC logs.

decisions and direction.

16/00

2. "Records and logs maintained throughout the emergency are 2/15-Independent poor."

16/00 Emergency Planning Event Analysis (rev 2)

3. Log entries re: TSC activation generally implied formal activation at 2059 (when the TSC was 'functional') rather than the'formal activation noted in the TSC log at 2220:

TSC Logentry: "Waited until roster persons arrived before officially TSC Log activating TSC."

2115/00 2220 EOF Tech advisor EOF Tech advisor log transcription: "TSC Activated."

2/15/00 2059 log transcription Repro of TSC Repro of TSC Event Chronology: "TSC Activated."

2/15/00 2059 Event Chronology TSC POM log TSC POM log: "TSC Activated,"

2/15/00 2059

4.

TSC brdefed the NRC Regional Office prior to activation:

"Conference Call with [NRC Regional Office personnel]"

2/15/00 2035 TSC POM log "Brief NRC Regi~opal office of plant status" 2/15/00 2122 TSC Log

5. Some Emergency Response Organization Logs inconsistently designatd time, generally did not indicate the date on every page:

TSC log initial entry is "2/15/00 2220"; Second entry (same page) is "9:22"; third entry (following blank page) is "0720 [no date appeart tobe 2/16//200"; at bott6m of page. "16:57"; following page, 2/15 first entry, "9:23" [no date-subsequent entries same page are 16/00 Many TSC Log consistent with morning of 2/1 6/00]; several pages later, entry time sequence is "... 13.36; 1346; 2:04; 2:11;... "

OSC 1&C Coordinator log: entry sequence, starting on first page, is

",,. 2049; 2059; 2110; 10:05; 1150; 1200; 1245; 0415; 0700;..."

2115 16/00 Many OSC I&C Log OSC Team Tracking Logs: Logs are undated; value of entries is not clear.

OSC Team TSC Comm Log: First 5 entries were from 11-07-90, crossed out.

Tracking Logs TSC Comm Log 3/16/00 27

,Fact Date Time Source

6. Thie media upon whic4 logs were kept were inconsistent across 2/15-Review of ERO tht ERO. Some logs were maintained in bound log books; some 16100 logs wore maintahn!ed in spiral notebooks; some were unbound pages.

Theteam was unable to find a "master list" of required logs. It it mit possible to det imine (after the fact):

If all required logs were maintained throughout the event;

"* if all logs that were kept were collected for post-event analysis; "a if the logs; collected after the event include all pages upon Wliidh eries _Were Mflade.

7.

Infofination flow between facilities was not clearly and 2/15-ERO Logs conslstently logged in ERO logs; level of log entry detail varied 16/00 slen~cantly from individual to individual within t)e same ERO positio.'n, 8,

Wetgency Operations Facility Information Liaison Package 2/15-EOF Info Liaison cohsisted of copies oftree press releases (including some draft 16/00 cwpies);'did not includ a 'Log' 9:

Eme, gency. Facility clocks were not synchronized during the 2/15-F. Inzirillo input; event clock error re: SAS clock was established after the event.

16/00 "Clock Synch Check"

10. Boron cbnttol inrormation (i.e., RCS and R.HR boron 2/15-Many Various Logs conctntration) was not consistently logged in~any single ERO 16/00 log.. horon concentration entries appear in:

Archived Operator Log, Central Control Room handwritten log; TSC Log; TSC Event Chronology board (reproduction);

TSC POM log; TSC Communicator Log; EOF Tech Advisor log (transcribed);

TSC COre Physics Engineer Log Watcl Chemistry Log With the exceptibn of the TSC POM log and TSC Comnmunlcatoirlog, each of the logs listed above had entries not found In any of the others. Boron concentration entreie in the POM and Communicator logs were also entered in oth.re logs...

11. Cooldpwn rate iog entries were few. Interviews with watch 2/16/00 EP Log review personnel suggest that cooldown rate was monitored, (incl. Archived however this is not reflected in log entries.

operatorlog) 3/16/00 228

Facijities lack desired human engineering attention (layout, design, signage),.

Contributing Cause EP-1:

Emergency Preparedness Pr ogires and the processes with which they interface are impacted by the following wea-kn-sses:

I Insufficient guidance for some situations

• Poor human factors Inconsistencies with current practices or equipment Factual Basis:

Fact Source TPC 00-05-EP, and TPC 00-06-EP were written to change

-PIjanL P-1035 CR200001126 respectively. It Is not apparent that the reviews required bk IOFR5Q.O.54(q)ere performed to ensure there--- 'no decrease in the effectiveness-o-Emergency Plan.

Two questions deleted from emergency planning requalification test for Emergency CR200001183 Direi-,Or (ED) by instructor without approval of EP Manager.C E~mergeency, Planning requalificatio'n test EP-IM-01, Test D, dated E/1 0/99 incorrectly CRR200000010 1 86

"'- scored at 779% rather than 75%. Passing grade Is 80%.

one was imm ediateiy available to continuously com municate with the NRC. The CR200001219 NRC Response Center stressed the urgency in getting this communications path Personnel ir the TSC/OSC used draft procedures (labeled "For, Training Purposes CR200001220 Only") along with existing procedures during the event. The overall opinion is that this enhanced response, however it did cause some confusion at the start of the event f

whether guidance In the new procedures could be used.

Some requirements of the curra' Implementing Procedures were a hindrance to ERO CR200001229 operations such as the setting up of Step Off Pads Into the TSC/OSC areas. The ERO had a temporary change made to the procedures to remove the step off pads when it became clear that contamination was not a concern later in the event.

Better guidance and aids must be provided to the Technical Advisors (TA) sent to the CR200001230 States-nd-County EOCs. Also need a better method of assigning personnel to these pw positions and ensuring timely relief of Individuals.

Due to a shortage of Security Personnel on shift there was a short time period when the CR200001233 main gate was closed without an officer present to allow ERO members to enter the site.

AlthouJgh the.Security Force established controlled the IP2 main gate, the IP3 gate was not controlled for some time. Some of the responders enter through this gate during the

,-K - event.

Security personnel were directing ERO personnel where to go when they entered the site. S6me were directed to report directly to their assigned facilities. This caused some confusion in the EOF where personnel are normally assigned to ERO positions.

3/16/00 30

CfL The procedure distribution process for Emergency Plan Implementing and Immediate Action Procedures is not functioning. Procedure revisions and TPCs are not being distributed to. all controlled coples in a timely manner.

CR200001258 CR200001298 3/16/00 Fact Source EVent termination vas held up for some time due to a request by senior management to CR200001234 notify offsite ExLcutives prior to termination. These notifications were performed outside the EOF. The integrated plans of Indian Point and the State and Counties already outline methods used to notify executives.

"The EOF was deactivated quickly after the termination of the ALERT. Although this is CR200001235 allowed y procefdure, the JNC was still activated and called for assistance after most of the staff had already left.

E-Plan, Section 8, Training: Initial Lesson Plans A through BB have not been reviewed CR200001240 and updated to reflect major revisions to the IP and lAP procedures dated 911/99.

(Raises questions about the way in which procedures are promulgated and reviewed to determine impact on training.)

E-Plan, Section 8, Emergency Plan Training Program Description, Sec. 5: requires CR200001241 annual retraining of. individuals qualified for the job functions identified In Fig. 8-1 of the plan using self studV modules. Self study modules (27) have not been revised to reflect Major -evisfons of the IPs and lAPs dated 911/99. (Raises questions about the way in which ptocedures are promulgated and reviewed to determine impact on training.)

E-Plan, IAP-9: 5.1.1 says *...if EDDS...operative,....oobtain computer printouts of Form CR200001242 42a, 42b, and 42c...every fifteen minutes" There Is no written procedure in IAP-9, associated IP-1021 or any other IP or lAP for obtaining these printouts.

E-Plan, IAP-9:, 5.1. T.c says "...if EDDS and dedicated telecopiers are CR200001248 inoperative,...obtain Forms 42a and 42c from the SAS/Proteus Operator'. Although there is a procedure (i.e., IP-1021) to obtain this data from the Proteus Terminal in the EOF, there is no comparable IP procedure for the SAS Computer Terminal. Procedures provided in the TSC and EOF for this purpose by Computer Applications are not user friendly and awkward to use end are not referenced for use in any lAP or IP. Data from the SAS is printed white on blaok, Setting the printer to print black on white will facilitate sending' this data by facsimile and could reduce the need for transposing the data as described In lAP-9:. 5.i.1.c. 2.

"E-Plan, Section 7T2, Communication Systems describes the communication systems.

CR200001251 however neither the plan, the lAPs nor the IPs describe or provide a comprehensive set of operating instructions for the communication equipment and systems available in the EOF and AEOF for the ED, ORAD, EOF Communicators, and the DAHP to use. E.g.; V Band Consoles, Positron Consoles, standard radio communication techniques.

Several requests have been mode to the Emergency Planning Organization to provide CR200001257 guidance to a newly hired person in the Site Services Procedure Section for the complex distribution of EP procedures and forms. EP had two TPCs last week and they were only disttibutedto the locations that could be found without guidance.

V i\\ wQ) 1 ý N

( \\\\

Identified as a result of the February 15th event, the ambiguity of what constitutes a release sets the stage for misunderstanding. The release well below Tech. Specs.

caused confusion offsite.

31 11 v =

I I II I

I I

I

=

w I

Fact Source

3) The JNC was slow to activate once personnel anrived. No access control was CR200001300 established allowing reporters to roam freely Into all areas.

4)The decision Was made in the JNC for individual organizations to perform independent briefings with the media. This is different from the agreed up6n approach of joint briefings. The issue of whether a radiological release had or had not occurred would have been caught in the JNC had the agreed upon procedures been followed.

5)The JNC is activated using a call-tree. The call tree has only one individual for the majority of positions, If that one person is not contacted, the rest of the tree will not be completed, JNC positions are not part of the site ERO mobilization process.

6)The JNC does not have physical activation procedure.

"E-Plan, Booki, IAP-9, Rev. 8: 6.1.1.a Direction to distribute Forms 42a, and 42c to the CR200001320 counities and Forms 42a, 42b and 42c to NYS, JNC and NRC (similarly to 5.1.1.b.4 &5) has been omitted.

lAP-l, Rev. 11, ADD. 8.1; CR200001324 Provides direction to the NYS EOC in Albany, NY but provides.no directions to the Orange, PUM-Rockland and Westchester EOCs. lAP-2, Rev.8. Does not Include procedure for the TA activities at the State and County EOCs; nor does it provide directions to these EOCs.

"IAP-,q: 5.1.1.b.4 says for the EOF Clerks to send only Forms 42a and 42c to the CR200001347 Counties;- 6.1.. b.6 says to send Forms 42a, 42b, and 42c to NYS, JNC and the NRC.

This distincton between which forms to send to the Counties end which to send to the others requires two separate operations on the facsimile machines which doubles the time for this operation. Eliminate this additional effort by sending Form 42b to the counties as well, With Technical Advisors at each county EOC, these knowledgeable individuals dOuid find this information very useful.

A survey was conducted to solicit Emergency Response Organization comments on CR200001361 emergency response activities during the event. The following k_.owledge and training deficiencles and observations were made by respondents:

EOF personnel responsible for completing form 30a notification procedures were not aware that for forms generated using MEANS software the event description section is editable and should have been edited subsequent to the initial notification to ensure the current status was being selected. Personnel were confused as to whether responding onsite during the event was considered to fall under the unscheduled work requirements as regards fitness-for-duty.

Some personnel onsite at the time that the accountability alarm was sounded either A

ignored it or were not sure what to do upon hearing It.

Numerous personnel, upon being beeped or hearing accountability alarm called the CCR to find out If It was a real event.

(Procedural guidance-eiod1Fd-b-5-ereviewed to determine the extent to which these deficiencies are procedurally based.))

~~!

3/16/00 V

P A

'UJ ThJ

ýý"o?

32

3/16/00 Fact Source Asurvey was conducted to solicit Emergency Response Organization comments on CR200001362

)emergency response activities during the event. The following procedure and guidance deficiencles and observations were made by respondents:

No guidance exists to keep site personnel Informed (such as use of plant page) of plant and emergency status.

Copies of phone nurmbers for TSC, OSC and EOF are not readily available in the CCR to tatcels coming into the CCR can be re-directed to the appropriate locations.

Copies of procedures and emergency telephone numbers are not available to the

-Technical Advisors sent to the counties. The Technical Advisor sent to the counties are not formally proceduralized as part of the implementing procedures.

A survey was conducted to solicit Emergency Response Organization comments on CR200001363 emergency response activities during the event The following Joint News Center aed Media Relations deficiencies and observations were made by resondents:

"* Insufficient person.nel were available to staff the JNC and/or relieve participant for a f\\

seCond shift.

"* Telephone numbers at the JNC and in the Media Relations Emergency Response Plan were not up to date.

The 6 year requirement to test the off-hours Emergency Drill capability has not been CR200001366 done since 1993. (Emergency Planning Administrative Directives should be reviewed to establish adequacy of processes intended to ensure all Emergency Planning "requirements are met.)

33

Contributing Cause 3-2:

Emergency Response Organization training is not fully effective:

Not all personnel in Emergency Response Organization positions have completed all required training a

The ERO has insufficient number of trained personnel to support requirements of extended emergency support 0

EP drills and exercises have not adequately tested the ERO in all aspects of their responsibilities Factual Basis:

Fact Source Level 11 staffing was met for emergency response organization mobilization.

CR200001090 Site accountability was not completed within the 30 minute requirement. (Review C.1900001091 exercise history to establish how frequently off-hours accountability has been tested.)

The TSC, OSC and EOF were not declared activated within 1 hour1.157407e-5 days <br />2.777778e-4 hours <br />1.653439e-6 weeks <br />3.805e-7 months <br /> of emergency C9200001092 declaratipn. (Per another CR, off-hour acivation has not been tested since 1963;

-effectiveness of past mobilization exercises should be evaluated.)

Facility logs and documentation standards were not met. Logs were incomplete and CR200001093 poorly kept.

Recovery actions were not initiated in accordance with IP-1048 "Closeout/De-CR200001098 escalation of Emergency and Initiation of Recovery" and IAP-14 "Recovery Manager."

Certain emergency response organization responders were not currently qualified to CR200001099 fulfill their emergency response organization positions. Positions included: Information La!son, ecovery Manager, and s.'

E-Plan, Section 8, Training: Inftia ns A through 88 have not been reviewed CR200001240 and updated to reflect major revisions to the IP and iAP procedures dated 9/1199.

(Lesson plans need to be updated, retraining performed as necessary.)

E-Plan, Section 8, Emergency Plan Training Program Description, Sec. 5: requires CR200001241 annual retraining of Individuals qualified for the job functions identified In Fig. 8-1 of the plan using self study modules. Self study modules (27) have not been revised to reflect major revisions of the IPs and lAPs dated 911/99. (Study modules need to be updated, retraining-performed as necessary.)

The callout process for ERO augmentation during off-hours does not have a testing procedure that is designed to test the entire callout process. Pagers are tested monthly but the test does nothing more than test the pager equipment for response, The ERO augmentation time has not been assessed since March of 1993. The CIG callout process is ineffective.

CR200001297 3/16/00 L

34 kv

Fact Source

2).The first responders arrived around 10:00 pm. Con Ed responders who arrived at CR200001300 the JNC set off the building alarm because the code was not entered properly. The police responded. There was a lack of keys available to responders,

3) The JNC was very slow to activate once personnel arrived. No access control was established allowing reporters to roam freely into all areas.

7) There Is no formal JNC staff training program. Interviews with county personnel indicate the JNC to be poorly maintained with ambiguous activation and operational requirements.

Failure to conduct an event critique with county and State response personnel CR200001301 immediately after the ALERT was a significant detriment to thecountfutility relationship.

This was evidenced by counties establishing corrective actions without coordination with the utility.

SSlSProteus Operators indicated the need for more SAS/Proteus training for both CR200001356 themselves and ERO member users.

A survey was conducted to solicit Emergency Response Organization comments on.

CR200001361 emergency response activities during the event. The following knowledge and training deficiencies and observations were made by respondents:

EOF personnel responsible for completing form 30a notification procedures were not aware that for forms generated using MEANS software the event description section Is editable and should have been edited subsequent to the initial notification to ensure the current status was being selected. Personnel were confused as to V

whether responding onsite during the event was considered to fall under the Unscheduled work requirements as regards fitness-for-duty.

Some personnel onsite at the time that the accountability alarm was sounded either ignored it or were not sure what to do upon hearing it.

Numerous personnel, upon being beeped or hearing accountability alarm called the CCR-to firid out If it was a real event.

(TrMning plans should be reviewed and revised as necessary to address these deficiencies, including training In response to potential procedural changes that also may respond to some of these issues.)

A survey was conducted to solicit Emergency Response Organization comments on CR200001363 emergency response activities during the event. The following Joint News Center and Media Relations deficiencies and observations were made by respondents:

"* lisufficient personnel were available to staff the JNC and/or relieve participant for a second shift.

"* The Assistant JNC Director stated that she had not been adequately trained to 1i respond to Inquiries from the media.

3/16/00

ý C-1

(- *ý-

35

Contributing Cause 3-3:

Facilities and Equipment did not fully support ERO needs:

Facility, reference material, and equipment maintenance/availability were deficient in some respects.

Facilities lack desired human engineering attention (layout, design, signage)

Factual Basis:

Fact Source Site accountability was not completed within the 30 minute requirement. [Reliance on a CR200001091 paper-based, rather than key-card-based system contributed.]

The TSC, OSC and EOF were not declared activated within 1 hour1.157407e-5 days <br />2.777778e-4 hours <br />1.653439e-6 weeks <br />3.805e-7 months <br /> of emergency "P,200001 092 declaration. [CIG page system problems contributed.]

The Emergency Data Display System (EDOS) and Emergency Response Data System CR200001094 (ERDS) were not functional fpr the first 5 hours5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br /> of the event.

A, ý The Reuter-Stokes offsite telemetered radiation monitor system did not provide normal CR200001095 display output for the duration of the event.

Reuter-Stokes offsite radiation monitor in sector 2 would not provide data remotely over telephone fine due to noise on the line.

CR200001104 The Reuter-Stokes offsite radiation monitoring system availability has not been CR200001218 adequate.

Many of the dedicated phone systems in the OSCITSC were in the process of being CR200001221 upgraded. This caused some confusion and some of the new systems were not g properly.

ERO members requested more phones in the OSC/TSC complex. Multi-line phones CR200001222 can only be used by one person at a time, Locating pho'ne numbers for Individuals within the Emergency Response Facilities was CR200001223 reported as difficult. The proposed Emergency Telephone Directory must be finalized and distributed.

The addition of several personal computers to the QSC/TSC was a great help to CR200001224 responders. However, systems had not been configured properly to allow access to all required data and additional computers were still needed.

More office supplies should be made available In the Emergency Response Facilities.

CR200001228 There were several minor equipment problems with phones, fax machines, copiers CR200001232 and printers. The ERO called in resources to correct or work around these problems.

... The CIG callout process Is ineffective. [CIG page system and/or the way it Is being CP,200001297 used contributed significantly to mobilization delays.]

j.,

.- I

2) The first [JNC) responders arrived around 10:00 pm. Con Eý responders who CR200001300 arrived at the JNC set off the building alarm because the code was not entered properly. The police responded, There was a lack of keys available to responders.

7)... Interviews with oounty ersonnel indicate theýJNC to be poorly maintained...

3/16/00 C-..

C V\\

(

36

Fact The following equlpment and facility deficiencies and observations were made by respondents:

0 EOF Communicator 2 V-band flash to TSC not functioning.

A survey meter from the field monitoring kit falled.

Migslng headsets from TSC. No headset was available for communicators.

TSC fax mpchines programmed to autodlal EOF only. Other necessary locations need to beprogrammed such as CCR, NRC, Westinghouse, etc.

Numerous telephones in the TSC did not work.

Plant Information System (Pl) needs to be loaded onto TSC PCs to allow access during an emergency.

There are exposed telephone and electrical wires in the TSC that should be in conduits or-properly controlled to prevent tripping and or damage.

Need several electrical extension cords for the TSC and OSC. Place in equipment lockers and add to Inventories.

No calculators were available In the TSC.

0. Tool room key was only available from Shift Manager.

1

Source

+

CR200001357 The following Joii't News Center and Media Relations deficiencies and observations CR200001363 were made by respondents:

a No link to the Con Ed intranet, e-mail service or LAN exists for Con Ed emergency responders In the JNC.

The JNC HVAC performed poorly resulting in excessive temperatures In the JNC.

This required the opening of windows that, due to the proximity of the building to the runway, resulted In excessive background noise and aircraft exhaust In the facility.

6 Numerous equipment deficiencies were noted including telephones and fax machines. The facility should be inspected for extent of condition.

EP-S-7.301, Rev. 13, Att 8.5, p.2/2 CR200001417 Four lead bricks found missing from TSC Emergency Locker for.02/15/00 inventory check.

EP-S-7.301, Rev. 13, Aft. 8.5, p.2/2 and Att. 8.6, p.113 both require A fod-bricks each CR200001424 in the TSC and the OSC Emergency Lockers. Lead bricks are used to shield the SPA 3 detector as prescribed in IP-1020, Add. 8.3. According to Add. 8.3, 9 to 11 bricks are required to shield the detector. The bricks in the lockers are hazardous material and not packaged for" routine handling.

HPN desk set not connected to NRC FTS-2000 phone line 700-661-5158. This line CR200001436 was run across TSC floor and applied to ERDS com Pube Line was taped to floor with masking tape. This Is a tripping hazard. si n TSC for data circuit disables the HPN extension in the EOF that would be ýIed for voice transmission, 3/16/00 37 QnCý P

_