ML17223A234

LER 89-005-00:on 890626,reactor Tripped on Loss of Load from 22% Power During Turbine Startup Due to High Steam Generator Level in Steam Generator.Caused by Personnel Error.Personnel Counseled & Training Methods evaluated.W/890726 Ltr

ML17223A234
Person / Time
Site:	Saint Lucie
Issue date:	07/26/1989
From:	Mclaughlin L, Woody C FLORIDA POWER & LIGHT CO.
To:	NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
References
L-89-272, LER-89-005, NUDOCS 8908010387
Download: ML17223A234 (5)

Text

l I ACCELERATED DQPGBUTION DEMONS~TION SYSTEM REGULATORY INFORMATION DISTRIBUTION SYSTEM (RIDS)

ACCESSION NBR:8908010387 DOC.DATE: 89/07/26 NOTARIZED: NO DOCKET FACIL:50-389 St. Lucie Plant, Unit 2, Florida Power & Light Co. 05000389 AUTH. NAME AUTHOR AFFILIATION MCLAUGHLIN,L.L. Florida Power & Light Co.

WOODY,C.O. Florida Power & Light Co.

RECIP.NAME RECIPIENT AFFILIATION

SUBJECT:

LER 89-005-00:on 890626,loss of load reactor trip on high steam generator level due to personnel error.

W/8 ltr.

DISTRIBUTION CODE: IE22T COPIES RECEIVED:LTR I ENCL L 50.73/50.9 Licensee Event Report (LER), Incident Rpt, etc.

SIZE:

4'ITLE:

NOTES:

RECIPIENT COPIES RECIPIENT COPIES ID CODE/NAME LTTR ENCL ID CODE/NAME LTTR ENCL PD2-2 LA 1 1 PD2-2 PD 1 1 NORRIS,J 1 1 INTERNAL: ACRS MICHELSON 1 1 ACRS MOELLER 2 2 ACRS WYLIE 1 1 AEOD/DOA 1 1 AEOD/DS P/TPAB 1 1 AEOD/ROAB/DSP 2 2 DEDRO 1 1 IRM/ DCTS/ DAB 7E 1

1 1

0 NRR/DEST/ADE 8H 1 1 NRR/DEST/ADS NRR/DEST/CEB 8H 1 1 NRR/DEST/ESB 8D 1 1 NRR/DEST/ICSB 7 1 1 NRR/DEST/MEB 9H 1 1 NRR/DEST/MTB 9H 1 1 NRR/DEST/PSB 8D 1 1 NRR/DEST/RSB 8E 1 1 NRR/DEST/SGB 8D 1 1 NRR/DLPQ/HFB 10 1 1 NRR/DLPQ/PEB 10 1 1 NRR/DOEA/EAB 11 1 1 NRQ~EP/RPB 10 2 2 NUDOCS-ABSTRACT 1 1 1 1 RES/DSIR/EIB 1 1 RES/DSR/P 1 1 RGN2 FILE 01 1 1 EXTERNAL EG&G WILLIAMSI S 4 4 FORD BLDG HOY I A 1 1 L ST LOBBY WARD 1 1 LPDR 1 1 NRC PDR 1 1 NSIC MAYS,G 1 1 NSIC MURPHY,G.A 1 1 NCTE TO ALL "RIDS" RECIPIWIS PLEASE HELP US TO REDUCE HASTE! CONI'ACI'HE DOCU~WZ CGFIROL DESK RDCN Pl-37 (EXT. 20079) TO EIZMHCQE YOUR NAME FBCK DISTIGE3UTIGN LISTS FOR DOCUMEMZS YOU DON'T NEEDf FULL TEXT CONVERSION REQUIRED TOTAL NUMBER OF COPIES REQUIRED: LTTR 43 ENCL 42

P.O. ox laGPOjuno ":>

JUL~ 2 6 196~i L-89-272 10 CFR 50.73 U. S. Nuclear Regulatory Commission Attn: Document Control Desk Washington, D. C. 20555 Gentlemen:

Re: St. Lucie Unit 2 Docket No. 50-389 Reportable Event: 89-05 Date of Event: June 26, 1989 Loss of Load Reactor Trip on High Steam Generator Level due to Personnel Error The attached Licensee Event Report is being submitted pursuant to the requirements of 10 CFR 50.73 to provide notification of the subject event.

Very truly yours, r

C. O. Woody Acting Senior Vice President Nuclear COW/JRH/cm Attachment cc: Stewart D. Ebneter, Regional Administrator, Region Senior Resident Inspector, USNRC, St. Lucie Plant II, USNRC

HRC Foirn 300 V.S. NUCLEAR REOVLATORY COMMISSION 1903)

APPROVEO OMS NOi 3150410C LICENSEE EVENT REPORT ILER) EXPIRES.'I31/59 FACILITY NAME (ll OOCXET NUMSKR 12) PA E ST. Lucie, Unit 2 o 5 o o o 389 > DF03 LOSS OF LOAD REACTOR TRIP ON HIGH STEAM GENERATOR LEVEL DUE TO PERSONNEL ERROR EVENT OATS (SI LCR NUMSCR ISI REIiORT OATE It> OTHER FACILITIES INVOLVEO (SI MONTH SEQVEHTIAI, OAY YEAR FACILITYHAMES OOCKKT NUMSER(SI OAY YEAR YEAR HVMSER MSER MONTH 0 5 0 0 0 0 626 8 9 8 9 0 0 00 072 6 8 9 0 5 0 0 0 THIS REPORT IS SUSMITTEO PURSUAHT TO THE REQUIREMENTS OF 10 CFR (): IChcch one or morc ot the tonowintl )11)

OPCRATINO MOOS (Sl 20A02)11 20AOS(el 50.734)(2) (icl 73.7) III)

~ OTTER 20AOS(c)(I)(n 50.35(c) Ill 50.73(el(2) (cl 73.71(cl LEVEL (10) 20 ASS 4) (I) I 5 1 50.35( ~ )(2) 50.734)(2) (cSI OTHER ISoecily in rcoitmct dHow oint in Tert, HRC Fonm 20AOS( ~ ill)(IS) 50.73( ~ ) (2)(il 50.73(c) (2) (el)I) IAI 35SAI 20AOK 4) Ill(HI 50.734) (2)(ill 50.73( ~ )(2) (ciiil(~ I 20AOS 41) 1 I (cl 50.7 34112) I IS) 50.73( ~ l(2)(cl LICKHSEE CONTACT FOR THIS LCR I12I NAME TELEPHONE HVMSER AREA CQOE L. L. McLaughlin, Supervising Engineer 407 465 -3550 COMPLCTE ONE LINC FOR 'EACH COMPONENT FAILURE OESCRISEO IN THIS REPORT (13)

CAUSE SYSTEM COMPOHEHT MAHVFAC. SYSTEM COMPOHFHT MAHUFAC. EPORTASLE 4

TUNER TVRER TO NPROS SUPPLCMENTAL RCPORT EXPECTCO IICI MOHTw OAY YEAR EXPECTED SVSMISSIOH OATS (151 YCS Ilt ycc, comon>> EXPKCTCO SVSMISSIOH OA N I HO ASST RACT ILimrt to tc00 cpccn. i, c,. coprochncteiy Ii tteen tinote toece tyoewnncn Anni II~ I On June 26, 1989 at 2347 hours, St. Lucie Unit 2 reactor tripped on loss of load from 22% power during turbine startup. The loss of load reactor trip was a result of a turbine trip due to high steam generator level in the 2A steam generator. The trip was uncomplicated and the unit was quickly stabilized in Mode 3, Hot Standby.

The root cause of the event was cognitive personnel error by utility-licensed operators due to less than adequate communication between the shift crew performing the turbine startup evolution.

The utility-licensed operators were counseled on the need for well controlled evolutions, in which good communication is of the utmost importance by all participants, as a short term corrective action. The plant training group will evaluate this event to determine appropriate training requirements and methods.

NRC Fcirn 355

'9 SSI

NRC form 388A U.S. NUCLEAR REGULATORY COMMISSION i

)84)3)

LICENSE VENT REPORT HLER) TEXT CONTI TION APPROVED OMB NO, 3150-0104 EXPIRES: 8/31/ml fAC)LITT NAME Ill DOCKET NUMBER )3) LER NUMBER (81 PAGE 13)

YEAR ?y$ . SEQUENTIAL "" ~M

~ REVISION NVM844 NVM844 St. Lucie, Unit 2 1%XT WRSSO RMc ~ NIOEv4e4 vop RES/4/N/i/RC %%drrrr 3884'4) l17) 0500038989 005 0 02 OF0 DESCRIPTION OF EVENT On June 26, 1989, St. Lucie Unit 2 was in Mode 1 with reactor power at 5%. The Unit was preparing to synchronize the main turbine generator

'(EIISSTB) to the grid. At 2335 hours0.027 days <br />0.649 hours <br />0.00386 weeks <br />8.884675e-4 months <br />, the main generator output breakers were closed and the main generator was synchronized to the grid. The reactor control operator at the turbine controls manually entered a load rate of 50 MW per minute to minimize the possibility of a main generator secondary lockout on anti-motoring protection circuit. The high turbine load rate resulted in a drop in primary system average temperature. The Assistant Nuclear Plant Supervisor noted the problem and instructed that the turbine load rate be reduced to 25 MW per minute. Turbine loading was stopped to help stabilize the plant. Control element assemblies (CEAs)

(EIIS:AA) were withdrawn to raise primary coolant temperatures to offset.

the rapid drop in temperature due to the turbine load rate. Reactor power increased from approximately 11% to 22% over a short period of time.

At this point, the control room operators were unable to compensate for the primary and secondary power mismatch. With primary coolant system temperature increasing, the steam generator levels swelled. At 2347, the turbine tripped on high level on the 2A S/G and the reactor tripped on loss of load due to the turbine trip. The Standard Post Trip Actions were performed and the unit was stabilized in Mode 3, Hot Standby.

The trip was an uncomplicated reactor trip and all systems functioned normally.

CAUSE OF EVENT The cause of the event was cognitive personnel error by utility-licensed operators due to less than adequate communication between the shift crew performing the turbine startup evolution. The operator at the reactor controls did not adequately convey the magnitude of the CEA withdrawal to the other operators at the steam generator level control station and the turbine control station. The turbine startup evolution was performed under the guidance of an approved plant procedure when the error occurred.

There were no unusual characteristics of the work location that directly contributed to the personnel error.

NRC PORM 344A oU S GPO 1988 0 834 538/455

NRC IIIRIR 38EA U.S. NUCLEAR REGULATORY COMMISSION gHQ)

LICENSEI+ENT REPORT (LERI TEXT CONTINllON APPROVEO OM8 NO. 3150-0)04 EXPIRES: 8/31/88 PACILITY NAME I'I) OOCKET NUMBER Ql LER NUMBER Id) PAGE (3I YEAR jiRA SEQUENTIAL REVISION

X48 NVMSER JIVE NVMSER St. Lucie, Unit 2 0 S 0 0 0 38 989 005 0 0'3 oFO 3 TSCT WIRN4 EPSCP /4 /40VPNE VP4 akNCR4////IC FCnn 38SAS/ ))Tl ANALYSIS OF EVENT The event is reportable under 10 CFR 50.73 (a)(2)(iv), "any event or condition that resulted in manual or automatic actuation of any Engineered Safety Feature, including the Reactor Protection System."

The event was observed to be an uncomplicated reactor trip on loss of load. The loss of load reactor trip is for equipment protection and is not required for reactor safety. The resulting transient was well enveloped by the St. Lucie Unit 8'2 Final Updated Safety Analysis Report section 15.2.1.2 "Limiting Reactor Coolant System Pressure Event-Isolation of Turbine (100% power)." All plant safety functions were met and there

'were no additional complications. Consequently, the health and safety of the public were not affected by this event.

CORRECTIVE ACTIONS

1. The utility-licensed operators were counseled on the need for well controlled evolutions, in which good communication is of the utmost importance by all participants.

2. The plant training group will evaluate this event to determine appropriate training requirements and methods.

ADDITIONAL INFORMATION FAILED COMPONENT INFORMATION:

There were no failed components during this event.

PREVIOUS SIMILAR EVENTS:

For similar events involving reactor trips on loss of load due to high steam generator level, see Licensee Events Reports:

335-86-004 389-85-004 NRC PORM 344A RU S GPO 1988 0 83< 538/45S