ML17263A551

LER 94-003-00:on 940208,open Instrument Tube Resulted in Loss of Containment Integrity.Caused by Personnel Error. Swagelok Plug Installed on Open tube.W/940310 Ltr

ML17263A551
Person / Time
Site:	Ginna
Issue date:	03/10/1994
From:	Mecredy R, St Martin J ROCHESTER GAS & ELECTRIC CORP.
To:	Andrea Johnson NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM), Office of Nuclear Reactor Regulation
References
LER-94-003, LER-94-3, NUDOCS 9403170001
Download: ML17263A551 (11)

Text

ACCELERATED DISTRIBUTION DEMONSTPA.TION SYSTEM

~ ~

REGULATORY INFORMATION DISTRIBUTION SYSTEM (RIDS)

ACCESSXON NBR:9403170001 DOC.DATE: 94/03/10 NOTARIZED: NO DOCKET FACIL:50-244 Robert Emmet Ginna Nuclear Plant, Unit 1, Rochester G 05000244 AUTH. NAME AUTHOR AFFILIATION ST.MARTIN,J.T. Rochester Gas 6 Electric Corp.

MECREDY,R.C. Rochester Gas 6 Electric Corp.

RECXP.NAME RECIPIENT AFFILIATION JOHNSON,A.R. Project Directorate I-3 I

SUBJECT:

LER 94-003-00:on 940208,open instrument tube resulted in loss of containment intergrity.Caused by personnel error.

Swagelok plug installed on open tube.W/940310 ltr.

DISTRIBUTXON CODE: IE22T COPIES RECEIVED:LTR ENCL SIZE TITLE: 50.73/50.9 Licensee Event Report (LER), Incident Rpt, etc.

NOTES:License Exp date in accordance with 10CFR2,2.109(9/10/72). 05000244 RECIPIENT COPIES RECIPIENT COPIES ID CODE/NAME LTTR ENCL ID CODE/NAME LTTR ENCL PD1-3 PD 1 1 JOHNSON,A 1 1 INTERNAL: AEOD/DOA 1 1 AEOD/DSP/TPAB 1 1 AEOD/ROAB/DSP 2 2 NRR/DE/EELB 1 1 NRR/DE/EMEB 1 1 NRR/DORS/OEAB 1 1 NRR/DRCH/HHFB 1 1 NRR/DRCH/HICB 1 1 NRR/DRCH/HOLB 1 1 NRR/DRIL/RPEB 1 1 NRR/DRSS/PRPB 2 2 N ~S@jh/ PLB 1 1 NRR/DSSA/SRXB 1' G ILE 02 1 1 RES/DSIR/EIB 1' RGN1 FILE 01 1 1 EXTERNAL: EG&G BRYCE,J.H 2 2 L ST LOBBY WARD 1 1 NRC PDR 1 1 NSIC MURPHY,G.A 1 =

1 NSXC POORE,W. 1 1 NUDOCS FULL TXT 1 1 P2lg7 l g yg~

NOTE TO ALL "RIDS" RECIPIENTS:

PLEASE HELP US TO REDUCE WASTE! CONTACT THE DOCUMENT CONTROL DESK, ROOM Pl-37 (EXT. 20079) TO ELIMINATEYOUR NAME FROM DISTRIBUTION LISTS FOR DOCUMENTS YOU DON'T NEED!

FULL 'TEXT CONVERSION REQUIRED TOTAL NUMBER OF COPIES REQUIRED: LTTR 27 ENCL 27

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i Torr srrrr ROCHESTER GAS AND ELECTRIC CORPORATION ~ 89 EAST AVENUE, ROCHESTER N. Y. 14649-0001 ROBERT C i LECREDY TELEPHONE Vice Presidenl ArrEA COOE 7 l6 546 2700 Oinna Nuclear Producrion March 10, 1994 U.S. Nuclear Regulatory Commission Document Control Desk Attn: Allen R. Johnson Project Directorate I-3 Washington, D.C. 20555

Subject:

LER 94-003, Uninstalled Swagelok Tubing Plug, Due to Personnel Error, Causes a Loss of Containment Integrity R.E. Ginna Nuclear Power Plant Docket No. 50-244 In accordance with 10 CFR 50.73, Licensee Event Report System, items (a) (2)

(i) (B) and (a) (2) (v), which require a report of, "Any operation or condition prohibited by the plant's Technical Specifications", and "Any event or condition that alone could have prevented the fulfillment of the safety function of structures or systems that are needed to control the release of radioactive material or mitigate the consequences of an accident", the attached Licensee Event Report LER 94-003 is hereby submitted.

This event has in no way affected the public's health and safety.

Very truly yours, Robert C. Mecredy xc: U.S. Nuclear Regulatory Commission Region I 475 Allendale Road King of Prussia, PA 19406 Ginna Senior Resident Inspector 9403170001 940310 05000244 PDR 6

( >(H7(a ADOCK (r~(

PDR i tl j

NRC FORH 366 U.S NUCLEAR REGULATORY CQOIISSION APPROVED BY (NB NO 3150-0104 (5-92) EXPIRES 5/31/95 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS INFORMATION COLLECTIOH REQUEST: 50.0 HRS.

LICENSEE EVENT REPORT (LER) FORWARD COMMENTS REGARDING BURDEN ESTIMATE TO THE INFORMATIOH AND RECORDS MANAGEMEH1'RAHCH (MNBB 7714), U.S. NUCLEAR REGULATORY COMMISSION, I

for block) 'WASHINGTOH, DC 20555 0001 AND TO THE PAPERWORK reverse for required number of digits/characters v'See each REDUCTION PROJECT (31i0-0104), OFFICE OF MANAGEMENT AND BUDGET WASHINGTON DC 20503.

FAclLITY MANE (1) R. E ~ Ginna Nuclear Power Plant DOCKET NNGIER (2) PAGE (3) 05000244 10F0 TITLE (4) Uninstalled Swagelok Tubing Plug, Due to Personnel Error, Causes a Loss of Contairwent Integrity EVENT DATE 5 LER NQIBER 6 REPORT DATE 7 OTHER FACILITIES INVOLVED 8 SEQUENTIAL REVISION FACILITY NAME DOCKET NUMBER MONTH DAY YEAR YEAR MONTH DAY YEAR NUMBER NUNBER 2 8 94 94 --003-- 00 03 10 FACILITY NAME DOCKET NUMBER OPERATING THIS REPORT IS SUBMITTED PURSUANT TO THE REQUIREMENTS OF 10 CFR  : Check one or mor e 11 N(X)E (9)

N 20.402(b) 20.405(c) 50.73(a)(2)(iv) 73. 71(b)

POWER 20.405(a )('l)(i) 50.36(c)(1) 50.73(a)(2)( ) 73.71(c) 098 50.36(c)(2) 50.73(a)(2)(vii)

LEVEL (10) 20.405(a)(1)(ii) OTHER 20.405(a)(1)(iii) X 50.73(a)(2)(i) 50.73(a)(2)(viii)(A) (Specify in 20.405(a)(1)(iv) 50.73(a)(2)(ii) 50.73(a)(2)(viii)(B) Abstract below and in Text, 20.405(a)(1)(v) 50.73(a)(2)(iii) 50.73(a)(2)(x) NRC Form 366A LICENSEE CONTACT FOR THIS LER '12 NAME John T. St. Hartin - Director, Operating Experience TELEPHONE NUMBER (Include Area Code)

(315) 524-4446 C(NPLETE ONE LINE FOR EACH C(NPONENT FAILURE DESCRIBED IN THIS REPORT 13 REPORTABLE REPORTABLE CAUSE SYSTEM COMPONENT MANUFACTURER CAUSE SYSTEH COMPONENI'ANUFACTURER TO HPRDS TO HPRDS SUPPLENENTAL REPORT EXPECTED 14 EXPECTED MONTH DAY YEAR YES SUBIIISSION (lf yes, cceplete EXPECTED SUBHISSION DATE). X NO DATE (15)

ABSTRACT (Limit to 1400 spaces, i.e., approximately 15 single-spaced typewritten lines) (16)

On February 8, 1994, at approximately 1020 EST, with the reactor at approximately 98'. steady state power, an Instrument and Control technician observed an open instrument tube. Event reconstruction determined that this open tube had resulted in a loss of Containment integrity on November 18,,1993.

Immediate corrective action was to install a swagelok plug on the open tube.

The underlying cause of the open tube was a personnel error on the part of a plant technician. (This event is NUREG-1022 (A) cause code.)

Corrective action to preclude repetition is outlined in Section V (B).

HRC FORM 366 (5-92)

HRC FORM 366A U.S. NICLEAR REGULATORY CQIIISSION APPROVED BY QCI HO. 3150-0104 (5-92) EXPIRES 5/31/95 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS INFORMATION COLLECTION REOUEST: 50.0 HRS.

FORWARD COMMENTS REGARDINC BURDEN ESTIMATE TO LICENSEE EVENT REPORT (LER) THE INFORMATION AND RECORDS MAHAGEMEHT BRANCH (MHBB 7714), U.S. NUCLEAR REGULATORY COMMISSIOH, TEXT CONTINUATION WASHINGTON, DC 20555-0001 AND TO THE PAPERWORK REDUCTION PROJECT (3140-010C), OFFICE OF MANACEMENT AND BUDGET WASHINGTON DC 20503.

FACILITY NAME 1 DOCKET NNBER 2 LER NUMBER 6 PACE 3 SEOUENTIAL REVISION YEAR R.E. Ginna Nuclear Power Plant 05000244 M

94 -- 003 00 2 OF 8 TEXT (lf more space is required, use additional copies of HRC Form 366A) (17)

PRE-EVENT PLANT CONDITIONS The plant was at approximately 98% steady state reactor power.

Instrument and Control (I&C) department personnel were performing calibration procedure CPI-PI-70.5, "Calibration of Plant Field Mounted Pressure Gauges", on pressure indicator PI-2281, "Containment Equipment Hatch Pressure". This work is performed outside of Containment, in the area of the Containment (CNMT)

Equipment Hatch.

II- DESCRIPTION OF EVENT A. DATES AND APPROXIMATE TIMES OF MAJOR OCCURRENCES:

November 12, 1993, 1600 EST: Based on records review, not reinstalled in it was concluded that a swagelok plug was accordance with a surveillance test procedure completed on this date and time.

November 18, 1993, 0457 EST: Event date and time.

February 8, 1994, 1020 EST: Discovery date and time.

February 8, 1994, 1030 EST: I&C technician installs swagelok plug on open tube, eliminating the potential for a loss of CNMT integrity.

February 8, 1994, 1630 EST: Reportability date and time.

B. EVENT:

On February 8, 1994, at approximately 1020 EST, with the reactor at approximately 98'teady state reactor power, I&C technicians were preparing to perform calibration procedure CPI-PI-70.5 on PI-2281. An I&C technician observed a nearby instrument tube that had an open end, and recognized that the tube normally has a swagelok plug installed. The plug was sitting on a ledge approximately six (6) inches from the open tubing. (The technician did not observe any other plugs missing in the area.)

He notified his supervision (the I&C foreman) and was directed by the foreman to install the plug.

HRC FORM 366A (5 92)

NRC FORH 366A U.S NUCLEAR REGULATORY CQHI SS I OH APPROVED BY (HIB NO. 3150-0104 (5-92) EXPIRES 5/31/95 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS INFORMATION COLLECTIOH REQUEST: 50.0 HRS.

FORWARD COMMENTS REGARDIHG BURDEN ESTIMATE TO LICENSEE EVENT REPORT (LER) THE INFORMATION AND RECORDS MANAGEMEHT BRANCH (MHBB 7714), U.S. HUCLEAR REGULATORY COMMISSION, TEXT CONTINUATION WASHINGTON, DC 20555 0001 AND TO THE PAPERWORK REDUCTION PROJECT (3'ISO'104), OFFICE OF MANAGEMENT AND BUDGET WASHINGTON DC 20503.

FACILITY NAME 1 DOCKET NUMBER 2 LER HIISER 6 PAGE 3 SEQUEHTIAL REVISIOH YEAR R.E. Ginna Nuclear Power Plant 05000244 94 003 00 3 OF 8 TEXT (If more space is required, use additional copies of NRC Form 366A) (17)

The I&C technician then notified the Control Room of the event, and that he had installed the missing plug. The Control Room operators reaffirmed the I&C foreman's decision. The uninstalled plug was a 3/8 inch swagelok plug, normally installed on the instrument line for PI-2223, "Equipment Hatch Inner Volume "I" Manifold Air Pressure". This instrument line contains a manual valve (V-8060, "Instrument Root Valve to PI-2223<<). V-8060 is depicted on the. piping and instrumentation drawing as open, and was found open. With V-8060 open and the plug uninstalled, there was the potential for a direct path from CNMT to the outside any time the Equipment Hatch Inner access door was open.

The I&C foreman and the Control Room operators formally documented the event, and the operator notified higher supervision and the Nuclear Regulatory Commission (NRC) Resident Inspector.

The Shift Supervisor confirmed that the I&C technician had checked the CNMT Equipment Hatch area for additional missing plugs. As an additional precaution, the Shift Supervisor Hatch directed an Auxiliary Operator to check the CNMT Personnel area for any similar breaches of CNMT integrity. No similar or potential breaches were identified.

A review of plant records was immediately performed, to identify when the swagelok plug should have been installed, and when the CNMT Equipment Hatch Inner access door was open while the plug was not installed. This review concluded that the one swagelok plug that was found uninstalled in the Equipment Hatch area is addressed during the performance of surveillance procedure PT-22.4, "Equipment Hatch Between Door Volume Leak Rate Test".

As part of PT-22.4, two plugs are removed and subsequently reinstalled.

The review of plant records concluded that on November 12, 1993, one of the plugs was properly installed and the other was not, following performance of PT-22.4. The review also concludedon that the CNMT Equipment Hatch Inner access doorShutdown. was opened At November 18, 1993, with the plant not in Cold approximately 1630 EST on February 8, 1994, it was determined that this event was reportable under 10CFR50.72 (b) (2) (,iii)

(C). The NRC was subsequently notified at approximately 1710 EST.

HRC FORM 366A (5 92)

NRC FORM 366A U.S. NUCLEAR REGULATORY CQIIISSION APPROVED BY (S(B NO 3150-0104 (5-92) 1 EXPIRES 5/31/95 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS INFORMATION COLLECTIOH REQUEST: 50.0 HRS.

FORWARD COMMENTS REGARDIHG BURDEN ESTIMATE TO LICENSEE EVENT REPORT (LER) THE INFORMATION AND RECORDS MAHAGEHENT BRANCH (MNBB 7714), U.S. NUCLEAR REGULATORY COMMISSIOH, TEXT CONTINUATION WASHINGTON, OC 20555-0001, AHD TO THE PAPERWORK REDUCTION PROJECT (3150.0104), OFFICE OF MANAGEMEHT AND BUDGET WASHINGTON DC 20503.

FACILITY NAME 1 DOCKET HIMBER 2 LER NNBER 6 PAGE 3 SEQUEHTIAL REVI SIOH YEAR R.E. Ginna Nuclear Power Plant 003--

M 05000244 94 00 4 OF 8 TEXT (lf more space is required, use additional copies of HRC Form 366A) (17)

C~ INOPERABLE STRUCTURES I COMPONENTS i OR SYSTEMS THAT CONTRI BUTED TO THE EVENT:

The combination of the uninstalled plug and the open valve (V-8060) created a direct path from the CNMT to the outside, resulting in a loss of CNMT integrity, whenever the Equipment Hatch Inner access door was open. This door was opened several times on November 18, 1993, during a period of work activities in the CNMT.

D. OTHER SYSTEMS OR SECONDARY FUNCTIONS AFFECTED:

None E. METHOD OF DISCOVERY:

This event was identified by an I&C technician who was performing calibration of Equipment Hatch pressure gauges.

F. OPERATOR ACTION:

The Control Room operators reaffirmed the I&C foreman's decision to install the missing plug. Subsequently, the Control Room operators notified higher supervision and the NRC Resident Inspector. The operators also directed that the CNMT Personnel Hatch area be inspected for the potential of other missing plugs that could affect CNMT integrity.

After reportability was determined, the Control Room operators notified the NRC per 10CFR50.72 (b) (2), 4 Hour Non-Emergency Notification.

G. SAFETY SYSTEM RESPONSES:

None HRC FORM 366A (5-92)

NRC FORM 366A U.s. HUGLEAR REGULATDRY cQellssloN APPROVED BY ON NO. 3150-0104 (5-92) EXPIRES 5/31/95 ESTIMATED BURDEN PER RESPONSE TO COMPLY lllTH THIS INFORMATION COLLECTION REDUEST: 50.0 HRS.

FORNARD COMMENTS REGARDING BURDEN ESTIMATE TO LICENSEE EVENT REPORT (LER) THE INFORMATION AHD RECORDS HANAGEMENT BRANCH (MNBB 7714), U.S. NUCLEAR REGULATORY COMMISSION, TEXT CONTINUATION WASHINGTON, DC 20555-0001 AND TO THE PAPERNORK REDUCTION PROJECT (31i0-0104), OFFICE OF MANAGEMENT AND BUDGET WASHINGTON DC 20503.

FACILITY NAME 1 DOCKET NWBER 2 LER NIHIBER 6 PACE 3 SEQUENTIAL REVISION YEAR R.E. Ginna Nuclear Power Plant 05000244 94 -- 003 00 5 OF 8 TEXT (If more space is required, use additional copies of HRC Form 366A) (17)

III. CAUSE OF EVENT A. IMMEDIATE CAUSE:

The immediate cause of the loss of CNMT integrity was an undetected potential leak path from CNMT to the dutside. This leak path existed because one swagelok plug was uninstalled on an instrument line containing an open manual valve. This only existed when the CNMT Equipment Hatch Inner access leak'ath door was simultaneously open.

B. INTERMEDIATE CAUSE:

A records review concluded that the intermediate cause of the uninstalled plug in the Equipment Hatch area was related to surveillance test procedure PT-22.4, last performed on November 12, 1993. A Human Performance Enhancement System (HPES) evaluation was conducted, and confirmed that one of the

. plugs was not properly reinstalled when PT-22.4 was completed, at approximately 1600 EST on November 12, 1993.

C. ROOT CAUSE:

The underlying cause of the failure to properly reinstall the swagelok tube plug in the Equipment Hatch area was a personnel error. (This event is NUREG-1022 (A) cause code, Personnelof Error.) This was a cognitive personnel error onactions the part and Test (R&T) technician, in that the of the a'esults R&T technician were not in accordance with the direction of procedure PT-22.4. There were no unusual characteristics of the work location.

HRC FORM 366A (5-92)

NRC FORH 366A U.S NUCLEAR REGULATORY COHHISSION APPROVED BY (NB MO. 3150-0104 (5-92) EXPIRES 5/31/95 ESTIHATED BURDEN PER RESPONSE TO COMPLY WITH THIS IHFORHATIOH COLLECTIOH REOUEST: 50.0 HRS.

FORWARD COMMENTS REGARDING BURDEN ESTIHATE TO LICENSEE EVENT REPORT (LER) THE IHFORHATION AND RECORDS HANAGEHENT BRANCH TEXT CONTINUATION (MHBB 7714), U.S. NUCLEAR REGULATORY COMMISSIONS WASHINGTON, DC 20555-0001, AND TO THE PAPERWORK REDUCTION PROJECT (3'150-0104), OFFICE OF MAMAGEMEHT AND BUDGET WASHINGTON DC 20503.

FACILITY NAME 1 DOCKET MNIBER 2 LER MIHIBER 6) PAGE 3 YEAR SEQUENTIAL REVI SIGH R.E. Ginna Nuclear Power Plant 05000244 94 -- 003 00 6 OF 8 TENT (If more space is required, use additional copies of HRC Form 366A) (17)

IV. ANALYSIS OF EVENT This event is reportable in accordance with 10 CFR 50.73, Licensee Event Report System, items (a) (2) (i) (B) and (a) (2) (v), which require a report of, "Any operation or condition prohibited, by the plant's Technical Specifications", and "Any event or'ondition that alone could have prevented the fulfillment of the safety function of structures or systems that are needed to control the release of radioactive material or mitigate the consequences of an accident".

The potential for a leak path was created on November 12, 1993, and a loss of CNMT integrity existed for short periods of time on November 18, 1993. Loss of CNMT integrity, prior to the plant being in the cold shutdown condition, is a violation of Technical Specification (TS) 3.6.1.a.

The tubing for PI-2223 connects to the Equipment Hatch assembly between the Inner and Outer access doors. PI-2223 is used during performance of a pressurization test between the two doors, as required by TS 4.4.2.4.c. Procedure PT-22.4 accomplishes this test. Each access door is supplied with two separate seals, such that either door can provide the necessary CNMT boundary,. Both doors are normally locked closed when CNMT integrity is required, and only one door can be opened at a time. Therefore, the CNMT leak path can only exist when the Equipment Hatch Inner access door is open. The conditions to create this leak path existed since November 12, 1993, but the actual leak path condition only existed on November 18, 1993, during times when the Equipment Hatch Inner access door was open.

NRC FORH 366A (5-92)

NRC FORM 366A U S. NUCLEAR REGULATORY COltIISSION APPROVED BY OMB NO. 3150-0104 (5.92) EXPIRES 5/31/95 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS INFORMATION COLLECTIOH REQUEST: 50 ' HRS.

FORWARD COMMEHTS REGARDIHG BURDEN ESTIMATE TO LICENSEE EVENT REPORT (LER) THE INFORMATION AHD RECORDS MANAGEMENT BRANCH (MHBB 7714), U.S. NUCLEAR REGULATORY COMMISSION, TEXT CONTINUATION WASHINGTOH, DC 20555-0001 AHD TO THE PAPERWORK REDUCTIOH PROJECT (3140 0104), OFFICE OF MANAGEMENT AND BUDGET WASHINGTON DC 20503.

FACILITY NAME 1 DOCKET NUMBER 2 LER NUMBER 6 PAGE 3 SEQUENTIAL REVISION YEAR R.E. Ginna Nuclear Power Plant 05000244 94 -- 003 00 7 OF 8 TEXT (If more space is required, use additionat copies of NRC Form 366A) (17)

An assessment was performed considering both the safety consequences and implications of this event. The results of this assessment are that there were no operational or safety consequences or implications attributed to the loss of CNMT integrity because:

The condition only existed for short periods of time on November 18, 1993. At this time, the plant was at the Hot Shutdown condition and borated to the Cold Shutdown Boron concentration, in preparation for repairing a non-radioactive steam leak inside CNMT.

~ Under these conditions, the consequences of any radiological accident are less severe.

~ The Equipment Hatch Inner access door, by itself, provides a sufficient CNMT boundary when closed. This door is maintained closed during normal plant operation.

With the plant at Hot Shutdown on November 18, 1993, the Inner

.access door was opened at approximately 0457 EST, and was subsequently opened several times on that date. Security personnel maintained a manual log of the use of this CNMT access point, as there is no automatic indication of Inner access door position.

Available logs and other records were used to attempt to quantify the length of time the Inner access door was open, as workers were moving materials in and out of CNMT. No accurate estimate could be made.

The plant was brought to the Cold Shutdown condition at approximately 2200 EST on November 18, 1993. In Cold Shutdown, TS 3.6.1.a does not apply. Therefore, even with the plug missing, the valve open, and the Inner access door open, no further violations of TS 3.6.1.a could occur. The plant left Cold Shutdown on November 20, 1993, at approximately 1235 EST. The Equipment Hatch Inner access door was not opened after that time. Thus, no leak path which would result in a loss of CNMT integrity existed after that date. Also, no event occurred during the time that the Equipment Hatch Inner access door was open which would result in a radioactive release.

Based on the above, it and safety was assured at all times.

can be concluded that the public's health NRC FORM 366A (5-92)

NRC FORM 366A U S. NUCLEAR REGULATORY CQIIISSIDN APPROVED BY MB NO. 3150-0104 (5-92) EXPIRES 5/31/95 ESTIMATED BURDEN PER RESPONSE TO COMPLY WITH THIS INFORMATION COLLECTION REQUEST: 50.0 HRS.

FORWARD COMMENTS REGARDING BURDEN ESTIMATE TO LICENSEE EVENT REPORT (LER) THE INFORMATION AND RECORDS MANAGEMEHT BRANCH (MHBB 7714), U.ST NUCLEAR REGULATORY COMMISSIOH, TEXT CONTINUATION WASHINGTOH, DC 20555-0001 AHD TO THE PAPERWORK REDUCTION PROJECT (31/0-0104), OFFICE OF MANAGEMENT AND BUDGET WASHINGTON DC 20503.

FACILITY NAME 1 DOCKET NUMBER 2 LER NUMBER 6 PAGE 3 YEAR SEQUENTIAL REVISION R.E. Ginna Nuclear Power Plant 05000244 M

94 -- 003 00 8 OF 8 TEXT (lf more space is required, use additional copies of HRC Form 366A) (17)

V. CORRECTIVE ACTION A. ACTION TAKEN TO RETURN AFFECTED SYSTEMS TO PRE-EVENT NORMAL STATUS:

~ The I&C technician, under the direction of h5.s foreman, installed the swagelok plug on the open tube end in the Equipment Hatch area.

B. ACTION TAKEN, OR PLANNED TO PREVENT RECURRENCE:

Management took appropriate disciplinary action for the individual involved.

Procedures and drawings will be changed to maintain valve 8060 normally closed.

Surveillance test procedures for the Equipment Hatch between door volume and Personnel Hatch between door volume will be enhanced to clearly control removal and reinstallation of the swagelok plugs; Administrative controls will be applied to the tubing/

instrumentation configuration, for both the CNMT Equipment Hatch area and the CNMT Personnel Hatch area, as a CNMT penetration/boundary.

VI. ADDITIONAL INFORMATION A. FAILED COMPONENTS:

None B. PREVIOUS LERs ON SIMILAR EVENTS:

A similar LER event historical search was conducted with the following results: No documentation of similar LER events with the same root cause at Ginna Nuclear Power Plant could be identified.

C SPECIAL COMMENTS:

None HRC FORM 366A (5-92)