ML17292A568
| ML17292A568 | |
| Person / Time | |
|---|---|
| Site: | Columbia  |
| Issue date: | 10/25/1996 |
| From: | NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION IV) |
| To: | |
| Shared Package | |
| ML17292A566 | List: |
| References | |
| 50-397-96-14, NUDOCS 9610290181 | |
| Download: ML17292A568 (28) | |
See also: IR 05000397/1996014
Text
ENCLOSURE 2
U.S. NUCLEAR REGULATORY COMMISSION
REGION IV
Docket No.:
License No.:
Report No.:
Licensee:
Facility:
Location:
Dates:
Inspectors:
Approved By:
50-397
50-397/96-1 4
Washington Public Power Supply System
Washington Nuclear Project-2
3000 George Washington Way
Richland, Washington
September 23-27, and October 3, 1996
Gail M. Good, Senior Emergency Preparedness
Analyst
(Team Leader)
Thomas H. Andrews, Jr., Radiation Specialist
Ramon V. Azua, Project Engineer
Thomas H. Essig, Chief, Emergency Preparedness
and
Environmental Health Physics Section, Office of Nuclear Reactor
Regulation
George D. Replogle, Resident Inspector
Blaine Murray, Chief, Plant Support Branch
Attachment:
Supplemental Information
96i0290i8i 96i025
ADOCK 05000397
-2-
EXECUTIVE SUMMARY
Washington Nuclear Project-2
NRC Inspection Report 50-397/96-14
Routine, announced inspection of the licensee's performance and capabilities during the
full-scale, biennial exercise of the emergency plan and implementing procedures.
The
inspection team observed activities in the control room simulator, technical support center,
operations support center, and emergency operations facility.
Plant Su
ort
A deviation was identified for failure to satisfy a commitment to modify the
plans to identify the specific location of the alternate
emergency operations facility (Section P2).
Overall, control room performance was very good.
The control room staff's use of
the emergency operations procedure flow chart and procedures was especially
noteworthy.
Communications were generally good; the shift manager conducted
frequent and comprehensive*briefings
(Section P4.2).
Overall, the technical support center staff's performance was generally good.
The
facility was staffed in a timely manner; the technical support center manager
exercised good command and control; and participants were effective in their roles.
However, room for improvement was noted in the areas of internal and external
communications and habitability determination (Section P4.3).
Overall, the operations support center staff's performance was good.
Participants
demonstrated
the ability to effectively create and manage emergency response
teams to perform inplant repairs.
Command and control by the operations support
center's management staff was very good.
The periodic briefings were identified as
a strength.
There was room for improvement in the following areas:
(1) communication between the licensee and Hanford Fire Department;
(2) respiratory protective equipment use under accident conditions; and,
(3) procedural adherence
concerning center habitability (Section P4.4).
Overall, performance in the emergency operations facility was generally good.
Emergency events were properly classified; however, command and control of
facility activities was less than satisfactory at times.
An exercise weakness for
failure to make clear and timely offsite agency notifications and protective action
recommendations
was identified (Section P4.5).
~
The scenario was sufficiently challenging to test emergency response
capabilities
and demonstrate
onsite exercise objectives.
Significant similarities were identified
between the 1994 and 1996 exercise scenarios.
Once identified, prompt and
thorough action was taken.
Mock-ups were effectively used for some equipment
-3-
failures; however, exercise control could have been improved in some areas to
enhance the realism and training value of the exercise (Section P4.6).
~
The licensee's self-critique process effectively identified areas for corrective action
(Section P4.7).
-4-
IV. Plant Su
ort
P2
Status of Emergency Preparedness
Facilities, Equipment, and Resources
a.
Ins ection Sco
e 82701-02.02
The inspectors reviewed provisions for use of an alternate emergency operations
facility. The inspectors discussed the matter with licensee representatives
and
reviewed the following documents:
Washington Nuclear Project-2 Emergency Plan
GO2-83-529, dated June 16, 1983 (Supply System letter to NRC)
SECY-83-361, dated September
14, 1983
NRC letter to Supply System, dated October 7, 1983
NRC Inspection Report 397/85-10, dated July 5, 1985
b.
Observations
and Findin s
During the inspection, the inspectors were informed of the licensee's intentions to
lease its headquarters
facility located at 3000 George Washington Way, Richland,
Historically, the Supply System headquarters
facility has been
recognized as the alternate location for the emergency operations facility (as
opposed to a backup emergency operations facility). The location, which is 9.5
miles from Washington Nuclear Project-2, was the subject of several letters
between the Supply System and the NRC prior to licensing in late December 1983.
In reviewing this matter, the inspectors noted the following points:
GO2-83-529, dated June 16, 1983, stated that "the Supply System will
modify our emergency preparedness
plans to designate
an alternate location
for assembly of individuals who would normally respond to the EOF for use
in the event that travel in the vicinity of the EOF is hampered by accident
radiological conditions...
The alternate response
location for the Hanford Site
will be the Supply System headquarters
building at 3000 George Washington
Way in Richland."
The Commission approved the Supply System headquarters
facility as the
alternate location for the emergency operations facility in SECY-83-361,
dated September
14, 1983.
On October 7, 1983, the Supply System was informed of the Commission's
approval of the Supply System headquarters
facility as the alternate
emergency operations facility location.
-5-
The Emergency Response
Facility Appraisal (NRC Inspection Report
397/85-10, dated July 5, 1985) identified the Supply System headquarters
as the alternate emergency operations facility location.
Revision 17 to the Washington Nuclear Project-2 Emergency Plan did not
specifically identify the Supply System headquarters
facility as the alternate
emergency operations facility location.
Subsequent to the September 27, 1996, exit meeting, the inspectors were informed
that the emergency plan and procedures were never modified pursuant to the
commitment made by Supply System management
in the June 16, 1983, letter.
The failure to satisfy a commitment was identified as a deviation (397/9614-01).
On October 3, 1996, the licensee informed the inspectors of planned corrective
actions.
The licensee stated that appropriate sections of the emergency plan and an
implementing procedure would be changed to identify the Supply System
headquarters
as the alternate emergency operations facility location.
The
implementing procedure and emergency plan changes were scheduled to be
presented to the plant operating committee on October 9 and 16, 1996,
respectively.
These actions satisfactorily fulfilledthe June 16, 1983, commitment.
Conclusion
A deviation was identified for failure to satisfy a commitment to modify the
plans to identify the specific location of the alternate
emergency operations facility.
P4
Staff Knowledge and Performance
P4.1
Pro ram Areas lns ected
82301
The licensee conducted
a full-scale, biennial exercise on September 25, 1996. The
exercise was conducted to test major portions of the onsite (licensee) and offsite
emergency response
capabilities.
The licensee activated its emergency response
organization and all emergency response
facilities. The Federal Emergency
Management Agency evaluated the offsite response
capabilities of the State of
Washington, the State of Oregon, and Benton and Franklin counties.
The Federal
Emergency Management Agency will issue
a separate
report.
The exercise scenario was run using the control room simulator in a dynamic mode.
The exercise scenario began at 7:15 a.m. with the plant operating at approximately
100 percent power. At the start of the exercise, the high pressure
core spray pump
was inoperable due to scheduled maintenance.
At 7:25 a.m., the control room received
a report of smoke issuing from Building 10.
The plant fire alarm was sounded
and the fire brigade responded.
The Hanford Fire
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Department was called to support the licensee's fire brigade.
At 7:29 a.m., the
electrical power to Building 10 was secured.
At 7:32 a.m., Fire Pumps 2A and 2B
would not start.
The licensee evaluated the technical specification significance of
the fire pump failures and entered the limiting requirement for operation.
At 7:33 a.m., the control room received an alarm indicating a leak greater than 10
gallons per minute inside primary containment.
At 7:34 a.m., the shift manager
declared
a notification of unusual event, since the source of the leakage could not
be identified. This classification was not anticipated by the scenario developers.
Notification of state and local agencies was promptly initiated by control room
personnel.
These notifications were completed at approximately 7:44 a.m.
At 7:39 a.m., the control room was notified by radio that one of the fire brigade
members was experiencing chest pains.
An ambulance was requested.
The
Hanford Fire Department arrived at the site at 7:39 a.m., and the ambulance arrived
at 7:42 a.m. At 7:45 a.m., the responsibility for handling the fire and injured
individual was transferred to the Hanford Fire Department and ambulance crew.
The equipment operators on the fire brigade were directed to return to the plant.
The control room staff initiated actions to determine the source and magnitude of
the leakage.
At 7:58 a.m., the control room was notified that the leak was greater
than 30 gallons per minute, based upon a bucket test.
At 8:01 a.m., the licensee
upgraded the emergency declaration to an alert based on a leak rate greater than 25
gallons per minute.
The control room initiated offsite agency notifications and
activation of the licensee's emergency response
organization/facilities.
Following
the offsite agency notifications, the NRC (simulated via a control cell) was notified
at 8:10 a.m.
During the next hour, a series of events took place that impacted plant operations
and challenged the emergency response
organization.
At 8:29 a.m., the
intermediate range reactor building stack monitor failed. At 8:53 a.m., the control
room staff initiated a controlled shutdown to cold shutdown conditions.
At 8:59 a.m., a turbine building hi-hi alarm was received in several turbine building
areas, indicating that a leak had occurred.
At 9:10 a.m., the control room received
a report of a high-pitched noise in the turbine building. At 9:13 a.m., the leak was
identified as a non-isolable leak on Main Steam Trap 1A.
At 9:09 a.m., the operators discovered that the dump valves for the number
1
heater would not operate.
Several tubes in the number 5 heater failed, causing
a
high level trip to occur.
Water cascaded
through heaters 4, 3, and 2, causing
a
feedwater heater trip. As expected, the number
1 and 2 heaters isolated.
At 9:16 a.m., the operators noticed rapidly increasing drywell pressure.
The reactor
was at approximately 70 percent thermal power.
The shift manager ordered
a
manual reactor scram.
All control rods fully inserted, and the feedwater pumps
I
-7-
tripped.
All main steam isolation valves closed except the inboard and outboard
"A" valves.
This created
a release path to the unisolable leak in the turbine
building. The operators characterized
the leak as being large, based on the fact that
no safety relief valves were needed to control reactor pressure vessel pressure.
The
reactor core isolation cooling pump actuated when water level dropped below the
actuation setpoint.
Nuclear instrumentation, both startup and intermediate range
monitors, failed a short time after the scram.
At 9:21 a.m., the operators observed that the "A" residual heat removal pump was
not operating properly.
The operators suspected
a sheared shaft and dispatched
an
equipment operator to investigate.
At 9:26 a.m., a report of pump cavitation was
received; therefore, the operators determined that the suction strainer was blocked.
At 9:22 a.m., the emergency operations facility manager, after consultation with
the shift manager and technical support center manager, declared
a site area
emergency.
The site area emergency was due to failure of the main steam isolation
valves to close with an unisolable leak outside containment.
Offsite agency
notifications were made by the emergency operations facility as described in
Section P4.5 below.
At 9:34 a.m., the reactor core isolation cooling pump tripped.
This left control rod
drive cooling as the only operating high pressure source of water.
Reactor vessel
water level continued to drop until 9:55 a.m., at which time there was a rapid
decrease
in reactor vessel water level.
At 9:55 a.m., the supply breaker (SM-8) from one of the emergency power buses
failed, which made residual heat removal pumps "B" and "C" inoperable.
The
isolation valve for low pressure
core spray, LPCS-V-5, failed to open.
At 9:57 a.m., with no water supply sources, the control room entered the primary
containment flooding portion of the emergency operations procedure,
and the
emergency operations facility manager declared
a general emergency.
Offsite
agency notifications were made by the emergency operations facility as described
in
Section P4.5 below.
At 10:19 a.m., LPCS-V-5 opened and allowed low pressure core spray injection
which led to fuel rod damage.
The turbine and reactor buildings were evacuated
due to high radiation levels. At 10:53 a.m., the control room was notified that the
high pressure
core spray pump was available and then took steps to align and
operate this pump. At 10:56 a.m., injection from high pressure core spray was
initiated.
At 11:00 a.m., the control room was notified that the power supply for residual
heat removal pumps "B" and "C" had been restored and took actions to initiate
injection from these sources.
At 11:35 a.m., main steam isolation valve
MSIV-V-22Aclosed, isolating the leak to the turbine building.
-8-
The simulator failed three times between 11:08 and 11:48 a.m. After the last
failure, the controllers decided to manually supply data for the remainder of the
exercise.
The exercise was terminated at 2:08 p.m.
P4.2
Control Room
a.
Ins ection Sco
e 82301-03.02
The inspectors observed and evaluated the control room simulator staff as they
performed tasks in response to the exercise scenario conditions.
These tasks
included detection and classification of events, analysis of plant conditions,
notification of offsite authorities, and adherence to the emergency plan and
implementing procedures.
The inspectors reviewed applicable emergency plan
implementing procedures,
logs, checklists, and notification forms generated
during
the exercise.
b.
Observations
and Findin s
The shift manager coordinated and oversaw control room response,
redirecting the
response
as necessary.
With one exception, actions were performed in accordance
with applicable procedures
and instructions.
There were no control room logs taken
during the exercise.
This matter is discussed further in Section P4.6 below.
Control room operators correctly interpreted control room instrument displays.
From these and other available information sources, operators recognized that
events were progressing abnormally and developed appropriate strategies to bring
the plant to a safe shutdown condition.
Control room personnel correctly classified
the unusual event and alert events using the emergency action levels.
Following
event declarations, control room personnel correctly implemented the immediate
actions required by the emergency plan implementing procedures.
The control room
staff's use of the emergency operations procedure flowchart was especially
noteworthy.
The inspectors observed that the shift technical advisor used a checklist that was
not part of an official station document or emergency plan implementing procedure.
The inspectors concluded that the use of an uncontrolled checklist could create
a
problem, since there was no formal method to ensure that the information on the
checklist remained current.
Control room communications were generally effective.
The shift manager
conducted frequent briefings that included sufficient detail
~
Room for improvement
was noted in the following areas:
~
The shift technical advisor checked "Emergency" instead of "Exercise" on
the notification form that was transmitted via facsimile to state and local
agencies.
The form also included the telephone number for the real control
-9-
room (as opposed to the simulator).
The offsite agencies called to verify the
plant conditions.
Personnel were observed using the radio microphone instead of the plant
page microphone to make plant announcements.
As a result,
announcements
were not received in all locations.
Telephone calls were not always answered.
As a result, important messages
- may have been lost or delayed.
c.
Conclusions
Overall, control room performance was very good.
The control room staff's use of
the emergency operations procedure flow chart and procedures was especially
noteworthy.
Communications were generally good; the shift manager conducted
frequent and comprehensive
briefings.
P4.3
Technical Su
ort Center
a.
Ins ection Sco
e 82301-03.03
The inspectors observed and evaluated the technical support center staff as they
performed tasks necessary to respond to the exercise scenario conditions.
These
tasks included staffing and activation, facility management
and control, accident
assessment,
onsite protective action decisionmaking and implementation,
communications, assistance
and support to the control room, and prioritization of
mitigating actions.
The inspectors reviewed applicable emergency plan
implementing procedures
and logs generated
during the exercise.
b.
Observations
and Findin s
The technical support center had the minimum required staff and was activated
within 27 minutes after the alert declaration.
The technical support center was
activated in a coordinated and efficient manner and was staffed with a sufficient
number of individuals who demonstrated
the appropriate expertise for their various
positions.
Communications were promptly established with the control room simulator,
operations support center, and emergency operations facility. The technical support
center manager effectively communicated with the other participants and exercised
good command and control of the center.
Concise and informative briefings were
conducted every 30 minutes and appropriate log-keeping was observed.
The technical support center staff actively participated with the emergency
operations facility staff and the simulator control room shift manager in the
-10-
determination of the site area and general emergency classifications.
All
classifications were correctly determined.
The inspectors identified four areas for improvement.
First, requests for corrective
actions, from the technical support center to the operations support center, were
not consistently timely. For example, the failure of Valve LPCS-V-5 (which could be
manually opened and was easily accessible)
and emergency power source SM-8
occurred at approximately 9:55 a.m.
However, the operations support center was
not requested to manually open LPCS-V-5 or repair SM-8 until 10:17 a.m. (about 22
minutes later).
This appeared to be an excessive amount of time for making these
requests.
As a result of the delay, Valve LPCS-V-5 was opened (by the simulator)
before the operations support center team left to make the repairs.
Similarly, SM-8
was restored before repairs were completed.
Second, habitability of the technical support center was not appropriately verified.
Specifically, the technical support center entry door was ajar for most of the
exercise.
Emergency Plan Implementing Procedure 13.10.4, "Radiation Protection
Manager Duties," Revision 13, Section 3.1.8, required the radiation protection
manager to ensure that the technical support center airlock door at the card reader
was closed to maintain environmental integrity. When questioned about the
oversight, the radiation protection manager indicated that he had checked the door
when he initiallyarrived but that other participants may have entered through the
door afterwards.
It should be noted that the resident inspectors have identified a recurring problem
involving door closure.
Specific examples involved fire doors and other doors used
to control air balance.
In response,
licensee management communicated its
expectations concerning door closure; it is the individual's responsibility to ensure
that doors are fully closed.
The inspectors concluded that the licensee's corrective
actions have not been totally effective.
In the above example, individuals
entered/exited the technical support center without fully closing the door, and the
doors were not regularly checked during the habitability surveys.
Under certain
radiological conditions, the habitability of the technical support center could be
affected if the door was not closed.
Third, the status board sometimes reflected inaccurate information.
Examples are
provided below:
The time field (which identified the last time the information was modified)
was rarely updated.
For example, at 9:49 a.m., the status board was
modified to reflect current plant conditions.
However, the time field
indicated the board was last updated at 8:40 a.m. (over an hour earlier).
At approximately 10:00 a.m., the status board indicated that safety related
buss SM-8 was lost.
However, Residual Heat Removal Pump B was
identified as being in "wetwell spray" and Residual Heat Removal Pump C
-11-
was noted as being in the run mode of operation.
Contrary to the status
board, these pumps received power from SM-8 and were inoperable at the
time.
At approximately 10:50 a.m., the status board indicated that SM-8 was
restored, but Residual Heat Removal Pumps 8 and C were still identified as
being inoperable.
When SM-8 was returned to service, the pumps should
have been upgraded to an operable status.
~
At 11:44 a.m., the status board indicated that the C residual heat removal
pump was inoperable, but injecting to the vessel at the same time.
Fourth, the information coordinator did not consistently announce the failure of
significant safety equipment in a timely manner.
For example, when the loss of all
low pressure
and high pressure systems was experienced,
the coordinator quietly
updated the status board but made no announcement to alert the technical support
center participants of the problem until the scheduled 30-minute briefing (about 5
minutes later).
As a result, participants may not have learned of the failures in a
timely manner.
Toward the end of the drill, the information coordinator announced
some of the problems in a more timely fashion and demonstrated
overall improved
performance.
In contrast to the problems associated
with the status board, the inspectors noted
that the operations manager was in frequent contact with the control room and
appeared to keep the remainder of the staff informed of important plant parameters
and equipment problems.
c.
Conclusions
Overall, the technical support center staff's performance was generally good.
The
facility was staffed in a timely manner; the technical support center manager
exercised good command and control; and participants were effective in their roles.
However, room for improvement was noted in the areas of internal and external
communications and habitability determination.
P4.4
0 erations Su
ort Center
Ins ection Sco
e 82301-03.05
The inspectors observed and evaluated the operations support center staff as they
performed tasks in response to the scenario conditions.
These tasks included the
fire brigade response,
functional staffing, and inplant emergency response
team
dispatch and coordination in support of control room and technical support center
requests.
The inspectors reviewed applicable emergency plan implementing
procedures,
logs, checklists, and forms generated
during the exercise.
-1 2-
Observations
and Findin s
The plant fire brigade reached the area of the fire and set up its command post in a
timely manner.
The fire brigade leader properly selected the location of the
command post based on the weather conditions and the location of the fire.
Fire
brigade personnel took the necessary
precautions to make sure that their equipment
was functioning correctly before attempting other activities. Actions taken in
response to the injured (simulated) fire brigade member were appropriate; however,
the actions slowed the crew's progress in fighting the fire.
Communications during the fire brigade response
were not always effective.
First,
it was hard for the fire brigade leader to hear the control room on the hand-held
radio.
Second, the confusion caused by the efforts to assist the injured man, and
the failure of security personnel to direct the Hanford Fire Department personnel to
the fire brigade command post, resulted in the Hanford Fire Department personnel
responding to the fire prior to coordination with the site fire brigade.
Initially, there
was no apparent contact between the Hanford Fire Department and the site fire
brigade to communicate the existence of special circumstances
or hazards that
could affect personnel or plant safety.
Plant Procedures
Manual 1.3.36, "Plant
Emergency Response
Personnel Requirements,"
Revision 9, Section 5.1.1, required
the fire brigade leader to coordinate fire fighting activities with the Hanford Fire
Department senior officer.
The operations support center was activated within 17 minutes of the alert
declaration.
Upon arrival, personnel quickly readied the facility, updated status
boards, and obtained information from the control room relative to plant status.
The
operations support center manager,
and the supporting staff, were knowledgeable
of their duties and responsibilities.
Communications between the operations
support center, technical support center, and the control room were effective.
An
electronic status board for plant parameters
and emergency response team status
board were established
at the onset of the exercise.
Both boards were regularly
updated and effectively used by center management
during the exercise.
The operations support center manager exercised very good command and control ~
Briefings presented
by the manager throughout the day were informative, timely,
and readily audible (i.e., a localized public address system was used, enhancing
clarity and volume, overcoming background noise).
The briefings were presented
simultaneously to staff located in the main part of the facility and in a staff holding
area located
a short distance away.
Periodically, a member of the manager's
senior
staff was dispatched to the holding area to ensure that the craft personnel
(mechanics, electricians, etc.) understood the information provided in the manager'
briefing and to answer any questions.
The inspectors identified this area as a
strength.
The operations support center, with minor exceptions, maintained good control over
deployed emergency response/repair
teams.
Team briefings and debriefings were
-1 3-
found to be effective; however, the inspectors noted several occasions where
debriefings were not properly logged.
The inspectors accompanied
several teams
into the plant and observed prompt and efficient accomplishment of tasks.
When teams were formed, members were separately briefed on assigned tasks and
expected radiological conditions.
Team briefings were facilitated through the use of
Form 968-25560, Revision 7, "Repair Team Briefing/Debriefing Form." Twenty
forms were completed during the exercise.
The operations support center staff anticipated that two entries would involve high
contamination levels.
The first entry involved Team 4. This team was dispatched
to the 501 foot elevation of the reactor building at approximately 10:00 a.m. to
isolate the instrument air supply to Main Steam Isolation Valves 22A and 28A. The
briefing form indicated that high radiation levels and high surface contamination
levels were expected
in the area.
This information, coupled with deteriorating plant
conditions, appeared to warrant a recommendation for Team 4 to use protective
equipment; however, no such recommendation was made.
The second entry involved Team 16. The team was dispatched to the 501 foot
elevation of the turbine-generator
building at approximately 12:50 p.m. to check the
nature of the steam leak (via video camera).
Similar to the first entry, high radiation
and surface contamination levels were expected.
Since significant releases
had
occurred into the turbine-generator building which had the potential to produce very
high surface contamination levels (and associated
airborne contamination),
a
recommendation for Team 16 to use respiratory protective equipment appeared
warranted; however, no such recommendation was made.
Radiological habitability surveys of the operations support center were defined by
Emergency Plan Implementing Procedure 13.10.10, "Health Physics, Chemistry,
Operations Support Center Duties," Revision 11, as including the use of a
continuous air monitor and an area radiation monitor. A continuous air monitor was
used; however, an area radiation monitor was not used during the exercise.
The
failure to continuously monitor the ambient gamma radiation levels deprived the
licensee of early information relative to radiation levels which might warrant a
relocation of the operations support center to an alternate location.
Conclusions
Overall, the operations support center staff's performance was good.
Participants
demonstrated
the ability to effectively create and manage emergency response
teams to perform inplant repairs.
Command and control by the operations support
center's management staff was very good.
The periodic briefings were identified as
a strength.
There was room for improvement in the following areas:
(1) communication between the licensee and Hanford Fire Department;
(2) respiratory protective equipment use under accident conditions; and,
(3) procedural adherence
concerning center habitability.
-1 4-
P4.5
Emer enc
0 erations Facilit
a.
Ins ection Sco
e 82301-03.04
The inspectors observed the emergency operations facility's staff as they performed
tasks in response to the exercise.
These tasks included facility activation, event
classification, notification of state and local response
agencies,
development and
issuance of protective action recommendations,
dose assessment
and coordination
of field monitoring teams, analysis of plant conditions, and direct interactions with
offsite agency response
teams.
b.
Observations
and Findin s
The emergency operations facility was promptly staffed and activated following the
alert declaration at 8:01 a.m.
Full facility staffing was present at 8:32 a.m., and
emergency director duties were transferred at 8:42 a.m.
Upon arrival, facility
personnel signed-in on the staffing board and obtained position-specific procedures
and materials.
Communication links with other facilities were established
and the
status of other facility activations was quickly disseminated.
Emergency classifications made by the emergency operations facility were correct
and timely. The site area emergency was declared at 9:22 a.m., and the general
emergency was declared at 9:57 a.m.
In both cases,
the classifications were made
within minutes of meeting emergency action level conditions.
The shift manager
and technical support center were quickly informed of the emergency declarations
or were involved in preliminary discussions
regarding changing plant conditions and
applicable emergency action levels.
Command and control in the emergency operations facility was less than
satisfactory.
The inspectors observed several examples.
First, briefings tended to
ramble and did not hold the attention of all facility personnel
~ Moreover, it was
often difficultto determine when a briefing ended.
Second, briefings and other
peripheral activities occasionally interfered with important task completion.
For
instance, briefings continued while the emergency operations facility manager and
assistant emergency operations facility manager tried to make required offsite
agency notifications and protective action recommendations,
and press releases
were presented for review/approval at critical times.
As a result, the facility
manager/assistant
manager were challenged by the noise level and other
distractions.
Third, facility priorities were not established.
Fourth, the general
emergency public address announcement
was delayed because
the notification form
was not provided to the information coordinator in a timely manner.
The event was
declared at 9:57 a.m., but the announcement
was not made until 10:24 a.m., 27
minutes later.
Finally, briefings were frequently interrupted by plant public address
announcements.
-15-
The offsite agency notification process was not effectively executed
in the
emergency operations facility. As a result, untimely and unclear protective action
recommendations
were provided to the offsite agencies.
The inspectors observed
the following examples.
First, unclear protective action recommendations
were communicated to the offsite
agencies at the general emergency.
As verbally communicated over the CRASH
telephone, the recommendation
included evacuation of all sections within 0-2 miles,
sheltering of Section
1 from 2-10 miles, and sheltering of Sections 2-4 and the fast
flux test facility within 0-2 miles. This meant that both shelter and evacuation were
recommended for all sections 0-2 miles.
More importantly, due to population
density, the form (transmitted via facsimile) and verbal notification contradicted one
another concerning the recommendation for Sections 2-4 within 2-10 miles; the
boxes checked on the form indicated that all sections should be sheltered from 2-10
miles, whereas the verbal notification contained no recommendation
(shelter or
evacuation) for the same area.
The inconsistencies
were introduced when the radiological emergency manager
made a non-standard
notation on the notification form, using an arrow and circles,
to describe the recommended protective actions.
The notation actually modified the
options available on the form. Excluding the notations, as normally used, the form
actually indicated that the recommendation was to evacuate
all sections 0-2 miles
and shelter all sections 2-10 miles. As a result, it was necessary for the offsite
agencies to call and request clarification.
Second, the subsequent
upgrade of the protective action recommendations
(evacuate to 10 miles in Section 1) was not communicated to the state within 15
minutes, as required by Step 4.1 of 13.4.1, "Emergency Notifications," Revision
20. The protective action recommendation
change was made at 10:23 a.m.;
however, the state was not renotified of the change until 10:43 a.m., 20 minutes
later (the state was not on the CRASH call initiated at 10:35 a.m.).
Third, offsite agency notifications at the site area emergency were not initiated until
14 minutes after event declaration.
The delay was mostly attributed to form
completion, rather than the loss of the CRASH telephone.
The loss of the CRASH
telephone was pre-planned
in the scenario to prompt the use of backup notification
methods.
The site area emergency was declared at 9:22 a.m., and the emergency
operations facility manager attempted the CRASH call at 9:33 a.m.
Recognizing the
loss of the CRASH telephone system, the emergency operations facility
manager/assistant
manager initiated state/county notifications via the backup
method (dial-up lines) at 9:36 a.m.
The manager and assistant manager each made
a required call; one to the state and one to the county (combined Benton/Franklin
Counties).
Fourth, classification notification forms were not sent via facsimile to the offsite
agencies prior to the verbal notification, as required by Section 5.3.3 of 13.4.1.
-1 6-
The failure to follow the proceduralized process delayed the notifications, because
the information on the form had to be read to the offsite agencies
(as opposed to
verifying receipt of the forms and answering questions).
The inspectors concluded
that this failing contributed to the preceding examples.
The failure to provide timely and clear notifications and protective action
recommendations to offsite agencies was identified as an exercise weakness
(397/961 4-02).
In a related matter, the status of offsite protective action implementation was not
well-tracked in the emergency operations facility. Step 4.2.4 of 13.2.2,
"Determining Protective Action Recommendations,"
Revision 6, required the
emergency operations facility manager to track protective action recommendations
until implementation was completed and to track status on the protective action
recommendation status board.
The inspectors observed that completion status was
neither indicated on the status board nor tracked.
With the exception of the protective action recommendation
issue described above,
activities performed/directed by the radiological emergency manager were
performed well ~ Specific activities included dose assessment,
facility habitability,
and field team direction and control. The radiological emergency manager provided
excellent briefings and effectively interacted with offsite response team members.
Visual aids used in the emergency operations facility could have been more
effective.
The inspectors noted that the plant status board was not readable from
the emergency operations facility manager's table.
On several occasions the
manager had to walk up to the board to determine plant parameters.
In addition,
the plant status board was not always maintained.
For example, reactor vessel
level was not kept current.
The board indicated that vessel level stayed at
-88 inches until level was recovered; however, the level actually dropped below the
bottom of active fuel.
The inspectors also determined that training on the use of the CRASH telephone
monitoring headsets
appeared ineffective. The assistant emergency operations
facility manager and emergency operations facility manager secretary did not know
that the batteries had to be inserted prior to use.
Conclusions
Overall, performance
in the emergency operations facility was generally good.
Emergency events were properly classified; however, command and control of
facility activities was less than satisfactory at times.
An exercise weakness for
failure to make clear and timely offsite agency notifications and protective action
recommendations
was identified.
/w
-1 7-
P4.6
Scenario and Exercise Control
a.
Ins ection Sco
e 82301
The inspectors made observations during the exercise to assess
the challenge and
realism of the scenario and to evaluate the control of the exercise.
b.
Observations
and Findin s
The inspectors identified significant similarities between the 1994 and 1996
scenarios.
Although some differences were noted on the front-end, the release
path, equipment failures, and failure modes were identical in both scenarios.
The
site area and general emergencies
were based on identical events.
Once identified,
the licensee took appropriate actions; key facility personnel who had participated in
the 1994 exercise were replaced the night before the exercise.
Regarding exercise conduct, the licensee effectively used mock-ups (including
sound effects) to increase the realism of certain exercise response activities.
In
contrast, the following observations detracted from the realism and training value of
the exercise and were considered
areas for improvement:
Communication design differences between the control room and the
simulator were identified.
Examples included:
(1)
There was no plant page speaker
in the simulator.
As a result, the
control room simulator personnel did not hear plant pages,
announcements,
etc.
The licensee stated that the real control room
speaker volume was normally lowered to prevent operator distraction.
(2)
The telephone ringer volumes were set too low. As a result, some
telephone calls were not answered,
because the simulator personnel
could not hear the telephones
ringing over the ambient noise.
(3)
Some unanswered
telephone calls would roll over to a telephone
outside the simulator.
(4)
There was only one main console telephone on the shift manager'
desk.
According to exercise participants, the real control room has an
additional console telephone on the shift technical advisor's desk such
that telephone calls could be answered if the primary telephone was
busy.
~
Control room logs were not completed during the exercise as required by
procedures.
Plant procedures
required the use of either electronic or manual
logs for the control room.
The electronic log did not function during the
-1 8-
exercise and manual logs were not taken.
A controller contributed to this
situation.
There were several examples of unplanned/unexpected
simulator responses.
Examples included fire pumps not starting and nuclear instrumentation
failures following the reactor scram.
When the licensee notified the NRC of the alert declaration, the control cell
(simulated) operations officer unrealistically allowed the call to be terminated.
Consequently, the communicator, an equipment operator, was released from
the control room shortly after the alert notification.
The licensee did not provide a sufficient number of exercise controllers with
health physics background.
This led to several situations where the health
physics member of the inplant team either was given qualitative radiological
data (e.g., "radiation levels are okay"), or no data at all.
On one occasion the exercise scenario timeline did not allow enough time for
an activity to be performed before the equipment in question needed to be
back in service.
As a result, the work had to be stopped and completion
simulated.
Team 13 attempted to backfill the reactor level reference legs but
ran out of time. The team was instructed to simulate the completion of the
work, and the equipment was placed back into service for the remainder of
the exercise.
Some activities were over-simulated and detracted from the training value of
the exercise.
For example, habitability survey results in the operations
support center were provided before the information was fully earned.
The
responsible health physics technician made the determination to only survey
the outer hallway (buffer zone) and simulate the rest of the surveys by
asking the controller for the results of the surveys for each room. Also, the
process for issuing potassium iodide was not stepped-through to ensure that
personnel were familiar with applicable procedures.
c.
Conclusions
The scenario was sufficiently challenging to test emergency response
capabilities
and demonstrate
onsite exercise objectives.
Significant similarities were identified
between the 1994 and 1996 exercise scenarios.
Once identified, prompt and
thorough action was taken.
Mock-ups were effectively used for some equipment
failures; however, exercise control could have been improved in some areas to
enhance the realism and training value of the exercise.
-1 9-
P4.7
Licensee Self-Criti ue
a.
Ins ection Sco
e 82301-03.13
The inspectors observed and evaluated the licensee's
post-exercise facility critiques
and the formal management
critique on September 27, 1996, to determine whether
the process would identify and characterize weak or deficient areas in need of
corrective action.
b.
Observations
and Findin
s
The inspectors determined that the post-exercise
critiques were generally thorough,
open, and self-critical. With the exception of the emergency operations facility,
critiques included input from controllers, evaluators,
and participants.
In the
emergency operations facility, the controllers/evaluators
did not provide input during
the critique.
The inspectors noted that the post-exercise facility critiques provided a
vehicle to discuss performance/procedural
issues prior to corrective action process
completion.
As an area for improvement, the inspectors noted that individuals were assigned
multiple functions associated with exercise control and evaluation.
For example,
the control room had two controllers and one observer.
The controllers had to
watch participants'ctions,
provide input as needed, coordinate timing with other
facility controllers, and evaluate participant performance.
The lead control room
simulator controller was heavily involved in providing overall coordination support
for the exercise.
When the simulator failed, this individual had to prepare data
sheets for control room simulator personnel.
The assistant controller was divided
between providing controller duties, evaluation duties, and simulator support
activities.
As a result, the controllers were challenged to also evaluate participant
performance.
The input for the formal management critique included comments from participants
and controllers/evaluators.
The issues identified by the licensee's team were
generally consistent with those identified by the NRC inspection team.
Conclusions
The licensee's self-critique process effectively identified areas for corrective action.
-20-
V. Mana ement Meetin s
X1
Exit Meeting Summary
The inspectors presented the inspection results to members of licensee management
at the
conclusion of the inspection on September 27, 1996. The licensee acknowledged the
findings presented.
No proprietary information was identified. A followup discussion was
conducted on October 3, 1996, to, address
a change to the findings presented
during the
inspection exit meeting.
ATTACHMENT
PARTIALLIST OF PERSONS CONTACTED
Licensee
L. Ball, Emergency Planner
R. Bemis, Vice President,
Nuclear Operations
W. Estes, Acting Assistant Manager, Operations
D. Feldman, Shift Manager
D. Holmes, Emergency Planner
J. Ittner, Emergency Planner
R. Jorgensen,
Emergency Planner
A. Klauss, Emergency Planner
M. Nolan, Supervisor, Solid Waste
G. Reed, Corporate Emergency Preparedness,
Safety, and Health Officer
M. Reis, Supervisor, Reactor Engineering
R. Webring, Vice President, Operations Support
Other
A. Grumbles, Radiation Health Physicist, Washington State Department of Health
S. May, Radiation Health Physicist, Washington State Department of Health
R. Mazurkiewicz, Chief, Operations Branch, Bonneville Power Authority
D. Williams, Nuclear Engineer, Bonneville Power Authority
NRC
R. Barr, Senior Resident Inspector
B. Murray, Chief, Plant Support Branch
LIST OF INSPECTION PROCEDURES USED
Evaluation of Exercises at Power Reactors
Operational Status of the Emergency Preparedness
Program
LIST OF ITEMS OPENED AND CLOSED
~Oen ed
50-397/96014-01
DEV
Failure to modify emergency preparedness
plan to designate
the alternate emergency operations facility location (Section
P2)
50-397/96014-02
IFI
Exercise weakness
- Failure to make timely and clear offsite
notifications (Section P4.5)
-3-
Closed
50-397/96014-01
DEV
Failure to modify emergency preparedness
plan to designate
the alternate emergency operations facility location (Section
P2)
LIST OF DOCUMENTS REVIEWED
Emer enc
Plan Im lementin
Procedures
13.1.1
1 3.2.1
13.2.2
13.4.1
13.8.1
13.9.1
1 3.10.1
13.10.2
13.10.3
13.10.4
1 3.10.5
1 3.10.6
1 3.10.7
1 3.10.9
13.10.10
13.10.12
13.10.14
13.11.1
1 3.1 1.7
Classifying the Emergency
Emergency Exposure Levels/Protective
Action Guides
Determining Protective Action
Recommendations
Emergency Notifications
Emergency Dose Projection System
Operations
Environmental Field Monitoring
Operations
Control Room Operations and Shift
Manager Duties
Technical Support Center Manager
Duties
Technical Manager and Staff Duties
Radiation Protection Manager Duties
Operations Manager Duties
Plant/NRC Liaison Duties
Plant Administrative Manager Duties
Operations Support Center Manager
and Staff Duties
Health Physics, Chemistry, Operations
Support Center Duties
Repair Team Duties
Maintenance Manager Duties
Emergency Operations Facility Manager
Duties
Radiological Emergency Manager Duties
Revision 23
Revision 11
Revision 6
Revision 20
Revision 11
Revision 14
Revision 13
Revision 8
Revision 13
Revision 13
Revision 7
Revision 10
Revision 12
Revision 24
Revision 11
Revision 11
Revision 2
Revision 12
Revision 13
Other Procedures
1.3.36
3.1.10
Plant Emergency Response
Personnel
Revision 9
Requirements
Operating Data and Logs
Revision 11
Other Documents
Washington Nuclear Project-2 Emergency Plan
GO2-83-529, dated June 16, 1983 (Supply System letter to NRC)
SECY-83-361, dated September
14, 1983
NRC letter to Supply System, dated October 7, 1983
NRC Inspection Report 397/85-10, dated July 5, 1985