ML17303A986
| ML17303A986 | |
| Person / Time | |
|---|---|
| Site: | Palo Verde  |
| Issue date: | 03/18/1988 |
| From: | Richards S NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION V) |
| To: | |
| Shared Package | |
| ML17303A985 | List: |
| References | |
| 50-528-88-11-EC, 50-529-88-11, 50-530-88-11, NUDOCS 8804040090 | |
| Download: ML17303A986 (48) | |
See also: IR 05000528/1988011
Text
U. S.
NUCLEAR REGULATORY COMMISSION
REGION
V
Report Nos.
50-528/88-11,
50-529/88-11
and 50-530/88-11
Docket Nos.
50-528,
50-529,
and 50-530
License
Nos.
and
Licensee:
Arizona Nuclear
Power Project
P. 0.
Box 52034
Phoenix, Arizona
85072-2034
Facility Name:
Palo Verde Nuclear Generating Station Units 1, 2,
and
3
Meeting Location:
NRC Region
V Office, Walnut Creek, California
Meeting Conducted:
February 29,
1988
Approved by:
S. A. Richards,
Chief
Engineering Section
Date Signed
8804040090
8803l8
ADOCK 05000528
G
DETAILS
1.
Meetin
Partici ants
J.
B. Martin, Regional Administrator
D. F. Kirsch, Director, Division of Reactor Safety
and Projects
G.
W. Knighton, Director, Project Directorate
V,
F. A. Wenslawski, Chief, Emergency
Preparedness
and Radiological
Protection
Branch
A. D. Johnson,
Enforcement Officer
E. A. Licitra, Palo Verde Project Manager,
S. A. Richards,
Chief, Engineering Section
T. J. Polich, Senior Resident Inspector,
Palo Verde Site
Arizona Nuclear
Power Pro 'ect
E.
E.
Van Brunt, Executive Vice President
J.
G. Haynes,
Vice President,
Nuclear Production
L. G. Papworth, Director, guality Assurance
J.
E. Kirby, Director, Site Services
J.
E. Allen, Director, Engineering
and Construction
W. E. Ide, Unit 2 Plant Ma'nager
T. D. Shriver,
Compliance
Manager
2. ~iP
An enforcement
conference
and management
meeting
was held on February
29,
1988, at the
NRC Region
V offices in Walnut Creek, California.
The
enforcement
conference
related to the licensee's
inadvertently rendering
the steam driven auxiliary feedwater
(AFW) pumps in Units
1
and 2, as described
in Licensee
Event Report
(LER) 50-528/87-025.
The
management
meeting focused
on several
recent events at Palo verde,
an
update
on previously discussed
issues,
and
a discussion of the recently
issued
SALP report.
A summary of each
area
discussed
is provided below.
3.
Enforcement
Conference
Mr. Martin opened
the discussion
by stating his desire that the dialogue
be both open
and to the point.
Mr. Martin stated that recent events at
Palo Verde igdicate
a need to focus
on personnel
performance
and that any
developing
problems
should
be addressed
now by the licensee,
rather than
acting later in response
to
a significant event.
Mr. Martin expressed
concern that his recent visit to Palo Verde was generally unfavorable,
particularly with regard to the working atmosphere
in the Unit 2 control
room.
He also expressed
his concern that
ANPP management
is not devoting
sufficient personal
time to direct, meaningful
observation of plant
activities.
Mr. Van Brunt concurred that several
indicators point to
a
need to reaffirm management
expectations
with his staff and stated that
his staff shared
Mr. Martin's concern over recent events.
A discussion
was then held concerning the circumstances
leading
up to the
steam driven
AFW pumps at both Units I and
2 being rendered
inoperable in
violation of the applicable technical specifications.
The event
description
and the
NRC review are contained
in LER 50-528/87-025
and
Inspection
Report 50-528/88-07,
50-529/88-07,
and 50-530/88-07.
The
licensee
representatives
agreed with the content of the Inspection
Report.
All participants
also agreed that the event
was sianificant in
that several
levels of checks
and reviews failed to identify the
engineering error that led to the
pumps being inoperable.
A discussion
was then held concerning
the engineering
work associated
with the event.
Mr. Martin questioned
why work was assigned
to an
engineer
who was not qualified to do the electrical evaluation associated
with the work and why the engineer did not stop, rather than attempt to
complete
the work.
The error was primarily associated
with the
electrical
engineering discipline while the engineer
involved had
a
mechanical
engineering
type background.
The licensee
personnel
indicated
that the use of the Engineering
Evaluation
Request
(EER) process
to do
the work contributed significantly to the problem; also,
they agreed that
further followup was warranted
on
how the work assignment
was made.
Mr.
Hartin questioned
whether this event
was typical of engineering
work at
Palo Verde
and questioned
whether
a review of other completed
EERs would
be appropriate.
Nr. Hartin also questioned
whether the
ANPP engineering
staff understood
what was expected of them with regard to technical
work
and reviews of technical
work.
Mr. Haynes stated that additional efforts
would be made to ensure that expectations
are clearly understood
by
engineering
personnel
and that
a selective
review of past
EERs for
similar engineering
problems
would be conducted.
Nr. Van Brunt stated that 'he
had concluded that the personnel
involved in
the event relied too heavily on other people to ensure that the work was
correctly performed.
Mr. Van Brunt also stated that all personnel
should
approach
a job with a questioning attitude
towards all aspects
of the
work.
Mr. Johnson
agreed
and noted that a major concern of the
NRC was
that the many checks
and reviews associated
with the job failed to
identify the error, apparently
due to the lack of a questioning attitude
on the part of the personnel
involved.
The issuance
of the associated
work packages,
the
QA/QC involvement,
and
the testing aspects
of the event were then discussed.
Mr. Ide provided
a
summary of corrective actions
being taken.
These actions
centered
primarily on control of motor operated
valve limit switch settings
and
the use of the
EER process.
Nr.
Van Brunt observed that the event
indicated
a need to increase
ANPP's thoroughness
of event reviews
and
interviews with involved personnel.
Mr. Martin encouraged
the licensee's
representatives
to rethink the broader
aspects
of this event
and to
provide in writing a summary of their review of the event
and corrective
actions.
Hr. Van Brunt agreed.
Nr. Martin closed this area of discussion
by commenting that this event
and the licensee's
followup review indicate that the senior
ANPP managers
are not spending sufficient time in the plant talking to their personnel
and keeping personally
aware of the manner in which day-to-day business
is conducted.
4.
Performance
Indicators
The licensee
provided their analysis of selected
performance
indicators
which they trend
as
a management
tool.
The licensee
representatives
expressed
concern that the number of personnel
errors
had increased
recently
and that personnel
performance at Unit 2 was of particular
concern.
Nr. Kirsch added that observations
by
NRC personnel
and
managers
supported
the licensee's
concerns.
Mr. Martin again questioned
whether plant personnel
are receiving
an appropriate
level of management
attention.
Mr. Ide stated that he was focusing his attention
on the Unit
2 operations
personnel
and that he
had held meetings with all Unit 2
Shift Supervisors
to reiterate
his expectations
concerning
the
performance of operators.
5.
Safet
In ection at Unit 2
On February 21,
1988, with Unit 2 in Mode 5,
an inadvertent safety
injection (SI) actuation occurred.
Mr. Ide described
the circumstances
of event.
Several
personnel
errors
were identified by the licensee
including:
(I) the procedural
step to bypass all four channels of the
low pressurizer
pressure trip was signed off as complete with only one of
the four channels actually bypassed;
(2) the error was not identified
during
a subsequent
crew change
and control
board walkdown;
and (3) the
protective
system pretrips,
which were received prior to the SI, were
acknowledged
by the operators,
but apparently
not followed up.
Mr.
Martin observed that the event
was consistent with observations
he made
in January,
1988, concerning
the Unit 2 control
room.
At that time,
operators
were not consistently
responding
to alarms,
apparently
in part
due to the relatively large
number of bogus alarms.
At the time of the
observations,
Nr. Martin had discussed
his concerns with Nr. DeMichele,
the company President,
and Nr. Haynes.
Nr. Martin emphasized
the
need
for the licensee
to aggressively
pursue their program to reduce
the
number of bogus annunicators.
He also questioned
whether
ANPP holds the
Shift Supervisor
accountable
when members of his crew commit errors,
as
happened
during this event.
6.
Non-Safet
AFW Pum
Ino erable - Unit 2
On February 20,
1988, the licensee identified that the discharge
valve
for the Unit g non-safety
AFW pump had
been erroneously left in the
closed position for a period of about
10 days.
The valve was apparently
mispositioned
by an auxiliary operator
and the error was then not
detected
by a second operator,
who had checked
the valve position.
A
contributory cause of the event
was that the valve's rising stem provided
an erroneous
indication of valve position.
Corrective actions described
by the licensee
included disciplinary action, evalua'tion of the valve
stem indication,
and increased
training.
7.
Ino erable
Post Accident
Sam lin
S stem
(PASS
at Unit 2
As described
in Licensee
Event Report
(LER) 50-529/88-05,
the licensee
had identified that the
PASS at Unit 2 had
been inadvertently left in a
"valved out" condition following maintenance
on the system.
Mr. Ide
summarized
the personnel
errors of this event which included:
(I)
improper direction to restore
the system
by an Assistant Shift
Supervisor;
(2) failure to remove
one danger
tag by the chemistry
technician
who removed the clearance;
(3) failure of the chemistry
department
to question
the status of the system;
(4) failure to account
for all danger
tags
on restoration of the system;
(5)
a significant delay
in informing operations
personnel
that the
was inoperable;
and (6)
inadequate
retests
performed following the maintenance.
Nr. Ide
described
the licensee's
followup action, which included disciplinary
action
and administrative
improvements.
Mr. Martin observed that this
event
was yet again another major indication that overall
personnel
performance
was less
than expected.
Nr. Martin again questioned
whether
the Shift Supervisor
was held accountable
for the actions of personnel
assigned
to his crew.
8.
Forei
n Material in the Unit
1 Reactor
Vessel
U
er Guide Structure
While performing Control Element Assembly
(CEA) testing in preparation
for recovery from a refueling outage at Unit 1, the licensee
experienced
a stuck
CEA.
Subsequent
investigation
by the licensee identified the
cause
as
a ball bearing
from the Multi-Stud Tensioner
(MST), which
apparently
had inadvertently migrated into the reactor vessel
upper guide
structure.
A detailed description of this event is contained
in the
licensee's
letter to
NRC Region
V, dated
February 25,
1988.
Mr. Haynes
summarized
the event
and briefly described
actions
being taken to improve
Mr. Martin questioned
whether there
was
a
history of failures with the
MST casters.
Mr. Haynes
was not aware of
any history of failures which had resulted in ball bearings
being
released
from a caster;
however,
he committed to look into the question
and inform Region
V of ANPP's findings.
In a subsequent
letter to Region
V dated
March 2, 1988, the licensee
informed Region
V that
a
NST caster
had
come apart during replacement of casters
in October,
1987,
and
that the
numerous ball bearings spilled at that time were considered
to
be the likely source of the ball bearing that resulted
in the stuck
CEA.
9.
U date
on Efforts to Increase
En ineerin
Ca abilit
Nr. Allen opened the discussion
by describing
the status of the
licensee's
technology transfer
program.
He stated that the assembly of
the system design basis
manuals is scheduled for completion
by October,
1989.
On-the-job training is to be completed
by April, 1988, with makeup
training completed
by April, 1989.
Formal training from Combustion
Engineering
in the primary system design is expected
to be completed in
1990.
Nr. Allen commented that the recent inspection findings from the
NRC Safety System Functional
Inspection
and
comments
received
from INPO
would be incorporated into the program.
A discussion
was then held
concerning
the licensee's
plans to ensure
a complete retention of the
plant design basis.
The licensee
maintained that responsibility for the
design
basis
now rests with ANPP.
Nr. Martin requested
that
a copy of
the design basis
manual for the
AFW system
be provided to Region
V for
review and Mr. Van Brunt agreed.
Mr. Kirby then led
a discussion
on the status of the licensee's
system
engineer
program.
A schedule for completion of milestones
is contained
in enclosure
2 of this report.
Nr. Martin emphasized
the
need to ensure
that the expectations
for system engineers
is clearly defined.
Mr.
Nartin also observed that it would be worthwhile for management
to
periodically talk directly to the system engineers
to ensure that they
are properly directed.
Mr. Kirby concurred in these
comments.
Mr. Allen then described
the corporate
engineering
involvement in onsite
activities.
This lead to
a discussion
of the
need to be technically
self-sufficient.
Nr. Allen noted that
ANPP intends to continue to use
outside engineering
resources
to accomplish part of their workload.
Mr.
Hartin agreed that
a division of work was acceptable;
however,
he felt
that the licensee's
engineering
personnel
needed
to be technically
capable of overseeing
the work of contractors.
Additionally, Nr. Martin
suggested
that
a strong utility requires
excellence
in three
components:
operations,
quality assurance,
and engineering.
Mr. Martin observed that
ANPP needs
to promote engineering
involvement and ownership in the plant,
and then hold engineering
accountable for problems that should
have
been
foreseen
by the engineers.
10.
U date
on Simulator Utilization
Nr. Van Brunt described
the licensee's
efforts to achieve their
commitment of providing 60 hours6.944444e-4 days <br />0.0167 hours <br />9.920635e-5 weeks <br />2.283e-5 months <br /> of simulator time to each licensed
operator
each year.
This action is on schedule
and expected
to be
achieved.
Additionally, actions
have
been
taken to receive
feedback
from
the operations
department
on the type of training being received
by the
operators.
11.
Status of the Maintenance
Backlo
Mr. Kirby briefly discussed
the status of licensee efforts to manage
the
number
and type of outstanding
maintenance
items.
Senior management
is
reportedly
now receiving monthly status
reports.
Goals
have
been
established
for the number of various priority levels of maintenance
items
and
a comparison of the licensee's
data with the
INPO industry
average is favorable.
The licensee
maintains that the maintenance
data
base is now accurate
and that their focus is on reducing the total
long-term backlog to the degree
possible.
12.
Status of ualit
Assurance
Director Develo ment
Mr. Van Brunt briefly described
actions
being taken to develop
Hr. Papworth
as the
new Director of guality Assurance
(gA), which will
include formal training from an outside contractor.
Mr. Martin expressed
his concern that
ANPP did not seem to have
a strong
commitment to ensuring
that gA is
a major factor in the operation of Palo Verde.
Mr. Martin
questioned
the degree to which gA has participated in the resolution of
the events
discussed
during the meeting
and questioned
whether
gA had
detected
early on any indications of declining performance.
Mr. Martin
observed that
gA should
be held accountable
when significant problems
become self-revealing
and
gA had not previously identified the area
as
a
problem.
Nr. Haynes
agreed that
a strong
gA program is absolutely
necessary.
Nr. Papworth
agreed
and stated that his organization
was
becoming
more performance oriented,
rather than compliance oriented,
in
an effort to be more aggressive
in identifying problem areas.
Nr. Nartin
expanded
his comments
by indicating that
he considers
gA to encompass
all
oversight activities, including the onsite
and offsite review committees
and the Independent
Safety Engineering
Group.
13.
Hang ement Observation of Plant Activities
Mr. Martin stated that his staff had performed
a review of the amount of
time that senior
ANPP managers
were personally
spending touring important
areas
of the plant,
such
as the control
rooms
and the radiologically
controlled areas.
The results of this review were very disappointing,
and in fact, at the time of the meeting,
the Compliance
Nanager
and the
Director of Engineering
and Construction
were not badged for access
to
the plant protected
and vital areas.
Mr. Hartin observed
that experience
has
shown that utility managers
cannot possibly
know with confidence
how
their facilities are being operated without personally devoting time to
getting into the plant and then taking the time to look critically at
how
business
is being conducted
and question
personnel
at the working level.
Nr.
Van Brunt indicated that the badging of the Compliance
Manager
and
the Director of Engineering
and Construction
were in process
but delayed
for administrative
reasons.
Mr. Van Brunt acknowledged
Nr. Nartin's
comments.
14.
SALP Discussion
The licensee
had
no questions
concerning
the recently issued
SALP report.
Mr. Martin observed that the most recent
performance of the licensee
was
not reflected in the report and that
a significant improvement
was
needed
if ANPP intended to sustain
in the future the
SALP ratings contained in
the report.
Mr. Martin and Nr. Van Brunt both agreed
on the value of holding periodic
meetings.
It was agreed to meet again in approximately
two months time.
Nr. Martin cautioned
the licensee
representatives
to address
indications
of problems
now, rather than
have to deal with larger long-term problems
later.
Enclosure
2 to Inspection
Report 50-528/88-11,
50-529/88-11,
and 50-530/88-11
ANPP/NRC
MANAGEMENT MEETING
MALNUT CREEK,
CA
FEBRUARY 29.
1988
INTRODUCTION (EEVB)
AGENDA
2/29/88
II.
PERFORMANCE INDICATORS (TDS)
III.
EVENT REVIEW
A.
FOREIGN MATERIAL EXCLUSION (JGH)
1.
STUCK ROD
2.
LOSS
OF FUEL HANDLING TOOL SHEAR PIN
3.'ROGRAM EVALUATION
B.
UNIT 2 SAFETY INJECTION (NUE) (WEI)
C.
INOPERABILITY OF
NON CLASS AUXILIARYFEED
PUMP
(WEI)
D.
INOPERABILITY OF PASS
(MEI)
IV.
UPDATES
A.
TECHNOLOGY TRANSFER
(GAEA)
B.
SYSTEM ENGINEER
(RMB)
C.
CORPORATE ENGINEERS'NVOLVEMENT IN SITE ACTIVITIES
(JEA)
D.
STATUS
ON INCREASING SIMULATOR TRAINING TIME (EEVB)
E.
STATUS OF MAINTENANCE BACKLOG (RMB)
1.
HOW IS IT TRENDED
2.
WHAT IS AN ACCEPTABLE BACKLOG
(
F.
STATUS OF THE DEVELOPMENT OF THE OA DIRECTOR
(EEVB)
V.
SALP DISCUSSION
(EEVB)
FIGURE
1
LER!s PER UNlT PER QUARTER
~
I
~
~
25
20
uj
15
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K
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2nd
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2nd
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QTR
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QUARTERS SINCE THE ISSUANCE OF THE OPERATING LICENSE
UNIT
1
UNIT 2 ~ ~I
UNIT 3
~ ~ ~
~ ~ ~ ~
TS- Technical Specification
Violations
ST- Surveillance Test Deficiencies
r
LER 1-87-025
Applicable to Units 152
LER 1-88-008
Applicable to all three Units
Partial
Includes projections thru 2/25/88
N
FIGURE 2
UNlT COMPARlSON
LER's PER COMPLETE QUARTER
SINCE ISSUANCE OF OPERATING LICENSE
25
20
15
0
10
25
25
(TS-18) (TS-11)
(ST-5)
(ST-3)
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(TS-15)
(ST-9)
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%%
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1st
2nd
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4th wan
5th
6th
7th
8th
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11tlr
12th
13th"I~
OTA
OTA
QTA
QTA
OTA
QTA
OTA
QTfl
QTA
QTA
QTA
OTA
COMPLETE QUA'RTERS SINCE OPERATING LICENSE
UNIT I
UNIT 2 ~~
~
UIIIT 3
~ ~ ~ ~ ~ ~ ~
TS- Tcchnical Specification Violations
ST- Survcillancc Test Dcliclcnclcs
LEA 1-07-025
Appllcablc to Units 182
LEA I-00-000
Appllcablc to all thrcc Units
<> Partial
Includes projections tliru 2/25/Otr
25
FIGURE 3
OCCURRENCES INVOLVINGPERSONNEL
PER UNIT
20
(
)
19(3)
19(8)
15
OO0
0
uj
10
11(2)
1S(8)
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QT
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QTR
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0 .
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QTB
QUARTERS SINCE THE ISSUANCE OF THE OPERATING LICENSE
UNIT1
UNIT 2~~s
UNIT 3
~ ~ ~ ~ ~ . ~ ~
(
) Procedure VIoiations
- LER 1-87-025 Applicable to
Units 18t2
- Partial
Includes Projections thru 2/25/88
25
FIGURE 4
UNIT COMPARISON
OCCURRENCES INVOLVINGPERSONNEL
PER COMPLETE QUARTER SINCE
ISSUANCE OF OPERATING LICENSE
20
20(12)
19(3)
19(8)
Oziu
15
O00
10
z
13(8)
11(2)
8(7)
10(7)
11(8)
A
9(5)g
8(4)
4(3)
Q(~)
r
P 4(3)
3(3)
2(2)
2(2)
2(2)
1(1)
4(3)
2 2)
'3(1)
3(3)
1st
2nd
3rd
4th>>>>
5th
6th
7th
8th
9th>>>>
10th
11th
12th
13th
~ >>
QTR
QTR
QTR
QTR
QTR
QTR
COMPLETE QUARTERS SINCE OPERATING LICENSE
UNIT1
UNIT 2 ~~I
UNIT 3
~ ~ ~ ~ ~ ~
(
) Procedure Violations
- LER 1-87 025
Applicable to Units 1g2
- Partial
Incliidcs Prolcctions thru 2/25/88
il,
FIGURES
UNPLANNED REACTOR TRIPS
PER UNIT
I-.
K
5
0I-
O
ul
4
O
K
DZ
2
6IlllIl
4
lI
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js
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1st
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3rd
4th
1st
2nd
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4th 1967
1st
2nd
3rd
4th
88 1st
QTR 1986 QTR
QTR
QTR
QTR
QTR
UNIT1
UNIT2 "---~
UNIT3" ~ ~ ~""~
QUARTERS SINCE ISSUANCE OF THE OPERATING LICENSE
'PARTIAL THRU 2/25/88
FIGURE 6
UNIT COMPARISON
UNPLANNED REACTOR TRIPS
PER COMPLETE QUARTER SINCE
ISSUANCE OF OPERATING LICENSE
5
Id
0
Lu
DZ
6
Il
I l
II
II
'IIIII
~ 3P
3
IIIIII
I
'
I
III
4
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g1
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pl p
1st
2nd
3rd
- 4th
5th
6th
7th
8th
<<9th
1Pth
11th
12th
~ I 3th
QTR
QTR
QTR
QTR
QTR
QTR
UNIT1
UNIT2
UNIT3 ~ ~ ~
~ ~ ~ ~
~
COMPLETE'QUARTERS SINCE OPERATING LICENSE
<<PARTlAL THRU 2/25/88
FIGURE 7
ESF EVENT REPORTS PER UNIT
(Includes RPS Actuations)
(0I-
tt.0
W
CCz0I-
DI-
O
0
K
tu
IQ
Dz
20
19
18-
17
16
15
14
13
12
10-
9-
8-
2-
13
6
r40'1
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7/
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3
3
2
2
2
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1
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1985
4th 1g86
QTR
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2nd
3rd
4th
1987
1st
2nd
3rd
4th 1988
1 s t
QTR
QTR
QTR
QTR
UNIT 1
UNIT2-
UNIT3 """.".
QUARTERS SINCE THE ISSUANCE OF THE OPERATING LICENSE
'PARTIAL THRU 2/25/88
20
19-
C
FIGURES
UNIT COMPARISON
TOTAL ESF EYENT REPORTS
. (Includes RPS Actuations)
PER COMPLETE QUARTER SINCE
lSSUANCE OF OPERATING LlCENSE
17
16
15
0
14
13
Z
12
0
11
10
0
9
0
8
7
lQ
6
D
5
z
4
11
ly
9 j
/
A
6
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~ ~ ~ ~ ~
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7
6
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6
2
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2
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3rd
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5th
6th
7th
8th
.*9th
10th
11th
12th
+13th
QTR
QTR
.
QTR
QTR
QTR
QTR
UNIT 1
,UNIT2"
UNIT3 "~--""~
COMPLETE QUARTERS SINCE OPERATING LICENSE
- PARTIAL THRU 2/25/88
1
UNIT 2 SAFETY INGECTION (NUE)
ESCRXPTION
ON
FEBRUARY 21,
1988 UNIT 2
WAS IN MODE 5 BEING COOLED
DOMN AND
DEPRESSURIZED
IN PREPARATION
FOR A REFUELING OUTAGE,
WHEN AN ENGXNEERED SAFETY FEATURE (SIAS AND CIAS) ACTUATION
OCCURRED.
THE SXAS RESULTED
XN A SAFETY INJECTION
FROM THE SAFETY INJECTION TANK.
IMMEDIATE CORRECTIVE ACTION
APPROPRIATE
PROCEDURES
MERE ENTERED,
PLANT VERIFIED
IN A STABLE CONDITION AND THE ACTUATED EQUIPMENT MAS
RETURNED TO NORMAL CONFIGURATION.
NUE DECLARED BECAUSE
OF THE INJECTION.
00T
CAUSE
PERSONNEL
ERROR - PRESSURXZER
LOW PRESSURE
SIGNALS MERE
NOT BYPASSED IN ACCORDANCE WITH APPROVED
PROCEDURAL
CONTROLS AND IMPROPER
RESPONSE
TO
LOW PRESSURXZER
PRESSURE
PRETRIP
SIGNAL
UNIT 2 SAFETY INJECTION (NUE)(CONTINUED)
ONG TERM CORRECTIVE ACTION
APPROPRIATE DISCIPLINARY ACTION WILL BE ADMINISTERED
AND THE EVENT WILL BE REVIEWED BY ALL SHIFTS.
UNAVAILABILITYOF THE
NON CLASS AUXILIARYFEEDPUMP
~SCRIPTION
H FEBRUARY 20,
1988,
ATTEMPTS TO PROVIDE STEAM GENERATOR
FEED
FLOW DURING PLANT COOLDOWN USING THE
NON CLASS AUXILIARY
FEEDPUMP
WERE UNSUCCESSFUL.
INVESTIGATION FOUND THE
.
DISCHARGE VALVE WAS CLOSED.
IMMEDIATE CORRECTIVE ACTION
VALVE POSITION REALIGNED AND THE
FLOW VERIFIED
ROOT
CAUSE
PERSONNEL
ERROR
DUE TO IMPROPER
SYSTEM RESTORATION AFTER
MAINTENANCE ACTIVITIES
ONTRIBUTORY CAUSE
EXTENDED VALVE STEM
ON THE DISCHARGE VALVE (RISING STEM
VALVE) GIVES THE INDICATION THAT THE VALVE IS
OPEN
WHEN IT IS ACTUALLY IN THE CLOSED POSITION
I
A
I
k
c
UNAVAILABILITYOF THE
NON CLASS AUXILIARYFEEDPUMP
4
LONG TERM CORRECTIVE ACTION
1.
EER INITIATED TO EVALUATE/CORRECT VALVE INDICATING STEM(S)
DISCREPANCY
2.
ADMINISTRATION OF APPROPRIATE DISCIPLINARY ACTION
3.
AO TRAINING TO EMPHASIZE PROPER
VALVE POSITION
VERIFICATION
4.
EVENT DISCUSSION WITH ALL SHIFT
CREWS
NSSS/BOP - TECHNOLOGY TRANSFER
PROGRAM
A.
FORMAL TRAINING
1.
DESXGN,
ANALYSIS, APPLICATIONS
B.
DESIGN BASIS MANUAL PREPARATION
1.
CRITERIA, CALCULATION, FSAR,
NRC BULLETINS 5
NOTICES,
SPECIFICATIONS,
VENDOR MANUALS
C.
ON-THE-JOB TRAINING
1.
SPECXFIC
DESIGN
OF
NEW MODIFICATIONS BY
BECHTEL/APS ENGINEERS
WORKING TOGETHER
INCLUDING WALKDOWNS, EVALUATIONS, ETC.
D.
DESIGN
RECORDS
1.
TURNOVER FOR
DOCUMENT MAINTENANCE AND
CONTROL COMPLETE FEBRUARY, 1988
INCLUDING
COMPUTER-AIDED DRAFTING/DESIGN PROGRAM
E.
FORMAL CE TRAINING
1.
IN REACTOR COOLANT AND SAFETY SYSTEMS
F.
ASSESSMENT
OF
CURRENT TRAINING NEEDS
G.
MAKEUP/ADDITIONALTRAINING
SYSTEM ENGINEER
PROGRAM
DEVELOPMENTAL REFERENCES
ENGINEERING EVALUATION DEPARTMENT GUIDELINE (EEDG-034)
SYSTEM ENGINEER REPONSIBILITIES - ISSUED 11/87
GOOD PRATICE (TS-413)
USE
OF SYSTEM ENGINEERS - ISSUED 9/85
III.
INPO EVALUATION OF
EVALUATION RESPONSES
(RELATING TO SYSTEM ENGINEERS) - FINALIZED 2/88
IV.
NRC SALP EVALUATION - RECEIVED 2/88
V.
NRC SSFI
EXIT MEETING - 2/88
VI.
SURVEY OF OTHER UTILITIES'YSTEM ENGINEER
PROGRAMS 5 EXPERIENCE - 3/88
RMB-1
2/28/88
ti
SYSTEM ENGINEER
PROGRAM
UMMARY OF MAJOR TA K
EXPAND AND REFINE DEFINITION OF SE RESPONSIBILITIES IN EED-034.
SCHEDULE:
DRAFT PREPARED,
FINALIZE - 4/88.
DEFINE SPECIFIC
SE JOB/TASK REQUIREMENTS.
SCHEDULE:
DRAFT - 4/88;
FINAL - 5/88.
EVALUATE ADEQUACY OF PRESENT
STAFFING LEVELS,
RECOMMEND CHANGES, IF REQUIRED.
SCHEDULE:
COMPLETE
7/88.
EVALUATE SE SKILLS VS.
JOB/TASK REQUIREMENTS.
SCHEDULE:
COMPLETE - 7/88.
DEVELOP TRAINING PLAN AND INITIATE FOR SE
BASED ON IV.
SCHEDULE:
COMPLETE - 8/88.
IMPLEMENT SE TRAINING AND TESTING.
SCHEDULE:
COMPLETE - 11/88.
REVISE PROCEDURES/DEPARTMENT
INSTRUCTIONS TO IMPLEMENT JOB/TASK REQUIREMENTS,
INCLUDING
INFORMATION SYSTEMS REQUIRED BY SE.
SCHEDULE:
COMPLETE - 8/88.
EVALUATE RESULTS
OF ITEMS I-VII AND REVISE, IF NECESSARY.
SCHEDULE:
COMPLETE - 6/89.
RMB-2
2/28/88
LVKzS
1988
F
H
A
M
J
J.
A
S
0
N
I .
SE RESPONSIBILITY
DEF IN l TI ON
I I .
SE JOB/TASK'NAL.
III.
EVAL. STAFF LEVEL
lV.
EVAL. SE SKILLS
I
I
l
I
V.
DEVEL.
TRNG PLAN
VI.
TRNG
Im
TEST
Vll.
REVISE PROCEDURES.
INFO'YS.
VIII.
RESULTS EVAL.
6/89
~
RMB-3
2/28/88
SURVEY OF
OTHER
UTILITIES'YSTEM
ENGINEER
PROGRAMS
TO BE COMPLETED MARCH, 1988
WILL COMPARE SE
INYOLYEMENT IN:
PLANT MODIFICATIONS
MAINTENANCE
PERFORMANCE MONITORING
SE TRAINING
PLANTS TO BE CONTACTED:
SALEM
WNP-2
DIABLO CANYON
RMB-4
2/28/88
SYSTEM ENGINEER OVERVIEW
AT
PALO VERDE
50
SYSTEM ENGINEERS (4 OPEN
SLOTS)
(NOT INCLUDING LEADS 5 SUPERVISORS)
"3.1
SYSTEMS/SE
30
8.9
1.8
3.7
B.S.
DEGREES
YEARS NUCLEAR EXPERIENCE
YEARS DESIGN EXPERIENCE
YEARS PVNGS
EXPERIENCE
RMB-5
2/28/88
SYSTEM ENGINEER
PROGRAM
SHIFT IN EMPHASIS
OF JOB
FUNCTIONS
EEDG-034
FUNCTIONS
1988
PROGRAM CHANGES
A.
TECHNICAL KNOWLEDGE
1.
SYSTEM DESIGN
2.
REQUIREMENTS
3.
SYSTEM MODIFICATIONS/MAINTENANCE
4.
LICENSING REQUIREMENTS
A.
INCREASE BY FORMAL TRAINING/TEST
AND OJT;
INCLUDING:
DESIGN BASXS
SYSTEM INTERFACE KNOWLEDGE
POST
MOD TESTING REQUIREMENTS
B.
WORK PRODUCTS
1.
ENG.
EVAL. REQUESTS
2.
PLANT CHANGE REQUESTS
3.
DESIGN
CHANGE PACKAGES
4.
S-MODS
5.
POST
MOD.
TESTS
6.
ASSIST
PREP.
OF OPS/MAINT PROCEDURES
7.
EVAL. SYS
PERFORMANCE TRENDING
8.
PREPARE 5 DIRECT PERF.
EVAL TESTS
9.
PERFORM
ROOT CAUSE ANALYSES
1.
DECREASE - SHIFT TO OFFSITE
ENG.
ORG.
EXCEPT HIGH PRIORITY EVALUATIONS.
2.
INCREASE IN DEPTH EVALUATION.
3.
SAME - ASSIGNED
TO OFFSITE
ENG.
NOW.
4.
DECREASE - SHIFT TO OFFSITE
ENG.
EXCEPT
HIGH PRIORITY MODS.
5.
INCREASE - DEFXNE DESIGN BASES/TECH
TESTING.
6.
DECREASE - SHIFT TO PLANT STANDARDS.
7.
INCREASE -
NOT
NOW FULLY ACCOMPLISHED.
8.
INCREASE - NOT
NOW FULLY ACCOMPLISHED.
9.
INCREASE - NOT
NOW FULLY ACCOMPLISHED.
RMB-6
2/28/88
EEDG-034
FUNCTIONS
SYSTEM ENGINEER
PROGRAM
SHIFT IN EMPHASIS OF JOB
FUNCTIONS
1988
PROGRAM CHANGES
C.
REVIEW & COMMENT TASKS
1.
PLANT CHANGE PACKAGES
2.
LOGS
& INSTRUMENTATION
3.
ST TEST RESULTS/TRENDING
4.
.LICENSING SUBMITTALS
5.
VENDOR INSTRUCTION MANUALS
6.
OPERATING PROCEDURES
7.
INDUSTRY OPS.
EXPERIENCE
(ISEG)
8.
WORK REQUESTS
1.
SAME
2.
INCREASE - DATA TRENDING NOT FULLY ACCOMPLISHED.
3.
INCREASE - NOT NOW FULLY ACCOMPLISHED.
4.
SAME
5.
INCREASE - NOT
NOW FULLY ACCOMPLISHED.
6.
SAME
7.
SAME
8.
INCREASE - NOT NOW FULLY ACCOMPLISHED.
D.
OBS ERVATIONS/WALKDOWNS
1.
OBSERVE SYS.
CHANGES/
DEGRADATIONS
2.
INITIATE CORRECTIVE ACTIONS
D.
INCREASE - NOT
NOW FULLY ACCOMPLISHED.
E.
TECHNICAL SUPPORT
1.
MAINTENANCE ACTIVITIES,
AS REQUEST
E. 'EVISED - SUPPORT
TO MAINT. WILL BE DECREASED
F.
MAINTAIN SYSTEM FILES
F.
REVISED - AS REQUIRED TO REFLECT ABOVE PROGRAM
CHANGES.
RMB-7
(
CORPORATE ENGINEERS'NVOLVEMENT IN SITE ACTIVITIES
I.
RESIDENT
GROUP MAINTAINED ON SITE
II.
POST TRIP REVIEW EVALUATION TEAM MEMBER
III.
REVIEW OR CREATE ALL PLANT MODIFICATIONS
IV.
ESTABLISHED INTERFACES WITH SYSTEM ENGINEERS
V.
CO-RESOLUTION
LEAD IN MAJOR PROBLEMS
('I.
FREQUENT
ON SITE ASSIGNMENTS
VII.
ATTENDANCE AT UNIT MEETINGS
(I
SIMULATOR TRAINING TIME
A.
1988
OBJECTIVE
TRAINING
1.
SIXTY HOURS
SCHEDULED PER
LICENSED OPERATOR
II.
ENHANCEMENTS
A.
SIMULATOR UPGRADE
1.
MODEL IMPROVEMENTS CURRENTLY BEING TESTED
2.
EXPECTED
IMPLEMENTATION IN MAY, 1988
B.
OPERATIONS
INVOLVEMENT
1.
MEETINGS ARE BEING CONDUCTED BETWEEN TRAINING
AND OPERATIONS
DEPARTMENT PERSONNEL
APPROXIMATELY EVERY SIX WEEKS
A.
IDENTIFY ADDITIONAL NEEDS
REQUIRED
FOR
UPCOMING CYCLES
MAINTENANCE BACKLOG
PROGRAM ESTABLISHMENT
A.
TRENDING PROGRAM ESTABLISHED AND
PROCEDURALIZED - 12/88
B.
REPORTING
REPORT
PROVIDED TO SENIOR LEVEL MANAGEMENT
ON A MONTHLY BASIS - FIRST
REPORT
ISSUED
FOR
JANUARY, 1988
DATA.
REPORT
PROVIDED TO RESPONSIBLE
MANAGERS PROVIDES
REASONS
FOR DELAY BY DISCIPLINES,
RESPONSIBLE
DEPARTMENT AND UNIT
GOALS
A.
CURRENT PROJECT
GOALS ARE ESTABLISHED IN
ACCORDANCE WITH INPO GUIDELINES
RMB-M-1
2/28/88
1988
OBJECTIVES
DURING 1988
DEVELOP A PLAN AND SCHEDULE TO ACHIEVE INDUSTRY AVERAGES FOR
THE FOLLOWING PERFORMANCE INDICATORS:
A. 'AINTAINA CORRECTIVE MAINTENANCE BACKLOG (MR'S GREATER THAN
3
MONTHS OLD)
OF LESS
THAN INDUSTRY AVERAGE.
B.
MAINTAINA RATIO OF HIGHEST PRIORITY MAINTENANCE WORK REQUESTS
(MWR'S)
TO TOTAL MWR'S COMPLETED OF LESS
THAN INDUSTRY AVERAGE.
C.
MAINTAIN PREVENTIVE MAINTENANCE ITEMS
(BASED ON MR'S)
OVERDUE
BELOW INDUSTRY AVERAGE.
D.
MAINTAINA PREVENTIVE MAINTENANCE RATIO (BASED ON MR'S)
ABOVE
INDUSTRY AVERAGE.
RMB-M-2
2/28/88
PROJECT
MAINTENANCE GOALS
PERFORMANCE
INDICATOR (NON-OUTAGE MO'S)
INDUSTRY AVERAGE
7/87
STATUS 1987
4TH Q
3RD
Q
OPEN
90
DAYS
TOTAL OPEN
52.0%
57.4%
54.5w
HIGHEST PRIORITY CM
TOTAL CM
OVERDUE
(25% INTERVAL)
TOTAL PM'S
COMPLETED
TOTAL PM
MH
TOTAL CM +
5. 4%
7.5%
40.84
1. 0%
15.7%
45. 6%
3. 0%
19.0%
RMB-M-3
2/28/88
STATUS
OF QA DIRECTOR DEVELOPMENT
TRAINING
A.
CURRENTLY EVALUATING CONTRACTOR PROPOSALS
TO PROVIDE TRAINING
B.
EXPECTED
COMPLETION BY COMMITMENT DATE OF
APRIL, 1988
I
l
t
i
1