ML17326B315

LER 87-014-00:on 871215,programming Error Causing Alarm to Be Inoperable,Discovered.Caused by Personnel Error.Computer Operators Counseled in Proper Method of Computer Software Troubleshooting & Program installation.W/880114 Ltr

ML17326B315
Person / Time
Site:	Cook
Issue date:	01/14/1988
From:	Ross C, Will Smith INDIANA MICHIGAN POWER CO., INDIANA MICHIGAN POWER CO. (FORMERLY INDIANA & MICHIG
To:	NRC OFFICE OF ADMINISTRATION & RESOURCES MANAGEMENT (ARM)
References
87-014-00, 87-14, LER-87-014-01, LER-87-14-1, NUDOCS 8801210055
Download: ML17326B315 (5)

Text

'1 AC CELEMTED DISHGBUTION DEMONSTRATION SYSTEM REGULATORY INFORMATION DISTRIBUTION SYSTEM (RIDS)

ACCESSION NBR:8801210055 DOC.DATE: 88/01/14 NOTARIZED: NO DOCKET FACIL:50-316 Donald C. Cook Nuclear Power Plant, Unit 2, Indiana & 05000316 AUTH. NAME AUTHOR AFFILIATION ROSS,C.A. Indiana Michigan Power Co.

SMITH,W.G. Indiana Michigan Power Co.

RECIP.NAME RECIPIENT AFFILIATION

SUBJECT:

LER 87-014-00:on 871215,surveillance missed due to personnel

.-error in process computer software programming.

W/8 ltr.

DISTRIBUTION CODE: IE22D COPIES RECEIVED:LTR +ENCL+ SIZE:

TITLE: 50.73 Licensee Event Report (LER), Incident Rpt, etc. D NOTES S

RECIPIENT ID CODE/NAME PD3-3 LA COPIES LTTR ENCL 1 1 ID RECIPIENT CODE/NAME PD3-3 PD COPIES LTTR ENCL 1 1 j

WIGGINGTON,D 1 1 A INTERNAL: ACRS MICHELSON 1 1 ACRS MOELLER 2 2 AEOD/DOA 1 1 AEOD/DSP/NAS 1 1 AEOD/DSP/ROAB 2 2 AEOD/DSP/TPAB 1 1 ARM/DCTS/DAB 1 1 DEDRO 1 1 NRR/DEST/ADS 1 0 NRR/DEST/CEB 1 1 NRR/DEST/ELB 1 1 NRR/DEST/ICSB 1 1 NRR/DEST/MEB 1 1 NRR/DEST/MTB 1 1 NRR/DEST/PSB 1 1 NRR/DEST/RSB 1 1 NRR/DEST/SGB 1 1 NRR/DLPQ/HFB 1 1 NRR/DLPQ/QAB 1 1 NRR/DOEA/EAB 1 1 NRR/DREP/RAB 1 1 NRR/DRE P/RPB 2 2 IS/SIB 1 1 NRR/PMAS/I LRB 1 1 REG FI 02 1 1 RES TELFORD,J 1 1 B 1 1 RES/DRPS DIR 1 1 RGN3 FILE 01 1 1 EXTERNAL: EG&G GROH,M 5 5 FOR'D BLDG HOY P A 1 1 H ST LOBBY WARD 1 1 LPDR 1 1 NRC PDR 1 1 NSIC HARRIS,J 1 1 NSIC MAYS,G 1 1 S

A TOTAL NUMBER OF COPIES REQUIRED: LTTR 46 ENCL 45

NRC Form 355 V.S. NUCLFAR REGULATORY COMMISSION (94)3)

APPROVED OMB NO. 319)410I LICENSEE EVENT REPORT (LER) EXPIRES.'5/31/SS FACILITY NAME (1) DOCKET NUMBER (2) PAGE 3i D. C. Cook Nuclear Plant - Unit 2 0 5 0 0 0 3 1 6 1 OF 0 3 TITLE (4)

Missed Surveillance Due to Personnel Error in Process Computer Software Programming EVENT DATE (5) LER NUMBER (5) REPORT DATE (7) OTHER FACILITIES INVOLVED ISI MONTH DAY YEAR YEAR iySI sEQUENTIAL MONTH DAY YEAR FACI LITY NAMES DOCKET NUMBER(S) 4&re NUMBER FSc ER 0 5 0 0 0 1 2 1 5 8 7 8 7 0 1 4 0 0 0 1 14 8 8 0 5 0 0 0 THIS REPORT IS SUBMITTED PURSUANT T 0 THE REOUIREMENTS OF 10 CFR ()t ICnrcp onr oc mocr of thr follovflnpl )11 OPERATING MODE (Sl 20.402(b) 20A05(c) 50.73(r)(2)(ivl 7$ ,71(b)

POWER 20.405(r) (I ) Ol 50.35(c) (I) 50,73(r ) (2) (v I 7$ .71(cl LEVEL (10) P 8 P 20.405(r) (I l(E) 50.35(c) l2) 50.73(c)(2)(vSI (vill)(B)

OTHER ISprclfy In AOttcrct recto w r net In Trxt, NitC Form "P'r,cine 20.405 ( ~ l(1 l(iil) X 50 73(r)l2)(i) 50.73(r ) (2) (vi ii) (Al 366A) 20A05( ~ l(1)(lv) ~ 50.7$ (c) (2)(SI 50,73( ~ ) (2) jh&jegif 20.405( ~ l(1)(vl "

50.73 Ir ) (2)(i ii) 50.73( ~ )(2)(xl LICENSEE CONTACT FOR THIS LER (12)

NAME C. A. Ross AREA CODE TELEPHONE NUMBER Computer Sciences Department Superintendent 6 1 64 6 5- 5 90 1 COMPLETE ONE LINE FOR EACH COMPONENT FAILURE DESCRIBED IN THIS REPORT (13)

MANUFAC. REPORTABLE ': .jan&'42 MANUFAC.

CAUSE SYSTEM COMPONENT TVRER TO NPRDS ',+

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x4 CAUSE SYSTEM COMPONENT TVRER REPORTABLE TO NPRDS sPa I~xX4

. x xc kLPMkP(B SUPPLEMENTAL REPORT EXPECTED (14) MONTH DAY YEAR EXPECTED SUBMISSION YES llfyrr, COmplrrr EXPECTED SUBMISSION DA TEI DATE II 5)

NO ABSTRACT ILlmlr to f400 rprcr 5 I r., rpproxlmrtrly fifrrrn tlnplr corer ryprwrittrn linrtl (15)

On December 15, 1987, at 1409 hours0.0163 days <br />0.391 hours <br />0.00233 weeks <br />5.361245e-4 months <br />, while investigating the cause of. a failure of, the P-250 process computer, a programming error was discovered that had caused the Quadrant Power Tilt Ratio (QPTR) alarm to be inoperable.

The'condition had existed since December 7, 1987, when the Annunciator program was inadvertently written over during software troubleshooting.

Surveillance requirement 4.2.4.b was not performed during this eight day period, because it was not known that the alarm function was inoperable.

Should an actual QPTR have occurred the potential existed that the action statement time limit for Technical Specification 3.2.4 might have been missed.

The computer continued to calculate the QPTR during this period. The ratio did not exceed 1.02.

The cause of the annunciator program being inoperable was personnel error.

The space allocation for the software program was not checked prior to loading into the system disk. All computer analysts who have the responsibility of performing this task have been counselled in the proper method of P-250 computer software troubleshooting and program installation.

8801210055 880114I PDR ADOCK 05000316 8 DCD (94)3)

((RC form 388A U.S. NUCLEAR REGULATORY COMMISSION (983)

LICENSEE EVENT REPORT (LER) TEXT CONTINUATION APPROVEO OMB NO. 3)SOW104 EXPIRES: 8/31/88 FACILITY NAME (1) DOCKET NUMBER (2) LER NUMBER (5) PAGE (3)

YEAR P'EGVENTIAL REVISION NUMBER NVMBER D. C. Cook Nuclear Plant-Unit 2 o s o o o 3 1 6 8 7 0 1 4 ~

0 0 0 2 pF0 3 TEXT //II>>FP e>>co /I RR)VBed, v44 BREEIN>>/I HRC Form 3554'4/ (IT)

Conditions Prior to Occurrence Unit 1 in Mode 1 at 90 percent Reactor Thermal Power Unit 2 in Mode 1 at 80 percent Reactor Thermal Power Descri tion of Event On December 15, 1987, at approximately 1409 hours0.0163 days <br />0.391 hours <br />0.00233 weeks <br />5.361245e-4 months <br /> while investigating the cause of a failure of the P-250 plant process computer (EIIS/ID-CPU), a programming error was discovered in the Quadrant Power Tilt Ratio Annunciator Computer Program. This alarm program is called when the P-250 plant process computer senses the tilt ratio to be greater than 1.02 and alerts the operator of the condition.

The program 'error had existed since December 7, 1987, when the annunciator program was inadvertently written over while troubleshooting a P-250 computer program software change.

Technical Specification 3.2.4 requires the Quadrant Power Tilt Ratio (QPTR) not to exceed 1.02. The action statement for this limiting condition for operation requires compensatory measures to be taken within two hours if the QPTR exceeds 1.02. Surveillance requirement 4.2.4.b requires a manual calculation of the QPTR be performed every twelve hours if the QPTR alarm is inoperable.

The P-250 computer was performing its function and calculating the QPTR during this eight day period (12-7 thru 12-15). A review of the trend printout for this period shows that the QPTR did not exceed 1.02.

Although the QPTR calculation was being performed, the operators did not know that the alarm function was inoperable and as a result, the surveillance requirement to manually calculate the QPTR was not performed as required.

If an actual high QPTR had occurred the P-250 computer would have failed.

This would have caused the operators to believe that a surveillance was required to be performed within the next twelve hours, rather than having only two hours to comply with the action statement requirements of T/S 3.2.4.

Consequently, a potential existed for an action statement time limit to be missed.

No other components, systems or structures were inoperable which contributed to this event.

NRC FORM OBBA o U.S.GPO;1988 0.824 538/455 IO4IBI

'ARC Form 366A U.S. NUCLEAR REGULATORY COMMISSION (983)

LICENSEE EVENT REPORT (LER) TEXT CONTINUATION APPROVED OMB NO. 3150-0104 EXPIRES: 8/31/88 C$ FACILITY NAME (1) DOCKET NUMBER (2I LER NUMBER (6) PAGE (3)

. REVISION YEAR SEQUENTIAL'UMEER NUMEER D. C. Cook Nuclear Plant--

Unit 2 0 5 0 0 0 3 1 6 8 7 0 1 4 0 0 0 30F0 3 TEXT //moro <<ref 1( /Er)M)od, Irw d/I/one/HRC Forrrr 36//AS/ l(T)

Cause of Event The cause of the event was cognitive personnel error. The computer analyst did not check the size of the software program to ensure adequate space was available for installation.

Anal sis of Event This event is reportable under 10 CFR 50.73(a)(2)(i)(B) as operation prohibited by Technical Specification surveillance requirement 4.2.4.b. The surveillance requirement of manually calculating the QPTR every twelve hours was not performed because it was not known that the annunciator program was inoperable. Also there existed a potential to miss the two hour action statement for Technical Specification 3.2.1.

During, the entire period the P-250 was calculating the tilt ratio and it never exceeded the 1.02 limit. If an actual alarm signal had occurred the P-250 computer would have failed causing the operator to perform the same actions necessary to determine the quadrant power tilt ratio.

The QPTR is periodically checked by the Operators. The Nuclear Section reviews the QPTR daily. The weekly surveillance requirement of manually calculating the QPTR was performed during this event.

Since the QPTR was being calculated and did not exceed 1.02 for the duration of 'the event, it can be concluded that the health and safety of the public were not affected.

Corrective Actions Vhen the program error was discussed on December 15, 1987, the computer was immediately corrected by bootstrapping and reloading the alarm program into the computer. All computer analysts who have the responsibility of performing this task have been counseled in the proper method of P-250 computer software troubleshooting and program installation.

Failed Com onent Identification None Previous Similar Events RO 79-036/036-0

'NRC FORM 346A *U.S.GPO:(986 0 624 538/455 (9'63)

Indiana Michigan Power Company Cook Nuclear Plant P.O. Box 458 Sridgrnan. Mi 49I06 6I6 465 590t INDIANA NICHIGAN POWER January 14, 1988 United States Nuclear Regulatory Commission Document Control Desk Washington, D.C. 20555 Operating License DPR-74 Docket No. 50-316 Document Control Manager:

In accordance with the criteria established by 10 CFR 50.73 entitled Licensee Event Re ortin S stem, the following report is being submitted:

87-014-00 Sincerely, W. G. Smith, Jr.

Plant Manager WGS:afh Attachment CC J. E. Dolan A. B. Davis, Region III M. P. Alexich R. F. Kroeger H. B. Brugger R. W. Jurgensen NRC Resident Inspector D. L. Wigginton, NRC R. C. Callen G. Charnoff, Esq.

Dottie Sherman, ANI Library D. Hahn INPO PNSRC A. A. Blind P. A. Barrett/P. Lauzau