ML19209C842
| ML19209C842 | |
| Person / Time | |
|---|---|
| Site: | Crane  |
| Issue date: | 01/22/1965 |
| From: | AMERICAN INSTITUTE FOR RESEARCH IN THE BEHAVIORAL |
| To: | |
| Shared Package | |
| ML19209C834 | List: |
| References | |
| TASK-TF, TASK-TMR NUDOCS 7910180367 | |
| Download: ML19209C842 (120) | |
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t Revised Crsft IV.
Critical Requirements and Preli=ina:f Rationales for Fredictor Cevelopment THE FIFFCE?tA:lCE CF :IUCLT.AR REAC*CR CPEFATCps A
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he uses of the critical incident data described in previcus sectiens of this report were aimed tcvar:i the development of measures of cperator perfor ance.
"'hus, the incidents were scrted into job-related categories.
The major categories were developed independently cf the incidents and are ec==cnly used in the reacter field.
Fcr. cur:cses of redictor develeprent> a different set of categories was developed. These categeries were induced frc= the critical incidents directly.
"'he atte=c.t.was to avoid.a. criori catecories and tc reflect the actual cen-tent of the incidents.
Tc the extent that there was a point of view in devel-ping these categories, it was that they shculd be relatively free Of the specific content of the reacter operator's 'cb but should rather e=phasize a
the underlying skills, kncvledge, and attitudes which are critical for success in the jcb. This classification scheme is presented in outline as Table 22 en page 50.
-'he categories in Table 22 Ocnstitute a set of critical require-
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.?cr each of the sub-areas of these critical requirenents, a preliminary ra:icnale was develcped. A raticnale is a description ind justifi:ation cf
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n Preliminarr Classificatien Scheme
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Area 1.
emenstrating Ocerating Skills dl e
A.
Manipulates Centrols and Times Actions 3.
Cperates Mechanical Equipment C.
Cperates Equipment to Minimize Reactor Stress Area 2.
Knowing Fencter Physics and Facility Systems A.
Knows Funda=entals of :eactor Physics and Can Apply Knculedge to nterpret Reactor Status 3.
Learns About "His" Reacter:
Physical Layout, Locaticn of and Intrica-cies of Iquipment, Cperating Characteristics and Peculiarities C.
Learn the Interaction Effects of Reactor Syste= Variables, Effects of Interlock Actions, Syste= Veaknesses and Cangers D.
Keeps Inferned of the Variables Affecting the Cperating Status of the
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.e Area _3_.
Monitoring Reacter Creratices A.
Monitors *nstruments and Cther Indicators 3.
Verifies Indicatcr Readings '..here ?cssible C.
Performs Scutine Field and Area Checks Area 1.
Fellevine Preceduras (This area has not been divided into sub-areas.)
Are a f_.
Cc=nunicating Effectively A.
Maintains and Utilizes Cperating Legs and Cther Records 3.
Keeps Infer =ed Atcut the Status of the Peacter and the 3eacter Area 0.
Keeps Cthers Infer =ed About the Status of the Reacter D.
Oc==unicates with Ctners in an Iffective "anner Area c.
Accecting Restensibility A.
Tahes Charge of the Reacter and the Eeae cr Area 3.
Insures that Persennel Cbserve Safety Frecedures C.
C;erates 3eacter in a Safe and Responsible Manner 2._,22
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Ares 1,.
De=cnstratine Oceratine Skills This area deals with the skills required to operate the reactor. Cperators
=ust perfor= coordinated, =anipulative tasks during startup, normal cperatien, pcVer changes, unusual operating conditiens and =alfunctions, and during shut-devn.
Sub-Areas A.
Manipulates Centrcls and Times Acticns 3.
Operates Mechanical Equip =ent C.
Operates Equi;=ent to Mini = ice Reactor Stress Sub-Area A.
Maniculates Centrcls and Ti=es Acti ns
' he operator uses his centrols during sta.- up to bring the reactor critical and to bring auxilia'f s/ stems into Oper2tien as required.
During cperatien, he uses centr:1s in =anual or autcmatic modes of operation to
=aintain the syste= in an appropriate balance.
He =ust coord.inate al'.
syste=3 changes, using centrcls to change pcuer levels s:cothlf and change s c a ' a s e.r. 4..a.-"
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2.
V'sually verifies centrol selected before t.aing, even t:nder stress o f startup or scrs=.
3 Operates pumps and valves in prcper sequence to assure minimu=
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Takes care in verking near centro 11er to avoid accidental activatica.
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Controls the reactor =anually during startup or nor :a1 operation when autecatic not available.
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[6 Sa=ple Incidents for Sub-Area A.
,J 22 Effective SITUATION:
Operator bringing reacter up tc power (100 watts) and had cenpleted water fill.
ACTICN TAKIN:
Operator was to level off at ene pcVer level, take data, and then go to another power level. Operator had taken level to designate pcuer. Many people vere in centrol rces but didn't bestrict.
When a spike cecurred en the power level =eter, he ih=ediately had his hand en the range switch, turning the range up, and the other hand en the scram butten in case the excur-sien was any more than a te=pora:/ spike.
WHY ::::CTIVI:
His acticn was predeter=ined, ind he knev vhat his action was to be when he saw the spike, lISS ::: CT!7E:
- 1) Wouldn't have noticed the spike.
- 2) Wculd have been distracted by persennel.
- 3) W uld have igner-d the indication as instrunentatien errer.
h) Wculd have pre =aturely scra==ed reacter.
- 5) Would have called for help.
Ineffective 5!!UATION:
Reacter was at full pcVer.
The regulating red had travelled its full operating range 30 the shi: reds were being pulled.
21e operator did not lock to see which operating handle he was grabbing.
As a consequence, he grabced the vreng one and initiated an insertion of all the shi= reds.
This caused the regulating red to leave its operating range and a resulting less of pcVer.
WEY INI??IC"'!7E:
He =ay have ~ grabbed a handle causing an increase in power and as a result =ight have been 5 hours5.787037e-5 days <br />0.00139 hours <br />8.267196e-6 weeks <br />1.9025e-6 months <br /> ics in operations for refueling.
"CRE E77IC'"I7I:
Would have glanced at the operating har.dles tc.d.e sure he had the correct ens. 864 10~
l Analysis 1.
Visual-Motor Coordination.
Skill in adjusting motor responses accurately in accordance with visual display indications.
2.
Safety 0rientatien. Ccncern vita safety of equipment and per-sonnel.
3 Planning. Ability to develop and carry through a icgical plan.
h.
Careful Checking. Habitual tendency to check thoroughly and accurately before proceeding.
Sub-Area 3.
Ceerstes Mechanical Ecuir=ent This sub-area is cencerned with the operatien of equipment where the operator depends on direct visual centact to deter =ine hev he is doing.
It includes operation of standard equip =ent, such as cranes and hoists, and special equipment, such as fuel ind sa=ple handling tecls. Operation of all this equip =ent is ec= plicated by the peculiar enviren=ent and the sensitivity of sc=e reacter ec=penents. Operatcrs =17 have to verk en fuel or sa=ples, reaching through 30 or = ore feet of water, using a lens-handled tecl. He has to carefully =aneuver long, veignty, and avkvard tools, eften verting under cenditiens of peer visibility and encumbered by protective clothing.
Cc=renent Beh aviors 1.
Uses hand tcols prcperly, even under unusual cenditicas 2.
Makes use of =echanical assists such as lifts, ersnes, er hoists,
being careful not to damage reacter ec=penents 3
Uses special handling tools 4
Never uses force where it is pcssible to cause damage to the reactor Bus 4 108
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l Samele Incidents for Sub-Area B Effective SITUATION:
Operator purging cask car du-ing preparation for test and return to service (during 12 - 8 shift).
ACTION TAKE:T:
Operator had problem with release of purging valve.
Could not release manual handle. Teck ti=e to trace mechanical leakage. Did not use force. 'After several trials, succeeded in freeing valve.
?cund 11:1t switch set vreng.
'GY EFFECTIVE:
Solved problem hi=self. :b maintenance people available. Able to continue test without delay.
iESS EFFECTI'E:
Stepped test until maintenance technician available.
Ineffective SI~UATICN:
Cperating a crane (reactor shut devn), rencving tool from heck of crs.e.
AC*IC:T TATIN:
Cperator was guiding the crane devn to lever the tcol. The cperator pushed the vreng butten causing the heck to sving and release the tcol.
'GY I:TE7FEC*I'E:
""nis veuld have rest:lted in physical damage to others or ds= age to equipment.
MCRE :.:::.C*I'E:
Weuld have been mere fami';iar with the centrols.
864 109
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Analysis 1.
Visual-Motor Ccordination.
Skill in adjusting motor responses accurately in accordance with visual appearance or display indi-cation.
2.
Safety Crientatien.
Concern with safety of equipment and per-sonnel.
Sub-Area C.
Ocerates Eculement to Minimize Resetor' Stress Not every peor operatica results in 1 =ediate, dramatic consequences.
An effective operator vill perfors his duties to =ini=ize the stress and da= age to the reactor.
He vill avoid sudden changes in temperature and pressure. He vill not depend on safety li=its to stop operation, but vill =anually =aintain the proper level.
Cc=renent Behaviors 1.
Uses ecolant fans and pu=ps as necessary, but not in excess of requirement 2.
Maintains a constant period during startup or power level change 2.
Avoids excessive temperature and pressure changes, even when these are within safety li=its
- i. Avoids scrs=s or fast setbacks whien can damage the reactor 5
Manually initiates :;.ndevn when scras limits are approached 864 ii0
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Sa= ele Incidents _ for Sub-Area C lr
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The reactor plant was shut devn following a scheduled cutage. The electrical systen was having voltage fluctuations fres 350 to ever 500 volts en the hho
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These fluctuatiens listed frec 13 to 15 minutes before they finally drcpped off to nothing.
ACTION TAKEN:
The shift operator recogni:ed the possible bad effects that si ht occur en the electrical motors which vere 6
operating at the time and i==ediately suggested that we shut them all devn until the reactor pcver situation was rectified. This was dene by all hands in the shortest possible ti=e.
WY EFFECTIVE:
His acticn was peticularly effective since the prompt-ness of his suggestion undoubtedly resulted in the saving of sc=e =otors and extended the lifetime of the remainder.
LESS ::sCTIVE:
A less effecti re cperator =ight not hava
-=*-ad the fact that significant voltage chan6es may ruin or da:a6e an electrical :otor.
Ineffective SITUATICN:
The reacter vas =aking a standard recovery frca 1 scr1=.
The reactor had a heavy " fuel leading," 30 the recovery time was tot extre=ely critical.
AC*ICN TA EN:
2 e Operator vas pulling reds to keep the reacter en a pcsitive period. Althcugh he had been given instructicas by the senior engineer to keep the period greater taan 50 seccads, he alleved the pericd to decrease to abcut five seccnds. The pcVer increased rapidly 2nd the senior engineer was forced to threw the reverse switch to prevent a pcver evershcot.
- "dY INE77EC*I7E:
Ead the power centinued to increase, it might have a
resulted in excessive experiment temperstures er caused sncther scrz: fren which recovery night not nave been made withcut refueling.
MCRI ::::CTI75:
A =0re effective Operater vculi have paid eleser attentica and kept the pcVer under centr:1. 0bk
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4 Analys12 1.
Enevladre gi', System. Ability and noti ration to let.rn about the
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Knowing Peactor Phys es and Facility Systems This area is ccccerned with the technical k culedge the cperator =ust have available to hi= in order to be effective in his jce. He must have a basic understanding of nuclear physics and nuclear engineering.
This understanding
=ust be practical, and criented to the Jcb. The cperator =ust amass and use a considerable body of additional informatica cn the physical laycut of the reacter, 1ccation of equipment, syste= intericeks, and external envircement effects.
All of this knculedge must be available for use at all times, but put to use in-frequently, if at all.
Sub-Areas A.
K=ovs ?unda= ental Reactor Physics and Can Apply K:culedge 00 Interpre:
Reacter Status 3.
Learns About "His" Reactor: Physical Laycut, Locatic: Of and Intricacies of Equi; cent, C;erating Characteristics and ?eculiarities C.
learns the Interact 10: Effects Of React 0r Syste= Yariaoles, Effects Of Intericek Actions, Syste= Weaknesses and Dangers D.
Keeps Infer =ed of the Variables Affecting the C;erating Status of the
?.eacter Suo-Area A.
s:cus Fundamentals cf Reacter Physics and Can Apply Kaculedge
_t_o Interpre: Reac cr Status The react:r :;ers:cr must have a basic : derstancing :f nuclesr physics and be able to apply this understandd=g to practical problems.
He uses his k:culedge in interpreting and understanding data fr : instru=ents.
/,13 0, as the reactor is not fixed and unchangeable, the cperator must daily exercise his k cvledge 12 :sking any change er adjustment :: the system.
It is because of this requirement f:r a basic understanding Of reactor ;nysics, tha: ne operator is required to be present whenever 2:y 0;erations are perf0rted c:
the reacter, which are relatad :0 the nuclear system. The ;er2t:r is 3130 the persen charged with the responsibility f:r handling radicactive na:erials in the reacter area.
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The Operator's k culedge of reactor physics is especially useful in deter =ini=g the consequences of a particular malfunction and the corrective actica required. While health-physics persecuel vill =cr= ally care for radiatics hacards, the operator is in a position to give them the informatica they need to take action.
Cgsponent Eehaviors
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1.
Must be able to use properly individual and area radiation scnitors 2.
Must kncv how to calculate the effects of poisons on the reactor which could delay startup after shutdown 3
Mt.st have sufficient knowledge of radiological safety to protect himself, other workers, and equip =ent tres the popsibility of ecctacination k.
Aust have a clear understanding of the ces=ing of terms ccm=cn to nuclear engineering, such as pericd, delayed neutress, flux, etc.
5 Must be able to use tables, graphs, calculations, slide rules, etc., in determining red verth and expected criticality c.
Must be able to concrol the reacter ecolants and main-tain a centrclied pcVer cutput 7
Must be able to predict the effects of adding er takirs away ccc rcl red, or changing ecclant flev en power cutput, prior to =aking the changes 3.
Must kncv and adhere to the facility Operating restrictions 864 114 D**D OD l
~N Saccle Incidents for Sub-Area A aaf h f(jk $
o Effective SrrUNTION:
Reactor centrol red measurements were being taken.
ACTICN TAKIN:
Operator measured total excess reactivity and fcund it to be 0.15 below the stated amount. Operator realized the danger of the possibility of this less comin6 back all at ccce and i==ediately shutdown the reactor, notified the reactor supervisor and reported his observation.
'M EFFECTIVE:
He avoided what could have been a real prcblem.
LESS ir: CfIVE:
No respcese at all until the centrols repcrted the danger.
Ineffective SITUATICN:
Reactor apprcaching full pcVer (50 MW).
Cperator was increasing pcuer by pulling cut reds. At the anticipated red height, the pcuer was in excess of the required a= cunt.
ACIICN TAKEN:
Cperator had to put reds back in to reduce pcVer level.
~4h? INEFFICTIVE: Crerator did not realize that increased Xencn in ccre veuld change characteristics of red-power curve.
His lack of derstanding caused a pczer fl2ctuaticc.
Reds were raised and then drcpped back.
MCRE IF "ECT3'E:
4culd have considered Xencn productict in his calculaticcs.
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K culedge of nuclear physics and nuclear engineering terms.
Acility to7 earn att understant terms and concepts unique to the nuclear industry.
2.
Lc21 cal resscuing. Ability to anticipate and predict the con-sequences of actices involving the cuclear syster.
3 Problem solving. Ability to manipulate concepts and data to solve practical proble=s.
k.
Rule using. Ability to follow rules and directicus under unusual conditicus. The operator =ay have been trained to follow a general rule in the abstract. When a particular, rare circumstance arises, he must be able to follow and apply this abstract rule.
5 Safety crientaticc. concern for the protectice cf the reacter at persettel frc: cuclear hacards.
Sub-Ares 3,.
learns Abcut "His" 3 actor: physical Layout, Locatice of and Intricacies c{ Icuipment, Cperating Characteristics and~~
Feculiarities Ee =ust lear the 2ccatice of numercus pieces of rechanical and electrical equipment, valves sud other centrols, lines, etc., in the reecter and asscciated areas. A pcVer reacter with its associated systems ccetains literally thousands of pieces of such equipment.
Cc=peten: 2ehaviors 1.
Learns Over a period cf time the locatic: and functics of all plant equi; en 2.
Must relate equipment Oc its functice, e.g.,
relates specific valves and pumps to their systems, electrical circuits and detec:crs, etc., Oc particular conscle locatiens. This facili-ta es locatics cf scurces of equipment nalfunction, and repair, and re=cte 0;eratic: cf equipment 3
K cvs how equipmen c;erates, the mechanical linkages, relays, switches, etc., k culedge vcich can be invaluacle in diagacsing causes of equipme : failure, and to sc e extent can be used :
prevent equipment failure k.
Uses blueprints and sche atics in understacding and trcuble-shcoting facility equipment 864 116 Samole Iccidents for Sub-Area 3 70 0
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Reactor was not operating. Safety injection system was being tested. At cce.pletien Of test Of safety injection s.y s t e..*; r.cumo. "stco" butten was trie' red cut
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continued to cua, as the suction water level was low and being used up rapidly.
ACTION TAKEN:
The control rec = operatcr stopped the pump by opening the " supply breaker" to the bus' supplying feed to the pump.
WHY EFFECTIVE:
Cperator corrected the =alfunction quickly and directly withcut any undesirable sice effects and prevented severe fama e to pump.
LES5 EFFIC'"IVE:
Panic and to respense.
Ineffective SI*UA*ICU :
The reacter was operating steady at 30 Wr.
All systems were ner al.
The make up water fer the hetvell in the hcid up tank vas getting very low.
AC* CU TATE:':
The crerster whc was senicr to.yself (I was cperating the plant) phened me to infern me that the condensate tank level was getting icv.
I asked him to start the rav vater made up :r else the plant vculd have to shut down due s icss of feed-water. The operator told me that he didn't krev hev to start the make up and that if I didn't get scmecce else or myself dcwn there to start the make up; he couldn't care less if the plant vent down.
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Besides having a lack of interest in the plant.
MCRE EFFE'. _ :7E :
A mere effective :;erator vculd have encen the area he was suppcsed te be watching.
Which points cut the need for a ecntinucus training pr:6r25-8, tI ems:-
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K culedge g ec= lex system..ibility and =ctivatice to learn abcut a nignly ec= plex 20: cceplicated system.
2.
Me= cry. Lceg-te r.
.e= cry of syste= characteristics.
3 Visualizatice. Ability to understand equipment and relaticeships frc= crav =gs and descriptices.
r-Sub-Area C.
Learns the Interactic Effects of Syste= Variables cc the Reactor, i.
Effects of Interlock Actices, Syste= Weaknesses and Dangers The cc=plexities Of a reactor syste= are due to the multitude cf inter-acting cc=petents. Pri=ary syste=, auxiliary and experimental systems all influence each other as part of the overall reacter syste=.
Instrurentatic:
?
reperting the status of these syste=s is often included in safety circuitry.
Cc=:ccent Eehavicrs 1.
Knows the ccepccents :r systems which are subject to failure, and gives priority to these when trcuble is indicated 2.
Follows rules and precedures in removing system interlecks 9"*
3 Carefully ccesiders the effect on the entire syste= before activating er adjusting auxiliary secccdary systems, er ex;eri-
= ental icops k.
K cvs and fclievs facility licensing ccustraints when re=cving safety instru=ents frc= cperstic:
5 Traces critical circuitry frc= =c= cry, arking i :per act valves cr switches as well as lines in con ect sequence 6.
Can iccate bypass valves er backup syste=s quic'dy in emerseccies L
864 118
_7h-i.
na nn D
D
( hf f ee m
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t m
h.
Takes over centrol rces from previous operator, quickly assimilating any permissible changes from previous shift 5
Makes proper record of minor instru=ent deviatien or adjustments made in log book 6.
Follows directions of senior operator 7
Takes over in =anual control frem autc=atic when necessary S.
Makes routine rod adjustments as required 9
Does not allcw anyone or anything to detract his attention from monitoring safety instru=ents 10.
Uses experience as well as instrument data in analyzing situations 11.
Checks position and frequency of regulating red movement while in autc=atic centrol rode 12.
Kncvs normal Operating range of all meters, indicaters, displays,
etc., and identifies any deviation frem nor=al range 864 ii9 Sa. e Incidents for Sub-Area A cd D
D n
n r
,D r Tf' I
F4 Effective
'9."l
'/UbL Mb J \\
22 SI5UATICN:
Reacter at full power. One of the three neutron level indicators spiked frc=.99N, ( full pcuer) to 1.0' N,.
a I==ediately ec=ing back down to.99Nr.
ACTION TAKEN:
The censole operator immediately noticed this abnor-
=ality.
He enecked the other neutren level recorders and all other nuclear instru=entaticn to see if this was a true situation or if this neutron level instru-
=entation was erroneous.
Finding no other signs of flux level changes, the operator informed the super-visor and the electrcnic technician of the situation.
'a~d? EFFECTI'E:
He noticed this abnor.ality i=cediately and was able to diagnose the proble= before the reactor was scra==ed due to instru=ent failure.
LESS EFFECTI7E:
A less effective operator vculd not have noticed the
=alfunction i==ediately, thus incr3asing the chance for a pcver reduction by faulty instrumentation.
Ineffective SITUATION:
Reactor en nor=al--full;cver auto. ?cver level cen-troller maintains pcVer vithin 1/2" cperating pcver.
Regulator =alfunctioning.
ACTION TAJ5CI:
Cperator didn't see any of three indicatiens of pcver level decrease (galvanc=eter, nuclear safety, auto pcVer level centroller}.
?cver dropped to lc 5
- f.i.
Cperater noticed ;117 enc =ecer, teck manual cen-trol and regained pcVer.
WHY INEFFECTIVE:
A11cved pcve r to '
-'--=-ass arily.
"CRE EFFECT!'C:
Mould have picked up change in instru=ents s_.d taken actica.
+.-
if Analysis 1.
71gilance. Ability to maintain attention to all the instruments and displays under his centrol for periods up te eignt hcurs.
2.
Percentual Accuraev. Ability to detect changes in reactor status frc: instru ents and other external cues, such as noise, s:cke, te=perature or pressure change, etc.
3 Knculedge o__f Diselays.
Capability and motivation to becc=e fa:il-iar with the use, location, and ex ected readings of displays for every level and mode of operation, for all displays, even those not in centrol roc: but in reactor area.
k.
Information Processine.
Ability to receive and process many ite=s of information and to deter =ine accurately these which are relevant and i=portant in the specific situation.
Sub-Area 3.
Verifies In'dicator Readines 'Jhere ?cssible Inherent in the design of the reacter centrol.s is censiderable redun-dancy in circuitry, especially in the required saf-ty circuits. Operators
=ay have up to six channels, with cne er scre reters and a reccrder for each channel all =easuring the sa:e phenc=enen.
In =any situations failure of one channel does not require shutdown.
In addition, more than one aspect of a particular phenc=enen =ay be measured. An operstcr vill be centinually checking and validating each channel against the others,
and leckin~ for indications en all appropriate instru=ents of the appre-e priate change. 3y crcss-checking instru=ents an Operator may be (rie to identify when ene is fluctuating er incensistent with the others and take the instrument out of service er recuire calibratien and, hence, preven-a scrs: frc: instrument =alfunctien.
7alidating instru=ent data is cften the only way to discover proble=s,
which can becc=e serious if not detected.
In addition, the operatar must use his kncvledge of the syste to deter =ine the relative reliability of readings. A slight change ih a startup channel power level display nignt not =ean tec nuch. The sa:e change at an intermediate er high level could scra the reacter. All of this the operator must take into acccunt while ca.<ing his many readings.
864 l21
-ec-
Centenent 3ehaviors 1.
Constantly checks redundant er nultiple channels to assure all readings are in preper range 2.
Checks red latch indications, and nuclear instru=ents as well as red positica indicators, to assure that centrol reds are really bein6 withdrawn 3
Verifies whenever possible that nuclear instru=ents are reading the sa=e as in previcus runs at sa=e pcVer levels 6.
Analyces information based en reactor system and experience before taking acticn 5
Uses backup or alternative instruments or syste=s when he has reason tc question prica:y instru=entation
- ten operating pu=ps, checks for flew indication, as well as pu=p o.
a operating I.
7erifies instru ent readings in centrol rcCm Vith instr'.::ent3 in reactor area.
3.
- inenever he doubts or questions display, shuts dcun or holds until doubt or questien removed D
> \\\\ \\
8sa 122
-u-
Sancle Incidents for Sub-Area.3 Effective SITUATICN:
Reacter startup.
Plant en normal pressure 960 PSI.
ACTION TAK23:
He was raising pcVer in steps frc= h5 to 257, LG5, SC5, and 1005. Whil raising pcwer and after reacnf.ng each new power level, tne operater vculd lock at all his instru=entatica very closely. He vculd ecmpa:e readings that measured the same point but ca=e fro' different transmitters very cerefully before increising power to the next higher level.
WHY EFFIC"'IVE:
3y ec= paring all the reading: he vould have been able to spot sc=ething vreng right away and have it ecr-rected before it could cause any sericus trouble.
lESS E2::CTIVI:
A less effective operator vould have caly been watch-ing two or three instru=ents as he changed power level and if secething other than the one he was watching vent vreng or was indicating vreng he vouldn't have caught it for sc=e ti=e er until the plant was shut devn.
Ineffective 51.CATICN:
Reacter being brcught Oc critical, pulling rods to double power. Operator initially watching two channels,
one of which was doubling a lot faster than the other.
ACTIIN TA IN:
Cperater watched cely the One pcVer channel.
WHY INIFFICTIVI:
The cther channel started to pich up =_nd deur'_ed withcut cperater ncticing this. Ceuld have led to a fast period scran.
MORE.c::.C"!7E:
Wculd have been watching all instrr.entatien.
O uu 864 lz3
-C LI-
['
Analysis l.
Perceetual Accuracy. Ability to read and inter: ret displays accurately.
2.
Kncvledze cf. System.
Cac. ability and motivation to learn a ec= plex syste=, including tne various displays and 'centrols and the oper-ating rules.
3 Memo ry. Lcng-and short-ter =e: cry of actual and required dis-play readings.
4 Careful Checking. Habitual tendency to make thorough and pain-stakin6 checks, when required.
Sub-Area C_.
Performs Routine Field,and Area Checks While the operator's job is usually centered around the centrol rec =,
area cr field checks are also important to the Operation of the reacter.
- n some larze pcVer and test reacters9 operators are reutinel"J assigned to verk at stations re=cte fres the centrol rec =. At even the smallest reactor, area checks are =ade formally before startup and infor= ally whenever sa operator is verking around or passing thrcush the area.
These checks include both reutine checking of instruments and equipment and searching for cut-cf-the-ordinary happenings.
Another important function which is ccvered during area or field checks is the opportunity for che Operator to maintain centact with all maintenance work going en, equipment being verked en, and unusual cenditiens. A reacter is in ever-changing enviren=ent.
Impty verk ficcrs are filled with test equipment.
Auxiliary er energency lines are laid ever fleers. Cnits fail er require =ents change and major iters Of equip =ent are changed. The operater can caly maintain centact with his reacter by close associatien, which area and fieli checks u... - O a,yy.,.f.
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864
Ccerenent Eehaviors-
~
1.
Checks instr =ents in the field, reccrding data when required or assuring in tolerar.ce reading 2.
Inspects reac cr area lecking for leaks, listening for unusual noises, etc.
3 Inspects area for industria.1 safety hazards h.
Checks area for potential nuclear hazards 5
Operates and checks pu=ps and valves, in coordination with control rec = cperater c.
Checks all available data to supple:ent instrument readin68 7.
Operates electrical and =echanical equipment O
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-.c-
Satele Incidents for Sub-Area C_
Effective SI"UATICN:
Cperator not at censele.
Cce.ing into CR.
Noted leak en f1cer.
AC"'ICN TAKI'T:
Checked and found leak in H C system.
2 7dY E EECTIVE:
Alertness saved possible loss of all water in F 0 2
syste= and possible shutdown.
D *
- 3
' D
'W g' Ine f fee tiv_e.
. E Jt _,
d S!TUATION:
Area check (at pcVer, steady state operatien).
S.e operater nade two area checks in h8 hours and did not notice that a recirculating pu=p (en electrical system),which is supposed to be off, was running for two f ul days.
7d? INZ EECTIVI:
- !egligence, as he was supposed to be sure than this
=otor was off as part of the eneck.
MCRE :.:::.0"'IVI:
h*culd have found and reported the running =ctor.
Analrsis 1.
Alertness. Tendency to cctice and react in the environment.
2.
Knculedze of Peacter Ares.
Cacability and =ctivatien to learn vnere to find a particular pu=p valve er =cnitering station.
- catien and Tunctien.
Cacability 3.
inevledze of Auxili uictent
.c and motivatten to learn.c quickly identify, locate, and analyce auxiliar.t equipment proble=s in the field.
k.
Safety Crientation.
Concern fer the protection of the reacter and perscnnel frc= both nuclear and industrial hacards.
5.
Initiative.
Readiness o take action en cvr. initiative when required.
864 126
-M-
Area h.
Folleving Procedures The operatica of a reactor, especially the larger and nere elaborate experi-mental and pcVer reaccors, is a ecmplex task--although routiniced to a geat extent.
The perfc = ance of specific tasks cencerned with reacter cperation are usually prescribed to a high degee. It has been the operating philosophy of reacter installaticns to foresee all credible contingencies associated with reactor opera-tien and to specify precedures for these contirgencies.
Effective perfem ance of fc11 cuing stn-da-d procedures depends upen: Kncving what the precedures are or hev to find cut what they are, ability to carry cut such precedures, and wi4 gness to car:7 them out.
Because of the cenplexities of a reactor, persennel at the cperater level nay not have encugh infomatien to be able to see the necessity or purpose of certain cperations ened for in a checklist er sts & -d operating precedure. There must be ne tendency to " slack off" and c=1; or carelessly perfem cer ain precedures, er not perfem che*st checks en the assu=ption that they are unnecessary.
(This area has not been divided into sub-areas.)
lf!'
D**D
'l D 7 K :,
n sA
~~J Cc=renent,ehaviers z
1.
Has rote knculedge of standard cperating precedures and applytrg these precedures in day-tc-dc.y operatien 2.
Fellevs written checklists 3
Kncvs and fc11cus safety precedures k.
Kncvs and follevs precedures fer handling unusual operating conditiens and -^:.netiens 864 127
..n. -
Sample Incidents for Area h Effective SITUATICN:
Reacter at power.
Instrument man checking defective reccrder. Apparently,in switching recorder off and on to get drive,gave inadvertent scram signal.
ACTION TAKEN:
Operater heard tell, saw scram alarm. Red drive upper 1d'1t lights cut; latch lights still en.
Shoved cperater that scram had been initiated, but that reds had not dropped autc=aticay.
Reds did not scram but vere being driven in sicvly.
Pushed =anual scram button i= mediately. This was a standard procedure, for this had happened before.
'4HY u::CTTE:
Slov insertien at high pcVer level eculd burn cut lower length of red.
Could be sericus. Burn-up of safety red.
LESS EFFECTTE:
Hesitate, =ay'ce losing time.
Va<
D**D E[ D' m(b0
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a Ineffective 5ITUA^ ION:
Preoperation checkout. Operator involved in venting the primary system.
AC" ION TAEl:
He vented out of sequence to check list.
He did not line up venting system acccrding to precedure.
He did not pay attention to routine.
'4E? Du r r C"rE: May have dissolved gas instead of trapped air in che system.
In either case air in the system impreperl/
tented vculd cause damage to ecolant pu=p, and expen-sive ecuipment delay in cperation to revent system.
MCRI u :.CTE:
'4culd feliev precedure and pay attentien cc reutine operation.
864 128
-39_
Analysis 1.
Qlerance for Routine. '41111ngness and patience in felleving pro-tracted procedures.
2.
Me= cry.
Icng-teru me= cry fcr rules and procedures.
3 Following Directiccs. Accuracy in perfc: dng acts as directed by a checklist, k.
Safety Orientation. Concern for the protection of the reacter and personnel frca hazards.
864 129 D } }u
{
D
-9C-
Dn Ul D Cer=unicating Effectively [ hj Area 1 This area is cencerned with the cc=petence of the operator in obtaining and disseminating infor=ation by ec==unicating with other operating persennel and through the use of established legs, verk reports and other reccrds.
Sub-Areas A.
Maintains and Utill:es Cperating legs and Other Records 3.
Keeps Infor=ed About the Status of the Reacter and the Reecter Area C.
Keeps Cthers Infor=ed About the Status of the Reacter D.
"Cc==unicates With Cthers in an Effective Manner Sub-Area A,.
Maintains and Utilizes Ocerating Less and Cther Reccrds An operating leg is routinely kept for all reacters as are naintenance verk reccrds.
Operators are required to make scheduled entries and report unusual.
events as they cccur.
During reactor cperation, and especially during unusual cperating conditions, it is L=portant to have data ecccerning previcus operati=g cceditions.
Cc=cenent Senaviers 1.
Making routine entries as scheduled 2.
Making a record cf nc=-routine events 3
Writing legibly k.
Providing a clear and cencise entry cr report 5
Keeping up to date en reacter status through the use of legs and other reccid3
.macVing Vhere pertinent infor=ation Cencerning r?acter status is recorded 864
!30 el-
Sa=cle Incidents for Sub-Area A J
JJJ Iffective SITUATICN:
Two operators had been assigned a verk request.
The reactor was shut down for cycle refueling and work was in progress in all areas of the centain=ent vessel.
ACTION TAKIN:
Both operators read the los data boek en the work acec=-
plished during the two previous shifts and found a dis-crepancy.
In the operator entries in the leg, a differ-ence of opinion was expressed as to whether the test unit was under pressure or had a vacuu= drawn en it.
Lcg entries en the 12 to 8 shift told of hev the test unit had been depressuri-ing to a -5" H,0.
Then again on the 8 to k shift, les entries again showed the test unit as having been depressurizing to :ere. With instru=enta-tien undergoing preventive maintenance at the time, no acr=al =eans of being cc=pletely satisfied as to the test units pressure vere available.
Mechanical crafts were requested to cut into the =ain line piping for additional installations. With only =inutes to spare before the break in the pipe was to start, cne of the operators vent to the charging panel and atte=pted to fill the test unit piping with heliu= gas at only 50 pcunds regulated pres-sure. He was unable to do so until be had increased his regulated pressure to 300 pounds.
This shoved beyond any doubt that the test unit was under at least 260 pcunds pressure.
Ine f fect iv_e_
SITUATICN:
Cperator pulling sa=ples frc= cere.
ACTICN TAKIN:
Opera:cr did not check records.
When he pulled the sa=-
ple cut he reali:ed it vac het.
He recognized the cen-tainer 'ut did not recognize the experi=ent. When he c
saw the centainer he reccgni:ed this was a het sa=ple and quickly put it in a pet.
WHY INIFFICTI'/I:
Exposed se a-d
-"ars to high level radiation anneces-sarily because he didn't check card infer =2tien.
MCRI IFFICTI'/I:
He should have locked in the icg bcck to see what the sa=ple was.
Ceuld tell hev het frc= reccrd and kncving ti=e cf ex;csure and predicted red level.
.32-
~
864 131
i Analysis 1.
Tolerance for Reutine. Willingness and patience in making prescribed leg entries.
2.
Motor Accuracy. Writing legibly.
3 Cec =unicatine Skill.
Ability to express ideas and events concisely and clearly in writing, b.
Information Seekine.
Tendency to search activity for needed infor-
=atien.
Sub-Area 3,.
Keets Informed Abcut the Status of, the Reactor and the Reacter Area In crder to be constantly appraised of the operating status of the reacter, the operster must be the focal point of a ecc=unication network. Fart of this network, of course, are the control panels with their indicators.
In addition, the operater must obtain and disse:inate infor=ation fres/to other operating personnel.
?cr this there are eften established precedures fer ec==unicating between the operatcr and other persennel, such as technicians er experi= enters.
Ccerenent 3ehavice 1.
Establishing a set of precedures fer cc==unicating, and then verking within these precedures cr, verking within the established cc==unica-tien network.
B64 132 p
,d Sa=cle Incidents for Sub-Area 3, J1 Iffective SITUATION:
Prior to startup, cperator valking through contain=ent vessel felt drop of water en neck.
Locked up and fcund expert = enter re=cving sample without kncvledge of nuclear reactor group. Water was active.
ACTION TAKIN:
He stepped re=cval of sa:::ule and tock action to have area checked and decontaminated.
'4HY ser:CTIVI:
If =issed, could have caused =cre severe problem of cen-ta=1 nation.
Ineffective SITUATICN:
Change of shifts.
New cperator ca=e en duty and read instructions which called fcr disre5ard of =c=entary high scurce alar = due to changeover of channels in instr.:=ent rec =.
AC*ICN TAKZ'l:
Cperator saw alarm go cn.
I==ediately scrs==ed reacter without thinking. Realized after reaching for scra that this was vreng. He had been conditioned and trained to respend in this way.
He did it, even thcugh he had been instructed not to respond at this ti=e.
'4EY INIFFICTIVI:
He fellowed instinct, not instructions.
MCRI i.:::.C*IVI:
'4culd have re=e=bered crders.
864 i33
-9h-
t, l}
J1 Analys is 1.
Folleving Directions. Accuracy and consistency in follcuing directions.
2.
Cc=nunication Skill.
Ability to interchange information effectively with other personnel.
P 3
Perceetual Accuracy.
Ability to note and interpret display indicatiens quickly and accurately.
Sub-Area C.
Keers Others Informed About the Status o# the Reactor g
!!ct only =ust the operator acquire infer =ation, he must also relay and provide information to other operatin6 personn'el and inform supervisors when required.
Cc=cenent 3ehavior 1.
Infor=s supervisors of occurrences in sufficient detail to allev them to take action 864 i34 e
0go ]enhJ Sa= ele Incidents for Sub-Area C g
A t)U d
Iffective SITUATION:
Resc cr was scra==ed by an unkncvn experimental source.
ACTION TATIN:
The operator infor=ed the assistant shift supervisor,and the senior reactor engineer of the event and then played a large role in locating the cause of the scra=.
He in-for=ed the engineers en the console ficer that the reactor had received an unidentified experimental scra: and that the cause vould have to be located before recovery could be started. Cnce tne cause had been located and re=edied, he returned the reacter to servo-centrol and then raised pcVer in a s=coth =anner.
'4HY 1:::CTI7E:
Had the engineer not helped in locating the trouble and then =ade a s=ccth rapid recevery, the reactor could have suffered a refueling shutdevn. He did his Jcb in the efficient manner expected of him and did not allev the confusing events to upset him.
LISS ::::CTI7E:
A less effective cperator vould allow the confusion to upset his thinking and would not have been able to help selve the proble= or =ake a recevery withcut direct verbal instructions en what to dc.
Ineffective S!!UATICN:
Eeac cr shutdevn.
Changing shield biceks in scuth side of reacter during shift change.
ACTICN TAKI:::
Cne block did not fit right and day crew had spen: vncle day shi==ing it Oc make top holes fit bettc=.
Superviser operator of inec=ing shift was cli Oc be careful nct to change this arrange =ent.
Superviser operater =cved the=
and spent the night getting the= realigned.
WHY IT:.7?ICIT:
27 net listening oc advice, he les about six hcurs.
- CRI IFFICTI7I:
Weuld have been very careful in reving this block if it vere necessary at all.
Ohk b
..yo-
Anal:rsis 1.
Cc=unication Skill.
Ability to interchange infor=ation effectively with others.
S ub-Are a _D..
Cc==unicates '4ith Others _in _an Effective Manner
'~
Iffective perfor=ance in this sub-area involves operaters cert:=unicating information about the status of the reactor during unusual cecurrences. The supevisor is not always in the centrol rec =. During e=ergencies at a large reactor, several operators =ay be operating syste=s.
Encving what is going en helps everyone to de a better job.
Cc=cenent 3ehaviors 1.
Uses appropriate lines and neans of ec=unicating 2.
Sifts cut unnecessa f and irrelevant infer =atien before ce=unicating 3
Crganizes infor=atien fer clear, precise ec=unication. The cperater
=ust select, frc= all the infor=ation at his dispcsal that which is to be passed en to others.
He nust kncv vhat is i=pertant for each recipient, and cen=unicate this infer =ation at the recipient's level of understanding.
h.
Assures that the infor=atien is received and understccd 864 1.56 p?
9 e
07-
Sanele Incidents for Sub-Area D Effective _
SITUATICN:
Curing startup, an alar = indicating high radiation level annunciated.
I ACTICN TAKIN:
The operator prepared himself for a power reducticn while clearly calling out the position and levels of the ensuing radiation alarms. When the supervisor called for a pcVer reduction, the operator effected it al=ost instantaneously.
The cause of the alarm was a leak of fission products frc=
a fuel element.
WHY ::::CTIVE:
His =aintaining ce=pesure and clearly relaying infor=atica to the superviser allowed the supervisor to concentrate en pcssible causes without vasting time duplicating the operator's cbservations.
LISS ::::CTIVE:
The responses could range frc= panic to lack of concern.
Ineffective em co
-]r D
D 1 0 b
J.
SITUATION:
Pre-critical checkcut safety systert.
ao
_a ACTICH TAKIN:
Checkout recuired man in instru=ent rcce belev to give readings and get confir atien from C3.
Trainee did nct vant to slev devn process so didn't take time to check all channels.
Superviser operater told him abcut it.
Analysis 1.
Infernatien Prccessinz.
Ability to select ite=s of infor=atien which are relevant and inportant in the specific situation.
2.
Cennunicacien Skill. Abilit:r Oc interchange informatien effectively with c hers.
864 i3-
-t=-
0 0,bo 9n
.n).n [] R
'lf,jl d
Area c.
Accepting Responsi'cility This area deals with the c; era ar's villingness to accept responsibility for the operatic of the reactor. Althcugh the sphere of respc=sibility at the operator's level may be limited by the operating philosophy of the reactor, the operator's villingness to accept responsibility within that sphere is i=portant.
Also included here are emergency responsibilities which may not be explicitly included in the operating philosophy.
Sub-Areas A.
Takes Charge of the Reactor and the Reactor Area 3.
Insures That Persoccel Observe Safety Precedures C.
Cperates Reacter in a Safe ani Fesponsible Manner D.
Willing to Accept Respc=sibility fer Handling Reactor Malfunctices I.
K cvs the Extent of His Responsibilities and Authcrity and the Extent of Cthers' Res;cesibilities Sub-Area A.
Takes Cht rge of the Reactor and the Reacter Area The operator is respctsible for the safety of the area frc= both nuclear and industrial hacards. He cc trols the Ove=ent of nuclear :sterials and persc :el in the area.
He is respctsible for the handling cf fuels and samples in cr tear the reactor.
Ccapccent Behaviers 1.
During reutine inspectices, checks for nuclear and radiatica safety 2.
Ccatrols the movement of radicactive raterial in reactor area 3
When ecatrolling reacter, dces cet allev anycee to interfere 1
.?clicvs the instructic s of superviscr or serier cperatcr regarding cperatices, to assure safety 864 138
-sc-
Df q
qifby *V Sample Incidents for Sub-Area A b u, u
(
d U,3 Iffective SITUATICN:
Rese:cr at 30% pcwer.
Shift superviser began adjustics ccatrols withcut actifying operatcr.
ACTICN TAKIN:
Folitely asked shift superviser what he was doing and told his that he would like to be inferred when the shift supervisor adjusted any ecstrels as he was respcasible for the operatics of the reactor.
'4HY EFFECTIVE:
Showed his ccccern for proper cperatics of the reactor.
LESS : rtCTIVE:
- 4culd have allowed the superviser to do this and.said ncthing.
Ineffective SITUATICN:
Reacter shut devn. Refueling taking place. Cne fuel element had been removed. ?csitics e=pty.
ACTICN TAKEN:
Five-six people involved i:i fueling port (top cf reacter). Shielding protectica provided by 2 ft. of D20 above fuel.
In ccetrol roc: electrctic technician (perfcrning maintenance cc instru=entatica) accidently shorted scram circuit, causing rajor scrs=, cpening dump valve, drcpping C20 level 2 ft. in ecre tank. As a result, perscanel cc Ocp cf reacter received high dcse rate through unshielded fuel pcsitice. C;erater actified perse--a' 4--adiately of dump. They stepped away frca pcsitics until D 0 pu= ped back in tank.
2
'4hT I' EFFECTIVE: Cperater shculd cet have alleved =aintenance to be perfcrmed during refueling cperatic.
MCRI starC*IVE:
'4culd have prevented short by =aking tea-4 dan valt until refueling cc=pleted.
864 139 "e&W*
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S AaQLR)n
-Analfs_is.
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Safety crientation. Concera fcr safety in.r.11 activities.
2.
qecisiver.ess.
Ability and villargness to take char e and make decisiccs vcea he is responsible.
~
s 3
Folleving directions. Accuracy and thercughness in folleving instruct 10Cs.
Sub-Area 3.
Insures That Persencel Cbserve Safety Precedures The operator =ust not ct:17 assure the nfety of :he reacter and area frc=
cechanical and nucissr hacards, but he must also ascure that all personnel caserve esfety precedures. ne cycrator is in a urique positica, due to hir, jcb and experience, to detect potential hacards that technicians might not nee.
A technician might verk for weeks in an area withcut any radiatics exposure.
Cne chacge -- sc e shielding re=cved -- and tre aree, althcugh it l'Ocks the same, could be dangerous. The Operster has to assume respctsibility fer all perscrcel adhericg to safety precedures.
Cc=rctent Echaviors 1.
Is aware cf all ec=taminated areas and is sure that to Oce is exposed to radiatice unnecessarily 2.
Uses cc m unication syste=s to infer = perscncel of transien cct-ditic=s, such as fuel er ea: ples movinr3 thrcugh the arers 3
Is aware Of 'tisitors in the area and takes special precautices to assure their safety L.
Cbserves all maintecance by act-cperating perseccel, and takes immediate action if he c'eserves safety violation 5
Checks area radiatice aceitering equip =ent 864 140
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ek,E
'lI Satele Incidents f:r gub-Area 3 e,(, ai o
2 Effective SITUATICN:
Reactor at full ;0ver unen supervisor got s' arm for too much radiati:.
ACTICN T.EN:
Before sending
.e in to check, the supervisor had the reacter shut dev: to insure the safety of the investigatcrs.
WL :.z::.LL B5:
Safe Iceffective SITUATICN:
0;erator in 00= trol rec = - reactor at full pcVer. Operator 2 caking hourly check of instrrents. Cperater 2 Octed that an audible pepper was shcVing activity.
AC*ICN T.E N:
He vent to instrt: ect, f:und that his bcdy shielded instrument. Deternized that a big piece of shielding had been removed and scattering cf ceutress was ccourring.
C;eratcr thcught that ::17 c:e shielding bl ck could have been re:Oved -- the water tank at the ::p cf the c0re.
C; erat 0r vent Over to tack, locked in, saw tank lov.
Superviser said stay away. C; erat:r =cved away.
Superviser came ever and locked 10.
No water. Technician had accidentally left pump : by : istake and partially drained water tank.
Mil I:<r.::iCTr/E: The 0;erator's and superviscr's locaing into the ta:s at unscielded core was ineffective. This 0:uld have stfejected the.: to high radiati:n levels.
MCRI ::::.C IVE:
Net daving 10cked ist: the tank directly.
864 141
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d b S X'trua oaD Acalysis 1.
Alertness.
Avareness of surrcunding cccditions, even these vnich may not ce.impcrtant at the =ccent.
2.
Cc: =unicatica skill. Ability to interchange informatica effecti'.ely
.tn otners.
3 Safety crientatics. Ceccern fer safety of equipment and persctnel.
Sub-Area C.
Operates Reactor in a Safe and Re:spensible Manner Ccuservative Operation of the reacter is stressed at all times and "censervation" is built into the reacter circuitry.
It is possible, partly because of the " fail safe" sture of the reacter, that operators : ay lese their initial " respect" for the reacter, and fail tc exercise the necessary csre and vigilacce required for safe and respcusible cperation.
Ccepecent Eehaviors 1.
Using deliberate care in the operatica of the reacter, e.g., visually verifying ccetrols before operating, careful manipulation Of ec=trols, careful handling of delicate instrumentation, etc., and other measures vedch lessen wear and possible damage to the reacter 2.
Fe aining vigilant while Operating the reacter, respcnding tc slares, not,1fying appropriate perscnnel cf malfunction, equipment failures, etc.
864 142
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m D
f)
D 1
i
-f'.D Same.le Incidents for Sub-Area C..
{d l J' J.
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a Effective SITUATICN:
The reactor was cperating scr-. ally at kCM'4 To a==unicaters were visible cc the beard indicating all locps were operating scr: ally.
ACTION TAKIN:
At abcut 3 p.., the ccuscle operator heard a whistle, turned and saw the semicr reacter engineer (SRE) pointing his thumb devn. The reacter operator 1. ediately turned the scram switch to scrac, shutting down the reacter.
Sc=ehow c=e of the locps had developed electrical trcuble shutti 6 off the circulating pu=ps and losing panel pover.
The circulating pu=ps were ecvi 6 the price ecolant for the experiment 'tich was situated in the reacter.
'4KY EFFICTIVE:
Because had he =ct scra==ed the reacter and vaited to questic: the 3RE, the experiment eculd have been selted dov: and consequently have been a radistics hacard at the' experiment re=cval time.
1ESS EFFIC"T/E:
questiccing of the SRE for his reasecs cf shutting dev:
the reacter delayed respense in Oct k cving exactly what to do.
Ineffective 5 2UAT :N:
The trainees were gcing thrcugh reacter startups under the direct supe: tisien of superviscry persccee!.. To test the Operator, c e cf the superviscrs reduced the setting of an amplifier which resulted in that instrument indicating a simulated power excursic.
AC*ICN TAKE'!:
The Operator trainee saw the change, tcck =c corrective actice but rather asked who was "fcoling arcund."
'icrf ::TEFFIC"/I: A: Operatcr should respend to the reacter behavicr as indicated by his instrur.e=ts.
Ee shculd ietermine cause after taking corrective action.
v.CRE :.:::.C* '/I:
The reacter vculd te cers:ced, then he vculd find cut who was "fccling arcued."
.)
t e,s4==
- J M
l d
a Acalysis 1.
Vigilance. Ability to maintain attention to displays over long periods.
2.
Careful checking. Habitual tendency to make thercuga checks, when required.
3 Visual-meter _ coordination. Skill in adjusting ecctrols accurately as gauged cy visual display.
Sub-Area D.
Willing g Accept Responsibility forEandling Reactor Malfuncticcs An operator must accept respcasibility for handling the reacter, even if he has made a mistake.
He must tase over in manual centrol if the autc=stic centrol
=alfunctions even thcush the autcmatic centrol is easier, and nacually, he could scram. He is responsible fer =ctifyicg theproper persennel in the event of a sericus incident.
He takes the initiative in uncovering the causes of mal-functions even when they are act his assigned respctsibility.
Cc=pocent 2ehaviors 1.
Willingness to take ever centrol of the reactor frc= autc=atic syste=s 2.
Takes the initiative to uccover the scurces of =alfunctics, where such actice is apprcpriate 3
Nctifies responsible persons whe malfunctict or unusual cperating cceditices cccur 864 i44
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f 3a=cle Incidents for Sub-Area 3 J
IGq v ad\\
2 4 m Effective 3 rJATICN:
Feacter at full po'er.
Seccedary system high eceductivity alarm este 10.
ACTICN T/JII:
0;erster had several ala=s.
After secced alarm, scra=ed reacter. This alar came in false 2 cr 3 times per shift.
Cperater responded to series. Superviser new.
Mac cc thrcttle shut devn en own volitien withcut requesting per.issicc.
WEY EFFECTIVE:
If waited for per:.:issicc vould have had al= cst pure sea water in generater.
I: effective S OJATICN:
C;erater secured distilling unit.
AC*ICN T/dCIN:
As he secured the crit, he filled the steam drain section ith salt water. He did Oct tell anyece accut it sed when another cperater began to start the generatcr up, salt water get into the generater.
'4'nf riEFFIC"!VE: Could have resulted in a rust problem (ccrresien due to salt).
MCPS :z::~"IVE:
- 1) WCuld Oct have ficcded cut the denicerali er.
- 2) Wculd have repcr:ed it, c ce dene.
864 145
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is Analysis 1.
Initiative. Readiness to take actica en his own initiative when required.
2.
Cc::=unication skill.
Ability to interchange infernatica effectively
.rita etners.
Sub-Area I.
Kncvs the Extent of His Respcasibilities and Authcrity and the Extent of Cthers' Respecsio111 ties It is important that thecperater accept the responsibility dele 6ated to him.
The operater shculd kncv what he may le6itimately expect frec subordinates, what areas and levels of responsibility he =ust accept respcnsibility for and what he
..:ust refer to his super tisor for decision.
Coccenent Eehaviers 1.
Retains respctsi'cility for the safe cperstics of the reacter.
Superviscrs' cr Senier Operatcrs' instructicus to by-pass safety circuits are not legitinate orders 2.
Refuses to startup the reacter without all requi--d safety circuits in operation 3
Refers decisicas to superviser when apprcpriate 864 146
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h,0 U
,d vig jjlm a iJ la, Sa=cle Incidents for Sub-Area i-I Effective SI"'UATICN :
Reacter being brcught up to power and startup channels being used and were apprcaching off-scale 11=1 3.
Shift Supervisor told Operator to svitch three channels Off s=d go by one channel.
ACTICN T/4G:T:
Cperater refused to de this, stating that he veuld rather
'ait until he could read all fcur channels.
'a~dY ETTICTIVE:
He knew it was dangercus to rely ce cce of fcur instr =ents during startup.
~
LESS EFFEC"'IVE:
'4culd have switched off the three recorders.
Ineffective 31~~UATICU :
Reacter had scrarned and operators were trying to bring up the reacter.
ACTICN TtXI'T:
Scme of the instr =ents vere ct functiccing prcperly and the operatcr eculd cet get an ckay to startup. Inscead of calling an instr =ent man, he put ju=per cables c these instr =ents, thus by-passing them.
Analysis 1.
Cecisiveness.
Ability and villingness to take charge and make decisiens vnen he is responsible.
2.
pclicving dir?ctiCOs.
Accuracy and thercughnes3 in fellcVing instructions.
- 2.s; -
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The operatien of a nuc'aa- --acter with its =ultitude of.echanical and elec-trenic equipment and interactir4 systems, like 2ny other ec= plex Operation is subject to breakdevn and =alfunction.
In addition to the equip =ent and circuitry necessary to the operation of the reacter there are nu=ercus backup syste=s,
~
safety devices and interlocks, a
adding to the overa cc=plexity of the syste=.
e Performance in this area is concerned with the Operatcr's ability to use his kncvl.
e dge and experience in proble solving and trouble shecting.
1 Sub-Areas A.
Uncovers Scurces of Malfunctica 3.
Sprovises and Encvates to Overec=e Malfunction Sub-Area A.
Uncevers Scurces of Malfunc=ica
^
The operater has =any sources cf infe =stien beyond his varning and ala: s i
annunciatcrs. Visual obcervation of an unusus1 occur ence vill have a
=eaning to an effective opera:Or.
2 spec 1cn of previcus leg sheets er re-7 corder traces can eften shew changes which have cecurred.
'4 hen a safety circuit calls for a red un in or scram, there are many demands en the cpera-c ter to char.oe cecir. s activate auxiliary equip =ent and assure the prcper r
shutdevn of the syste=.
b additten, he =ust dete:.ine the cause of the a
pcssible.
shutdown, take action 50 re=edy it, and ce=e 'cack 20 pcVe '"
a-Cc=penen: 3ehaviers
. a.
1.
Uses all available infermation to learn abcut = usual cperati 6 cen-ditiens x
2.
Effectively uses blueprints, bicek diag a=s, circuit diagess, and
=anuals in ::cuble shecting 3
Interprets indicater trends and =ultipla -aa % gs k.
Kncvs field iccatiens of auxiliary equip =ent and centr:13 5
Lees.tes =alfunctica th cugh 2:217.:.
if differen reacter s/stens 864 148
_.. c. _
G
Sa=cle Incidents fer Sub-Area A qD' V
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D I
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.t...c c. c. i v, wb SIT'.'AT CII:
Feacter at
~C'~. pcVer, lest a prinar/ pump by autc=atic trip an:1 reacter scra.med.
AC'"ICII TAKE3:
Cperater determined the cause in a short time and brought the reacter back to pcVer.
Checked to see all reds in.
Checked emergency stub bus.
31ceked emergencf inj ection.
Checked with maintenance who had turned pu=p eff acciden-tally. Started reds backup.
'aTf EFFECTIVE:
Everyone kept their heads.
Prevented less of steam and
- r.cderat e r.
LESS EFFECTL'2:
Would not have evaluated situation fast enough.
Ineffective SI~UATICN:
Operator venting the water above the red drive =echanis=
above the cere.
(Shutdown state)
AC"!ON TAT.ZU:
Cperatcr was hur:fing to get done, and put a snap en cennecter en the *eren-line 'an oil c. ressure. cit. e instead e
s.c. h e.'i y*
. a..a.
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e aa...a. '. - =
a' cove, but are easily distinguished if the Operator Icess devn at che side 3" to see if there is a 5,0 valve er
.ct.
c
'aTf 3E77ZCT!"Z: The Operatcr could have (1) Ics: all the pressure in the c.i.'.'.i..e, c.- ( c~ '1,a....a s 3 -
e..
c.4.'
. w.e n.i a..'.d
, c e- '..
o' y
MCFE EFTECTIVE:
Mculd have locked fer the.alve belev the ccane-tcr to
., e 3....
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Analysis 1.
Calmness Under Stress. Ability to maintain compcsure and effectiveness under time stress.
Sub-Area 3,.
Demenstrites Oced Judr=ent Ccncernin Malfunction There are cecasions when an operator has to accept another's verd regard-ing a =alfunction. He can receive a ecemunication frem a supervisor or see an alar frem an instrument. He has to know what to do, and do it without de-lay.
Effective performance in this sub-area involves =akins Judg=ents while under stress without lettin6 stress interfere.
Cem;cnent 3ehaviors 1.
Responds to alarm and evacuates building without hesitatien, when appropriate 2.
Follevs chutdevn procedures quickly in respense to general emergency 3.
Folicvs shutdevn and evacuation procedures, even when there is a pcssibility of the alarm being false i.
Is sure all personnel have cleared area during evacuation 5
Alvays assu=es the vers and takes action based en this 864 150
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Saccle Incidents for Sub-Area 3 C'
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n Effective SITUATICN:
Trainee operating reseter at icv power during training session.
ACTICN TAKEU:
While the reacter was at lcv pcVer, a superviser casually passed the instrument rack, as though merely =aking a curscry check.
He then steed in front of the " reactor peried" recorder, paused a =cment, and then in a frenzied voice yelled, "Scrs= it."
The trainee scra==ed the reactor before the supervisor was able to turn around.
WHY EFFECTIVE:
He did not seek ccnfir=ation, but accepted the crder as a legitimate necessity, regardless of his evn opinien.
LESS IFFECTIVE:
Might have questioned order before scra==ing.
Inerfective SITUA'fICH :
Reacter shutdevn, maintenance crev verking en it.
Due to i=prcper color ccding of pipe they inadvertently started to drain water fres reacter.
ACTICH TAKZ3:
Alar = vent off and opera. ;r did net kncv what to do.
Another operater came in and teck care of prcble:.
'G~Y I':EFFIC*IT: :
Shoved no cceprehensien cf instruments.
MCRE EFFICIVE:
Tc react instantly to alarm.
EL64 151
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h 9 D'3'3)L WD' Dfl:hd J l
U Analysis 1.
Safety Orientatien.
Concern for safety of equipment and personnel.
2.
Felleving Directions.
Readiness to follev prescribed,crecedures.
Sub-Area C.
Peacts Aceronriately in ?esconse to Scrams At sc=e s=all research and teaching reactors, scrams are routine and ex-pected. At a large test or pover reactor they are cecasiens for tremendous pressure en the operator.
The time for recovery and the less in cutput are certainly para =ount in the operater's =ind.
He has many cperations to perform and =uch infor=atica to process. Usually an audible alar = alerts everyone to the event. The operator =ust handle his cc==unication links with other per.
sonnel, *.*cuble shcot the cause of the scrs=, take the necessary steps to assure shutdevn and start recovery, if possible.
Effective perfor ance is reutine.
Ineffective perfor ance usually involves one er =cre tasks left un-done.
Oc=;cnent 3ehaviers 1.
Cc=p'etes all tasks quickly and thercushly when scrs= cecurs.
2.
Manually follevs through after autcmatic scrs= vhen possibility of ince plete shutdevn exists.
3.
- ctes positten of regulating reds and critical nuclear instru=ents Vhen sCrs= CCCurs.
h.
?!ctices any abncr=al conditions during sers= (e.g., rods not ccepletely driven in) 864 152
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D
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Samnle Incidents fer Sub-Area C-D "l P burvl'lAlR_
m Effective SITUATICH:
Autceatic scra: cecurred.
All reds dropped except one.
Latch light stayed on.
ACTICN TAJU3:
Cperator tried several times to manually drop red. Ecd would shov =c=entary unlatching, and then light en again.
He tried fcur to five times in 20 seconds. Unusual situation.
It had happened only ence before.
The opera-tor carried through while doing other duties observing power drop, period recorders negative. Centrol red run-ning in.
'4HY r. ::.C"'IVE :
Felleved instructiens. Could nave been sericus if at full power.
LESS EFFECTIVE:
'4culd not have done anything after once hitting scra=
butten.
Ineffective SITUATICH:
Eeacter was operatin~ at full pcver when a ec=plete ec=-
e mercial power outage was experienced.
ACTICN TAiza:
ihen a power cutage occurs, the building becc=es as dark as night until the emergency generater takes over the lead.
~4 hen the emergency pcver comes on, horns and bells start rin6 ng all cver the building.
It is a very frign:-
i ening situatien but there are cany pumps tc restart and
=uch verk for the opera cr to do.
The cperater in ques-tien had been varned about a pcver cutage and knew wha:
to do but under the pressure of the situatien, he became helpless and could do nothing.
~4HY INIFFICTIVI: He could not do verk that was required.
He was later relieved of the duties.
- tCRI IFFIC~I75:
He vculd cal =ly perfer the required duties.
Analysis 1.
Cal: ness Cnder Stress. Ability to maintain compesure and effective-ness under stress.
-113-864 1c7as
/
Y D
lD'9~\\!j' OL J h. ll m
o
_F_redictor Test Imelications The preceding rationales, even though preliminary, present streng indi-cations that the criterien behavicrs of reactor operators may be predictable by tests of underlying traits er functions of the individual.
Scte of these predictions may be possible by currently available tests; but = cst of the=
appear to require special test development.
It is of sc=e value to categorize sc=e of the underlying functions as reflected in the Analysis sections of the preceding rationales. A rough categoritation is as follows:
Percectual Pecuire=ents Vigilance Ferceptual Accuracy Alertness Visualisation
_C_ognitive Pecuirements Knowledge of Systems Me= cry Infor=ation Precessing logical Reasoning Preble= Sciving Technical Cc=prehensien Inncvative Skill Actica Recuire=ents Metcr Accuracy Visual-Mctor Coordination Careful Checking Cc==unication Skill Attitude Recuire=ents Safety Orientation initiative Infer stien Seeking
- clerance for ?cutine Felleving Directicns Decisiveness Mcst of these functicns appear to be measurable by paper-and-pencil tests.
In the area of Ferceptual Requirements, sc=e equipment right be u.eful :: test d64 154
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D9fD
} 3
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ob J.[b
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perceptual skills in a more realistic context than vould be pessible with paper and pencil.
For Attitude Sequirements, it seems probable that situs-tional, role-playing types of test situations might be effective; but paper-and-pencil tests should also be useful.
It is believed that the preliminary results are sufficiently prc=ising to justify proceeding to develop predictor measures. Tne next step is to ec=plete the rationales in ec=prehensive fashica and to prepare specifications for the =easures to be developed.
864 155
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