05000346/LER-1979-094-03, /03L-0:on 790924,boron Injection Flowpath Test Had Not Been Performed to Meet Surveillance Requirement. Caused by Personnel Error.Test Was Successfully Performed on 790925

/03L-0:on 790924,boron Injection Flowpath Test Had Not Been Performed to Meet Surveillance Requirement. Caused by Personnel Error.Test Was Successfully Performed on 790925

ML19259D705
Person / Time
Site:	Davis Besse
Issue date:	10/22/1979
From:	David Brown TOLEDO EDISON CO.
To:	NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION III)
Shared Package
ML19259D701	List: 05000346/LER-1979-094, Forwards LER 79-094/03L-0 05000346/LER-1979-094-03, /03L-0:on 790924,boron Injection Flowpath Test Had Not Been Performed to Meet Surveillance Requirement. Caused by Personnel Error.Test Was Successfully Performed on 790925
References
LER-79-094-03L, LER-79-94-3L, NUDOCS 7910260268
Download: ML19259D705 (2)

LER-1979-094, /03L-0:on 790924,boron Injection Flowpath Test Had Not Been Performed to Meet Surveillance Requirement. Caused by Personnel Error.Test Was Successfully Performed on 790925

Event date:
Report date:
3461979094R03 - NRC Website

text

U. S. NUCLE AR REGUL AT ORY COMMISSION NRC F ORM 366 E77)

LICENSEE EVENT REPORT 1

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6 E,0 bl DOCKE T NUMB E a 64 bJ EVENT DATE 74 75 REPORT DATE HJ EVENT DESCRIPTION AND PROBABLE CONSEQUENCES h l o 121 l On Sentember 24, 1979 at 1530 hours0.0177 days <br />0.425 hours <br />0.00253 weeks <br />5.82165e-4 months <br /> it was discovered that ST 5011.01. Section 6.01.

I o a i " Boron Injection Flowpath Test".iad not been performed to meet Surveillance Require-l 0

4 l ment 4.1.2.2.a.

The unit entered the Action StaterLent of Tecitn.ical_Specificition I

o 5 1 3.1.2.2 at 1945 hours0.0225 days <br />0.54 hours <br />0.00322 weeks <br />7.400725e-4 months <br /> on September 24, 1979 which is the final test due data with l o 10 l l the maximum extension. There wiis__no danger to tL _ health ani_nafety of the oublic or I l

[ t o S t a t ion pe r s1n n e_la Utg_{ wpath from the boralgd_ Vater stgr_aRe tank Was o

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40 41 42 43 d4 47 CAUSE DESCRIPTION AND CORRECTIVE ACTIONS h liloll The cause was personnel error.

A breakdown in communications occurred between the 1

[W l training and testing shif t and the operating shift. The test was successfully ner-1 it l2ll formed at 1700 hours0.0197 days <br />0.472 hours <br />0.00281 weeks <br />6.4685e-4 months <br /> on September 25, 1979. A change has been made in the scheduling I i a l of this test to ensure that the training and testine shift is more aware of this test.l

[ A signoff to perform this test has been added to the Monthly Equipment Lon.

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% POtsE R OTHER STATUS ISC RY DISCOVERY DESCRIPTION NA l

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68 69 80 5 a 9 to 419-259-5000, Ext. 296 DVR 79-137 NAYE OF PREPARER nwM M _ Ernun PHONE:

t TOLEDO EDISON COMPANY DAVIS-BESSE NUCLEAR POWER STATION UNIT ONE SUPPLEMENTAL INFORMATION FOR LER NP-33-79-109 s

DATE OF EVENT:

September 24, 1979 FACILITY: Davis-Besse Unit 1 IDENTIFICATION OF OCCURRENCE: Technical Specification late date exceeded on ST 5011.01, " Boron Injection Flowpath Test", Section 6.1, Boric Acid Flowpath Heat Tracing Conditions "rior to occurrence:

The unit was in Mode 1, with Power (MWT) = 2772, and Load (Gross MUe) = 919.

Description of Occurrence: On September 24, 1979 at 1945 hours0.0225 days <br />0.54 hours <br />0.00322 weeks <br />7.400725e-4 months <br /> the Technical Speci-fication late date passed on the Boric Acid Flovpath Heat Tracing Weekly Surveillance Test ST 5011.01, Section 6.01 with the maximum allowable extension. This required that the flowpath f rom the concentrated boric acid storage system be declared inopera-ble. This placed the unit in the Action Statement (a) of Technical Specification 3.1.2.2.a, which requires the system be restored to operable status within 72 hours8.333333e-4 days <br />0.02 hours <br />1.190476e-4 weeks <br />2.7396e-5 months <br /> or be in hot standby and borated to a shutdown margin equivalent to 1% a K/K at 200 F within the next six hours.

Designation of Apparent Cause of Occurrence: This incident was caused by personnel There was a breakdown of communications between the training and testing crror.

shift and the operating shift on September 21, 1979 and as a result, the test was not performed on that day.

Subsequently operating shifts from September 21 through September 25 failed to realize that ST 5011.01, Section 6.1 was ne t completed.

Analysis of Occurrence:

There was no danger to the health and safety of the public or to station personnel. The boric acid flowpath from the boric acid pumps to the nakeup system remained in use throughout the period of this occurrence being used an average of once every 5.3 hours3.472222e-5 days <br />8.333333e-4 hours <br />4.960317e-6 weeks <br />1.1415e-6 months <br />. There was no evidence of boric acid line block-age at any time. The flowpath from the borated water storage tank was operable.

Corrective Action

The test was successfully performed at 1/00 hours on September 25, 1979.

The Surveillance Test Engineer has changed the test desired day to Tuesday to ensure that the training and testing shift (which is also the day operating shif t on Tues-days) is more aware of this test.

As an additional reminder, the operations engineer has added a Tuesday signoff to perform ST 5011.01, Section 6.1 on the Monthly Equip-ment Log. He has also written a memo to all licensed operators explain,ing this event and the corrective action taken.

Failure Data:

There has been one previous occurrence when this test was missed, see Licensee Event Report NP-33-78-132.

12}2 24 I

18R #79-094