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LER-1981-023, /01T-0:on 810323,high Drywell Pressure Switches 2C71-N002A-D (RPS),2E11-N010A-D (ADS) & 2E11-N011A-D (RHR) Did Not Operate,In Violation of Tech Specs 3.3.2-1,3.3.3-1 & 4.3.3-1.Caused by Personnel Error.Valves Opened |
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9 LER flo.: 50-366/1981-023 Licensee: Georgia Power Company facility: Edwin I. Hatch Docket flo.: 50-366
'Harrative Report for LER 50-366/1981-023 With the unit in steady state operation at 2324 fRt, it was found that High o
Drywell Pressure Switches, 2C71-N002A-D (RPS), 2E11-N011A-D ( ADS) and 2E11-N011A-D (RHR), were not operable violating the two (2) operable channels required by Tech. Specs Sections 3.3.2-1, 3.3.3-1 and 4.3.3-1.
This is a non-repetitive event for these switches.
The health and safety of the public was not affected.
The cause of this event has been attributed to failure to follow procedure.
The technician responsible for performing the RPS/ECCS valve lineup procedure, HNP-2-1004, closed the panel isolation valves believing they were drain valves.
When the panel valves were found closed, they were immediately opened.
Veri fi-cation of proper valve lineup for the RPS/ECCS instruments was immediately performed.
Vital safety related instrument valves, (Vital meaning any instrument that gives a trip or isolation signal for safe reactor operation.), will be color coded to distinguish.which should be normally opened and normally closed.
The RPS/ECCS Instrument Valve Lineup procedure, HNP-2-1004, was completed on March 9,1981, following reactor shutdown for MSIV repair work.
This procedure was performed by a Senior Instrument Technician.
Following reactor startup on liarch ' 14, 1981, a maintenance request was written to investigate the response of the Primary Containment low Pressure Annunciator, because it did not seem to be responding to changes in containment pressure.
This annunciator is re-ceived. from 2C71-N004 The instrument was checked and found to be within specs.
It is tapped into the same header as;the High Drywell Pressure Switches.
The pane 1' isolation valves that had been closed during the RPS/ECCS valve lineup were not found at this time.
Another maintenance request, concerning the same problem was written. _Another calibration check of 2C71-N004 proved the setpoints to be acceptable, but this time the technician traced the instrument sensing lines down.and found the panel isolation valve closed.
This valve had instruments 2C71-N002A (RPS Channel Al High Drywall Pressure Switch) isolated.
Immediately the other three (3) panel valves on 2H21-P004, associated with High Drywell Pressure, were checked and found closed.
Panel 2H21-P005 was checked and the found (4) panel valves s
- - associated with High Drywell Pressure were also found closed.
The eight (8) valves were opened immediately.
The Instrument Technician that performed-the-valve lineup had not performed it before. He had closed:th'e panel isolation valves believing they were drain valves.
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His reasoning was that on typical -instrument racks, the process sample line comes -
in'at the top of the rack and the drain lines and drain valves exit the rack at the bottom. This is true on Panel H21-PO!1 and P005 with the exception of the eight (8) valves that were found closed. These valves are piped up with the process sample line' entering the rack from the bottom and there is no drain
Narrative
Report for 50-366/1901-023 (con't.)
valve for these particular instruments. When the valve lineup was performed initially, the eight (8) valves were found open, but the technician closed them because he thought they were drain valves.
The location of these. valves at the bottom of the instrument is common to Unit I and Unit II. All valves on these panels are tagged with identification numbers; however, these numbers were not on the valve lineup procedure, HMP-2-1004.
To prevent similar occurrences in the future, the.following steps will be taken:
- 1. Instrument valve lineup procedures for safety related systems will be revised to include valve identification numbers and independent verification.
- 2. Valves for USSS instruments will be color-coded to indicate the normal position. Green will signify normally closed valves.
Red will signify normally opened valves.
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| 05000366/LER-1981-001-03, /03L-0:on 810102,during Refueling,Drywell Isolation Valve 2T48/F209 Found Leaking When LLRT Performed on Drywell to Torus Dp Sys.Caused by Scratches on Valve Seat Due to Valve Closing on Debris | /03L-0:on 810102,during Refueling,Drywell Isolation Valve 2T48/F209 Found Leaking When LLRT Performed on Drywell to Torus Dp Sys.Caused by Scratches on Valve Seat Due to Valve Closing on Debris | | | 05000366/LER-1981-001, Forwards LER 81-001/03L-0.Detailed Event Analysis Encl | Forwards LER 81-001/03L-0.Detailed Event Analysis Encl | | | 05000321/LER-1981-001, Forwards LER 81-001/01T-0 | Forwards LER 81-001/01T-0 | | | 05000321/LER-1981-001-01, /01T-0:on 801228,HPCI Steam Line Pressure Switches 1E41-N001a,c,d Actuated Outside Tech Specs.Caused by Switch Setpoint Drift.Switches Recalibr | /01T-0:on 801228,HPCI Steam Line Pressure Switches 1E41-N001a,c,d Actuated Outside Tech Specs.Caused by Switch Setpoint Drift.Switches Recalibr | | | 05000366/LER-1981-002, Forwards LER 81-002/03L-0 | Forwards LER 81-002/03L-0 | | | 05000366/LER-1981-002-03, /03L-0:on 810106,reactor Core Isolation Cooling Steamline Pressure Switches 2E51-NO19A & C Were Found to Actuate Below Tech Spec Limits.Caused by Setpoint Drift. Switches Recalibr | /03L-0:on 810106,reactor Core Isolation Cooling Steamline Pressure Switches 2E51-NO19A & C Were Found to Actuate Below Tech Spec Limits.Caused by Setpoint Drift. Switches Recalibr | | | 05000321/LER-1981-002, Forwards LER 81-002/03L-0 | Forwards LER 81-002/03L-0 | | | 05000321/LER-1981-002-03, /03L-0:on 810101,more than 5 Gpm Leaked Into Drywell W/Reactor at 401 Mwe.Caused by Mechanical Seal Leaking Water from Reactor Recirculation pump,1B31-C001A. Seal Replaced | /03L-0:on 810101,more than 5 Gpm Leaked Into Drywell W/Reactor at 401 Mwe.Caused by Mechanical Seal Leaking Water from Reactor Recirculation pump,1B31-C001A. Seal Replaced | | | 05000366/LER-1981-003-03, /03L-0:on 810223,core Max Fraction of Limiting Power Density Found to Be Greater than Frtp During Startup. Caused by Time Delays for Adjusting Rods,Running Transient Incore Probe Scans & Processing Time for Computer | /03L-0:on 810223,core Max Fraction of Limiting Power Density Found to Be Greater than Frtp During Startup. Caused by Time Delays for Adjusting Rods,Running Transient Incore Probe Scans & Processing Time for Computer | | | 05000321/LER-1981-003-03, /03L-0:on 810130,HPCI Governor Valve Stuck Open. Caused by Lift Rod Being Bent & Galled Due to Interference Between Lift Rod Fork Connector & Valve Lever.Damaged Rod Replaced,Upper Guide Bushing Honed & Fork Modified | /03L-0:on 810130,HPCI Governor Valve Stuck Open. Caused by Lift Rod Being Bent & Galled Due to Interference Between Lift Rod Fork Connector & Valve Lever.Damaged Rod Replaced,Upper Guide Bushing Honed & Fork Modified | | | 05000366/LER-1981-003, Forwards LER 81-003/03L-0 | Forwards LER 81-003/03L-0 | | | 05000321/LER-1981-003, Forwards LER 81-003/03L-0 | Forwards LER 81-003/03L-0 | | | 05000366/LER-1981-004, Forwards LER 81-004/03L-0 | Forwards LER 81-004/03L-0 | | | 05000366/LER-1981-004-03, /03L-0:on 810122,nozzle Loads Found Exceeding Vendor Allowables for Reactor Core Isolation Cooling Steam Turbine During Reanalysis of Piping & Hangers Per IE Bulletin 79-14.Caused by Ae Error in Sys Design | /03L-0:on 810122,nozzle Loads Found Exceeding Vendor Allowables for Reactor Core Isolation Cooling Steam Turbine During Reanalysis of Piping & Hangers Per IE Bulletin 79-14.Caused by Ae Error in Sys Design | | | 05000321/LER-1981-004, Forwards LER 81-004/03L-0 | Forwards LER 81-004/03L-0 | | | 05000321/LER-1981-004-03, /03L-0:on 810106,w/unit in Steady State Power Operation,Qa Audit Showed That Temporary Procedure Change HNP-818 Was Not Approved by Plant Manager within 14 Days of Implementation.Caused by Deletion of Requirement | /03L-0:on 810106,w/unit in Steady State Power Operation,Qa Audit Showed That Temporary Procedure Change HNP-818 Was Not Approved by Plant Manager within 14 Days of Implementation.Caused by Deletion of Requirement | | | 05000366/LER-1981-005-01, /01T-0:on 810126,reactor Pressure Vessel Core Spray Loops Discovered Inoperable.Caused by Procedure HNP-2-1230 Being Performed,Closing Manual Injection Valves 2E21-F007A & B.Valves Reopened & Procedure Changed | /01T-0:on 810126,reactor Pressure Vessel Core Spray Loops Discovered Inoperable.Caused by Procedure HNP-2-1230 Being Performed,Closing Manual Injection Valves 2E21-F007A & B.Valves Reopened & Procedure Changed | | | 05000366/LER-1981-005, Forwards LER 81-005/01T-0 | Forwards LER 81-005/01T-0 | | | 05000321/LER-1981-005-03, /03L-0:on 810113,during Steady State Operation, Drywell Temp Recorder IT47-R612 Found to Be Inoperative. Caused by Misalignment of Cam Follower Contact W/Main Programming Cam.Follower Adjusted to Maintain Contact W/Cam | /03L-0:on 810113,during Steady State Operation, Drywell Temp Recorder IT47-R612 Found to Be Inoperative. Caused by Misalignment of Cam Follower Contact W/Main Programming Cam.Follower Adjusted to Maintain Contact W/Cam | | | 05000321/LER-1981-005, Forwards LER 81-005/03L-0 | Forwards LER 81-005/03L-0 | | | 05000366/LER-1981-006, Forwards LER 81-006/03L-0 | Forwards LER 81-006/03L-0 | | | 05000366/LER-1981-006-03, /03L-0:on 810123,standby Gas Treatment Sys Filter train,2T46-D001A,removed Less Halogenated Hydrocarbon Refrigerant Gas than Required by Tech Specs During Testing by Vendor.Caused by Defective Charcoal in Filter Bed | /03L-0:on 810123,standby Gas Treatment Sys Filter train,2T46-D001A,removed Less Halogenated Hydrocarbon Refrigerant Gas than Required by Tech Specs During Testing by Vendor.Caused by Defective Charcoal in Filter Bed | | | 05000321/LER-1981-006, Forwards LER 81-006/03L-0 | Forwards LER 81-006/03L-0 | | | 05000321/LER-1981-006-03, /03L-0:on 810119,standby Liquid Control Pump a Discharge Relief Valve 1C41-F029A Operated Outside Tech Spec.Caused by Setpoint Drift.Valve Reset | /03L-0:on 810119,standby Liquid Control Pump a Discharge Relief Valve 1C41-F029A Operated Outside Tech Spec.Caused by Setpoint Drift.Valve Reset | | | 05000321/LER-1981-007, Forwards LER 81-007/03L-0 | Forwards LER 81-007/03L-0 | | | 05000321/LER-1981-007-03, /03L-0:on 810203 & 19,unit 1 Cable Spread Room Sprinkler Sys Was Inoperable for Period Greater than 14 Days & Special Repts Were Not Issued.Caused by Personnel Error. Personnel Reinstructed | /03L-0:on 810203 & 19,unit 1 Cable Spread Room Sprinkler Sys Was Inoperable for Period Greater than 14 Days & Special Repts Were Not Issued.Caused by Personnel Error. Personnel Reinstructed | | | 05000366/LER-1981-007-03, /03L-0:on 810126,discovered That on 810124 & 25 Reactor Coolant Sampled from Wrong Sample Line.Caused by Lack of Communication Among Personnel Who Collect & Analyze Reactor Coolant.Personnel Instructed & Coolant Sampled | /03L-0:on 810126,discovered That on 810124 & 25 Reactor Coolant Sampled from Wrong Sample Line.Caused by Lack of Communication Among Personnel Who Collect & Analyze Reactor Coolant.Personnel Instructed & Coolant Sampled | | | 05000366/LER-1981-007, Forwards LER 81-007/03L-0 | Forwards LER 81-007/03L-0 | | | 05000321/LER-1981-008-03, /03L-0:on 810216,in Normal Operations at 309 Mwt, 1E51-N012A,B,C & D Actuated at 10.2,11.3,11.2 & 10.7 Psig, Respectively.Caused by Switch Setpoint Drift.Barksdale Switches Recalibr | /03L-0:on 810216,in Normal Operations at 309 Mwt, 1E51-N012A,B,C & D Actuated at 10.2,11.3,11.2 & 10.7 Psig, Respectively.Caused by Switch Setpoint Drift.Barksdale Switches Recalibr | | | 05000321/LER-1981-008, Forwards LER 81-008/03L-0 | Forwards LER 81-008/03L-0 | | | 05000366/LER-1981-008, Forwards LER 81-008/03L-0 | Forwards LER 81-008/03L-0 | | | 05000366/LER-1981-008-03, /03L-0:on 810119,pressure Switches Were Found Out of Tolerance.Caused by Setpoint Drift.Pressure Switches Recalibr & Returned to Svc | /03L-0:on 810119,pressure Switches Were Found Out of Tolerance.Caused by Setpoint Drift.Pressure Switches Recalibr & Returned to Svc | | | 05000366/LER-1981-009-03, /03L-0:on 810212,reactor Coolant Not Analyzed Once Per 24-h as Required by Tech Spec.Caused by Reactor Vessel Hydro During Time Period When Next Conductivity Measurement Was to Be Taken | /03L-0:on 810212,reactor Coolant Not Analyzed Once Per 24-h as Required by Tech Spec.Caused by Reactor Vessel Hydro During Time Period When Next Conductivity Measurement Was to Be Taken | | | 05000366/LER-1981-009, Forwards LER 81-009/03L-0 | Forwards LER 81-009/03L-0 | | | 05000321/LER-1981-009-03, /03L-0:on 810206,nitrogen Storage Tank Inventory Went Below 2000 Gallon Tech Spec Requirement.Caused by Supplier Delaying Shipment.Shipment Received.Supplier Instructed Not to Delay Shipments | /03L-0:on 810206,nitrogen Storage Tank Inventory Went Below 2000 Gallon Tech Spec Requirement.Caused by Supplier Delaying Shipment.Shipment Received.Supplier Instructed Not to Delay Shipments | | | 05000321/LER-1981-009, Forwards LER 81-009/03L-0 | Forwards LER 81-009/03L-0 | | | 05000366/LER-1981-010, Forwards LER 81-010/03L-0 | Forwards LER 81-010/03L-0 | | | 05000366/LER-1981-010-03, /03L-0:on 810222,reactor Core Isolation Cooling Auto Flow Controller Did Not Control Turbine Properly While in Auto Position During Quickstart Test.Caused by Loose Ribbon Connector on Flow Control M-4 Station | /03L-0:on 810222,reactor Core Isolation Cooling Auto Flow Controller Did Not Control Turbine Properly While in Auto Position During Quickstart Test.Caused by Loose Ribbon Connector on Flow Control M-4 Station | | | 05000321/LER-1981-010, Forwards LER 81-010/01T-0 | Forwards LER 81-010/01T-0 | | | 05000321/LER-1981-010-01, /01T-0:on 810211,AE Reported That Diesel Generator 1A,1C,2A,2B & 1B Outlet Svc Water Piping & Associated Seismic Supports Exceeded Tech Spec.Caused by Design Omission.Design Mods Made | /01T-0:on 810211,AE Reported That Diesel Generator 1A,1C,2A,2B & 1B Outlet Svc Water Piping & Associated Seismic Supports Exceeded Tech Spec.Caused by Design Omission.Design Mods Made | | | 05000321/LER-1981-011-03, /03L-0:on 810214,liquid Radwaste Sample Tank, WSTB1,discharged Prior to Analysis,Contrary to Ets.Caused by Technician Error in Collecting Unit 2 Radwaste Sample in Prelabeled Unit 1 WSTB-1 Bottle | /03L-0:on 810214,liquid Radwaste Sample Tank, WSTB1,discharged Prior to Analysis,Contrary to Ets.Caused by Technician Error in Collecting Unit 2 Radwaste Sample in Prelabeled Unit 1 WSTB-1 Bottle | | | 05000321/LER-1981-011, Forwards LER 81-011/03L-0 | Forwards LER 81-011/03L-0 | | | 05000366/LER-1981-011-03, /03L-0:on 810204,nonrated Window Discovered in 3-h Rated Fire Wall.Caused by Design,Mfg & Const/Installation Error.Direct Conversion Reactor Study 81-48 Submitted & Fire Watch Established | /03L-0:on 810204,nonrated Window Discovered in 3-h Rated Fire Wall.Caused by Design,Mfg & Const/Installation Error.Direct Conversion Reactor Study 81-48 Submitted & Fire Watch Established | | | 05000366/LER-1981-011, Forwards LER 81-011/03L-0 | Forwards LER 81-011/03L-0 | | | 05000321/LER-1981-012-03, /03L-0:on 810228,turbine Failed to Trip on Overspeed.Caused by Dried Lubrication Around Overspeed Tripping Mechanisms Causing Binding.Mechanism Disassembled, Cleaned,Relubricated & Reassembled | /03L-0:on 810228,turbine Failed to Trip on Overspeed.Caused by Dried Lubrication Around Overspeed Tripping Mechanisms Causing Binding.Mechanism Disassembled, Cleaned,Relubricated & Reassembled | | | 05000321/LER-1981-012, Forwards LER 81-012/03L-0 | Forwards LER 81-012/03L-0 | | | 05000366/LER-1981-012-02, /02L-0:on 810224,during Surveillance Testing, Standby Liquid Control Pump B Failed to Start,Losing Squibb Valve B Continuity.Caused by Failure of Control Fuse in Circuit Breaker.Fuse Replaced | /02L-0:on 810224,during Surveillance Testing, Standby Liquid Control Pump B Failed to Start,Losing Squibb Valve B Continuity.Caused by Failure of Control Fuse in Circuit Breaker.Fuse Replaced | | | 05000366/LER-1981-012, Forwards LER 81-012/02L-0 | Forwards LER 81-012/02L-0 | | | 05000366/LER-1981-013, Forwards LER 81-013/03L-0 | Forwards LER 81-013/03L-0 | | | 05000321/LER-1981-013-03, /03L-0:on 810228,HPCI Sys Was Declared Inoperable When Oil Line Near Rear Bearing Broke.Caused by Person Stepping on Oil Line & Turbine Vibration Finishing Separation.Line Repaired | /03L-0:on 810228,HPCI Sys Was Declared Inoperable When Oil Line Near Rear Bearing Broke.Caused by Person Stepping on Oil Line & Turbine Vibration Finishing Separation.Line Repaired | |
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