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Category:REPORTABLE OCCURRENCE REPORT (SEE ALSO AO
MONTHYEARML20042C0411982-03-22022 March 1982 Ro:On 820312,during Reactor Startup,Keyswitch Discovered in on Position.Caused by Failure of Reactor Operator to Follow Established Shutdown Procedure.Operator Interviewed & Guidance Issued for Performing Reactor Checklists ML20004D8801981-06-0101 June 1981 Ro:On 810527,during Preoperational Checkout,Polarizing High Voltage Was Removed from Safety Channel Compensated Ion Chamber Neutron Detector.Caused by Operator Inadvertently Reducing High Voltage Power Supply Output to Zero 1982-03-22
[Table view] Category:LER)
MONTHYEARML20042C0411982-03-22022 March 1982 Ro:On 820312,during Reactor Startup,Keyswitch Discovered in on Position.Caused by Failure of Reactor Operator to Follow Established Shutdown Procedure.Operator Interviewed & Guidance Issued for Performing Reactor Checklists ML20004D8801981-06-0101 June 1981 Ro:On 810527,during Preoperational Checkout,Polarizing High Voltage Was Removed from Safety Channel Compensated Ion Chamber Neutron Detector.Caused by Operator Inadvertently Reducing High Voltage Power Supply Output to Zero 1982-03-22
[Table view] Category:TEXT-SAFETY REPORT
MONTHYEARML20211G6811999-06-30030 June 1999 Pulstar Reactor Annual Rept to Us NRC for Jul 1998 - June 1999. with ML20238E8731998-06-30030 June 1998 Pulstar Reactor Annual Rept for Period Jul 1997 - June 1998 ML20198R9321997-10-30030 October 1997 Safety Evaluation Supporting Amend 12 to License R-120 ML20210Q7941997-06-30030 June 1997 Pulstar Reactor Annual Rept for Jul 1996 - June 1997 ML20141J9391997-04-30030 April 1997 Safety Evaluation Report Related to the Renewal of the Operating License for the Research Reactor at North Carolina State University ML20133F8501996-12-11011 December 1996 Ro:On 961206,PULSTAR Surveillance Program Was Deficient in prestart-up Check Since It Did Not Verify Full Operation of Scram Logic Unit as Described in Ufsar.Caused by Deficient Surveillance procedures.Re-soldered Connection ML20148G2811996-06-30030 June 1996 Corrections to Pulstar Facility Annual Rept Section 6.7.5.f.1 for Periods 950701-960630,940701-950630 & 930701- 940630 ML20117E8881996-06-30030 June 1996 Pulstar Reactor Annual Report to NRC for Jul 1995 - June 1996 ML20091P4731995-06-30030 June 1995 Pulstar Reactor Annual Rept for Period Jul 1994 - June 1995 ML20072P2401994-06-30030 June 1994 Pulstar Reactor Annual Rept for Period Jul 1993 - June 1994 ML20056G0841993-06-30030 June 1993 Pulstar Reactor Annual Rept for Period Jul 1992 - June 1993 ML20127P8261992-11-27027 November 1992 Offsite Dose Calculation for Noble Gases ML20099K2691992-06-30030 June 1992 Pulstar Annual Rept to NRC for Jul 1991-June 1992 North Carolina State Univ Nuclear Reactor Program ML20082H8171991-06-30030 June 1991 Pulstar Annual Rept to NRC for Jul 1990 to June 1991 ML20082A3911991-06-27027 June 1991 Ro:On 910625,reactor Operator Logged That Reactor Key Turned Off & Removed from Reactor Control Console While Key Still Turned On.Operator Suspended for 24 H & Operating Procedures Will Be Changed Re Custody of Reactor Key ML20059D1451990-06-30030 June 1990 Pulstar Annual Rept to NRC for Jul 1989 - June 1990 ML20246N6781989-06-30030 June 1989 Pulstar Annual Rept to NRC for Jul 1988 - June 1989 ML20245B4451988-06-30030 June 1988 Financial Rept for Yr Ending 880630 ML20153E1691988-06-30030 June 1988 Pulstar Annual Rept to NRC for Jul 1987 - June 1988 ML20196G8881988-03-0303 March 1988 Headquarters Daily Rept for 880303 ML20237H3851987-06-30030 June 1987 Annual Rept for Jul 1986 - June 1987 ML20215K3521986-08-20020 August 1986 Ro:On 860813,console Key Left in Keyswitch & in on Position.Caused by Personnel Error.Reactor Operator & Duty Senior Operator Suspended from Licensed Duties for 1 Wk ML20214L4891986-06-30030 June 1986 Pulstar Annual Rept to NRC for Jul 1985 - June 1986 ML20134L7461985-06-30030 June 1985 Pulstar Annual Rept to NRC for Period Jul 1984 - June 1985 ML20096C8311984-06-30030 June 1984 Pulstar Annual Rept to NRC for Jul 1983 - June 1984 ML20063J4611982-08-27027 August 1982 Pulstar Annual Rept to Nrc,Jul 1981-June 1982 ML20069D7661982-08-20020 August 1982 Errata to Pulstar Annual Rept to Usnrc,Jul 1981-June 1982, Environ Radiation Surveillance Rept for 811005-820820 ML20042C0411982-03-22022 March 1982 Ro:On 820312,during Reactor Startup,Keyswitch Discovered in on Position.Caused by Failure of Reactor Operator to Follow Established Shutdown Procedure.Operator Interviewed & Guidance Issued for Performing Reactor Checklists ML20041E1841981-09-30030 September 1981 to QA Program for Shipping Radioactive Matl ML20004D8801981-06-0101 June 1981 Ro:On 810527,during Preoperational Checkout,Polarizing High Voltage Was Removed from Safety Channel Compensated Ion Chamber Neutron Detector.Caused by Operator Inadvertently Reducing High Voltage Power Supply Output to Zero ML19344E6071980-08-27027 August 1980 Annual Rept,Jul 1979 to Jul 1980. ML19310A4041980-03-15015 March 1980 Dismantling Plan for Facility ML19275A5611979-09-11011 September 1979 QA Plan for Shipment of R-3 Fuel. ML19254A7851979-06-30030 June 1979 Pulstar Annual Rept, 780701-790630 1999-06-30
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NORTH CAROLINA STATE UNIVERSITY AT RALEIGH SCHOOL OF ENGINEERING -
Deranruxxx or Nuctura Escmarama Bos 5636 Zir 27650 1 June 1981 %)M h. .
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- 4 Mr James R. Miller, Chief o M O bn.
Standardization and Special Projects Branch
( D'7y [ fd /
Division of Licensing U.S. Nuclear Regulatory Commission
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Docket No.50-297 / /, , , -r(M Washington, D.C. '20555 Facility License 4 R-120 9
Dear Sir:
In compliance with NCSU PULSTAR Technical Specification 6.5.c. and 6.7.2.c. we hereby submit the following report:
During the PULSTAR reactor pre-eperational checkout on 27 May 1981, the m:rning shift reactor operator inadvertently removed the polarizing hl.gh voltage from the Safety Channel compenstced ion chamber nautron d .tector af ter having properly and successfu'.ly completed the channel -
t est on said Safety Power Channel. The operator then performed a r:utine startup and attained a steady power level of 100 kilowatts
( '0*'. of NCSU PULSTAR licensed maximum power) for some routine scheduled ,-
r . actor irradiations for a period of approximately two (2) hours.
J' the erfd of this two (2) hour period, the reactor was shutdown f or t'e lunch .eak.
W.ile performing a " key-on" checkout after lunch, the afternoon shift c:;erator noticed that the high voltage power supplies monitor meter indicated zero in the Safety Channel HVPS check position. At this t :'.me , the reactor operator notified the Designated Senior Operator a:d the Chief of Reactor Maintenance.
It was concluded that the morning shift operator had unintentionally reduced the Safety Chanael HVPS output to zero rather than the test source current power supply. The Safety HVPS shares one half of a standard 19-inch rack space in the reactor console with the channel-test current source occupying the other half. (The current source output is used to chanael-test the Safety Channel and is normally r??2 ed to zero after testing is successfully completed.)
Verbal examination of the morning shift reactor opera tor substanti-ated this conclusion.
Analysis of the subject occurecce in its entirety indicates the cause to be inattention en the part of the reactor operator to the pre-operational checkout procedure details. The occurrence is con-sidered to have been a function of tha operator performance only and hence the result of his own individual inattention to the check- o l i .a t steps being performed. We have performed over 2,000 such y
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pre-operational checklists at this facility and this occurrence is the first, therefore, we consider the console design and instrumen-tation layout net a factor in this event.
Immediataly following the subject occurrence, the Safety Channel HVPS control knobs were taped down to prevent another unintentional operation of the control knobs. A permanent metal shield will be attached over the HVPS knobs in a timely manner to prevent further recurrences of the subject event.
End of Report....
Postscript: We are aware of the change in definition of an "A0" produced by Sec'tioa 208 of the ERA of 1974 (Pub. L.
33 438), howevar, under our present Technical Specifi-cations 1.17.b. and 6.5.c., we are required to report
-the subject event as an Abnormal Occurrence. There exists now, in the planning stage, a proposed change to the NCSU PULSTAR Technical Specification to re-define our "A0s" as necessary to conform to Section 208 of the 1974 Snergy Reorganization Act.
Cnd of Postscript. ..
.Please notify me immediately should yo*u require additional information regarding this report. Telephene (919) 737-2323 or (919) 73 7-2 3 ?'? .
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Thomas C. Bray Acting Nuclear Operations Administrator TC3:Ish cc: M. Caudle Julian USNRC, Region II Dr. R.G. Cockrell NCSU RPC
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P00R 0RIGINAL