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Category:LICENSEE EVENT REPORT (SEE ALSO AO
MONTHYEARML20029E3351994-05-10010 May 1994 LER 94-006-00:on 940415,both Trains of CREVS Declared Inoperable.Caused by Tornado Warning & Sighting of Tornado Moving Toward Plant.Tornado Warnings downgraded.W/940510 Ltr ML20029E2021994-05-0909 May 1994 LER 94-004-00:on 940408,determined That TS Pressurizer Cooldown Limit Exceeded on 930618 & Not Restored within Required Timeframe.Caused by Unanticipated Sys Interaction. SI for Check Valve Opening Tests revised.W/940509 Ltr ML20029D8151994-05-0303 May 1994 LER 94-005-00:on 940403,inadvertent Fwis Occurred.Caused by Personnel Failure to Follow Work Document Instructions. Corrective Action:Individuals Were Counseled on Requirements to Follow Work Document Instruction steps.W/940503 Ltr ML20046B8351993-07-30030 July 1993 LER 93-017-00:on 930621,discovered 24-hour Telephone Notification Had Not Been Carried Out as Required by TS LCO 3.7.11.1 Action Statement (b)(2)(a) Due to Personnel Error. NRC Informed of Missed notification.W/930730 Ltr ML20046B8501993-07-30030 July 1993 LER 93-018-00:on 930704,DG Started Due to Improper WO Planning.Restored Power to 1BB Shutdown Board & Stopped Running DGs.W/930730 Ltr ML20046A4691993-07-19019 July 1993 LER 93-016-00:on 930619,Phase A,Auxiliary Bldg & Containment Isolations Manually Initiated as Result of Fuel Assembly Failing to Remain in Upright Position After Being Released. All Fuel Movement stopped.W/930719 Ltr ML20045J0111993-07-14014 July 1993 LER 93-015-00:on 930614,1A Start Bus Alternate Feeder Breaker Tripped Upon Start of Unit 1 RCP Which Resulted in Start of DG Due to Current Transformer Wired Incorrectly. Restored Offsite Power & Secured Final DG.W/930714 Ltr ML20045H0171993-07-12012 July 1993 LER 93-014-00:on 930611,determined That Inadequate Ventilation Design Resulted in Potential Inoperability of Vital Power Equipment.Design Being modified.W/930712 Ltr ML20045B9951993-06-15015 June 1993 LER 93-004-01:on 930222,determined That Blind Flange on Elevation 734 Personnel Airlock Outer Housing Leaking.Due to Improper Installation of Blind Flange.Evaluation Performed of Other 14 Double O-ring Blind flanges.W/930615 Ltr ML20045B9311993-06-10010 June 1993 LER 93-013-00:on 930514,fire Watch Was Not Performed within Time Frame Required by Tech Specs Due to Inadequate Supervision by Fire Protection Foreman.Fire Watch Patrol reestablished.W/930610 Ltr ML20045A7261993-06-0707 June 1993 LER 93-011-00:on 930507,discovered That Fire Barrier Breached W/O Proper Compensatory Measures Established.On 930505,door Leading to Room Housing Containment Spray HX 1A Breached.Roving Fire Watch Established & LCO 3.7.12 Entered ML20044H4501993-06-0303 June 1993 LER 93-012-00:on 930504,apparent Failure to Properly Identify & Plug SG Tube Determined to Exceed TS Plugging Limit.Caused by eddy-current Coordinator Not Ensuring Task requirements.Eddy-current Procedure revised.W/930603 Ltr ML20044H1561993-05-28028 May 1993 LER 93-010-00:on 930430,Westinghouse Identified Error in Development of Calculations for Cold Overpressure Mitigation Sys Setpoints.Caused by Vendor Failure to Consider Elevation Difference.Engineering Evaluation Performed ML20044E6341993-05-17017 May 1993 LER 93-009-00:on 930417,TS Surveillance Not Performed for Three Pipe Support Snubbers Because of Omission of Snubbers from Surveillance Instruction for Visual Insp.Snubbers Visually Inspected & Functionally tested.W/930517 Ltr ML20044B6751993-02-23023 February 1993 LER 93-001-00:on 930124,Unit 1 Ice Bed Temperature Recorder in MCR Declared Inoperable.Caused by Ineffective Communication.Appropriate Personnel Involved W/Event Have Been counseled.W/930223 Ltr ML20044B6141993-01-21021 January 1993 LER 92-026-00:on 921222,determined That Several ASME Section XI Pressure Tests Not Performed Due to Section XI Program Implementation Not Being well-defined,controlled or Documented.Test Expeditiously performed.W/930121 Ltr ML20024H2441991-05-22022 May 1991 LER 91-007-00:on 910422,LCO 3.0.3 Entered When Shaft of Train a Main Control Room Air Handling Unit Failed from Fatigue & Train B Out of Svc for Maint.Caused by Shaft Misalignment.New Shaft installed.W/910522 Ltr ML20029C1761991-03-21021 March 1991 LER 91-002-00:on 910211,unit Operated in Condition Prohibited by Tech Spec 3.3.3.8 Limiting Condition for Operation.Cause Under Investigation.Night Order Issued to Personnel Re Removal of Equipment from svc.W/910321 Ltr ML20029C1231991-03-18018 March 1991 LER 90-016-01:on 901117,determined That Calibr of Nuclear Instrumentation Sys intermediate-range Channels Set Nonconservatively.Caused by Lack of Operability Control for Rod Motion.Action Plan developed.W/910318 Ltr ML20029A6711991-02-25025 February 1991 LER 91-002-00:on 910124,LCOs 3.0.5 & 3.8.1.1 Entered When Both Trains of Emergency Gas Treatment Sys Declared Inoperable.Caused by Blown Fuse & Excessive Cycling of Air Start Sys.Fuse replaced.W/910225 Ltr ML20028H0331990-09-27027 September 1990 LER 90-019-00:on 900828,failure to Update P-250 Plant Computer Constants Resulted in Axial Flux Difference.Caused by Inadequate Procedures & Inappropriate Personnel Actions. Procedure 0-PI-NXX-092-001.0 revised.W/900927 Ltr ML20028G9201990-09-26026 September 1990 LER 90-020-00:on 900829,ventilation Sys Inoperable Due to Train B Diesel Generator Out of Svc.Caused by Stuck Microswitch Contacts on Pressure Switch 0-PS-311-172. Pressure Switch Adjusted & Returned to svc.W/900926 Ltr ML20044A9361990-07-0909 July 1990 LER 90-011-00:on 900608,determined That Actual Nuclear Instrumentation Sys Power Range Detector Currents Were 20% to 31% Lower than Predicted.Caused by Calibr Values Being Incorrectly Calculated.Channels corrected.W/900709 Ltr ML20044A3241990-06-25025 June 1990 LER 90-010-00:on 900526,limiting Condition for Operation Entered Because MSIV Failed to Close When Another MSIV Inoperable for Maint.Cause Attributed to Valve Stem & Valve Guide Binding.Operations Training Ltr issued.W/900625 Ltr ML20043H5091990-06-21021 June 1990 LER 90-009-00:on 900527,automatic Start of Auxiliary Feedwater Pumps Occurred When Both Main Feedwater Pumps Placed in Tripped Condition.Caused by Personnel Error.Trip Circuitry Reset & Operators counseled.W/900621 Ltr ML20043E5401990-06-0707 June 1990 LER 90-008-00:on 900514,two Control Room Isolations Occurred as Result of Spurious Spikes.Caused by Loose Terminations on Relay Socket.Loose Connections Properly terminated.W/900607 Ltr ML20043A4211990-05-16016 May 1990 LER 90-010-00:on 900416,containment Ventilation Isolation Occurred.Caused by Allowing Gaseous Radiation Level to Increase Too Close to Alarm Setpoint.Recovery from Isolation initiated.W/900516 Ltr ML20043A2261990-05-14014 May 1990 LER 90-009-00:on 900404,lower Containment Radiation Monitor Found Inoperable & Lower Containment Atmosphere Aligned to Upper Containment Radiation Monitor During Sampling.Caused by Personnel Error.Chemistry Training revised.W/900514 Ltr ML20043A2271990-05-14014 May 1990 LER 90-006-00:on 900414,auxiliary Bldg Isolation Occurred from Spent Fuel Pit Area Radiation Monitors 0-RM-90-102 & 103.Caused by Personnel Error.Training Ltr Issued to Instrument Mechanics & Operations personnel.W/900514 Ltr ML20043A2201990-05-14014 May 1990 LER 90-007-00:on 900413,discovered That Tech Spec Surveillance Requirement Not Performed within Required Interval.Caused by Personnel Error.Surveillance Successfully Performed Since missed.W/900514 Ltr ML20042G7861990-05-0909 May 1990 LER 90-005-00:on 900409,emergency Start of Four Emergency Diesel Generators Occurred While Attempting Transfer of Power.Caused by Personnel Error.Individuals Reprimanded, Training Initiated & Procedures revised.W/900509 Ltr ML20042G7931990-05-0909 May 1990 LER 90-008-00:on 900410,reactor Trip Occurred Resulting from General Warning Alarm on Both Trains of Solid State Protection Sys.Caused by Personnel Error.Individuals Disciplined & Site Wide Message distributed.W/900509 Ltr ML20042F3741990-05-0202 May 1990 LER 90-003-00:on 900404,control Room Ventilation Sys (CRVS) Transferred to Pressurization Mode.Caused by Electrical Transient in Vital Instrument Ac Bus PY-21A.CRVS Reset & Returned to Normal Operating modes.W/900502 Ltr ML20042E4191990-04-13013 April 1990 LER 90-007-00:on 900317 & 26,containment Ventilation Isolations Occurred During Purge Activities.Caused by Inadequate Procedural Guidance for Setpoint Determination. Alarm & Trip Setpoints increased.W/900413 Ltr ML20042E2021990-04-13013 April 1990 LER 90-005-00:on 900315,inadvertent Containment Vent Isolation Occurred While Preparing to Purge Containment. Caused by Lack of Attention to Detail by Operator.Operator Counseled & Received Administrative reprimand.W/900413 Ltr ML20012F5221990-04-0505 April 1990 LER 90-006-00:on 900307,containment Ventilation Isolation Occurred.Caused by Containment Particulate Level Too Close to Setpoint.Module Replaced.Radiation Alarm Setpoint Increased from 10% to 40% of Tech Spec limit.W/900406 Ltr ML20012D8611990-03-23023 March 1990 LER 90-004-00:on 900221,handswitches Controlling Operation of Isolation Valves on Steam Supply Line to Auxiliary Feedwater Pump Found in Manual Position.Cause Undetermined. Handswitches Placed in P-auto position.W/900323 Ltr ML20012C4271990-03-12012 March 1990 LER 90-003-00:on 900211,inadvertent Containment Vent Isolation Occurred.Caused by Lack of Attention to Detail in That Operator Did Not Look Closely Enough at Switch Designations.Personnel Involved counseled.W/900312 Ltr ML20011F7191990-03-0101 March 1990 LER 89-031-01:on 891205,RHR Pumps Determined to Have Deadheading Problem Identified by NRC Bulletin 88-004.Caused by Inadequate Technical Response to Bulletin.Training Ltr Issued to 10CFR50.59 reviewers.W/900301 Ltr ML20011F7421990-02-26026 February 1990 LER 90-002-00:on 900127,control Room Isolation Occurred When Circuit Breaker Opened Supplying Power to Radiation Monitor. Caused by Failure by Personnel to Exercise Sufficient Caution.Responsible Engineers reinstructed.W/900226 Ltr ML20011F7391990-02-26026 February 1990 LER 90-002-00:on 891122,value for Distance from Floor to Ctr Line of Level Switch 2-LS-87-21 Transposed in Variable Leg Calculation.Caused by Inattention to Detail.Procedure Revised to Replace Incorrect setpoint.W/900226 Ltr ML20006E3311990-02-0909 February 1990 LER 90-001-00:on 900112,Limiting Condition for Operation 3.0.3 Entered When Three of Four Lower Compartment Cooler Fan Motors Exceeded Lubrication Frequency.Caused by Personnel Error.Personnel counseled.W/900209 Ltr ML20006D5341990-02-0707 February 1990 LER 90-001-00:on 900108,discovered That Several ERCW Valves Not Being Periodically Verified to Be Correct.Caused by Personnel Error During Procedure Revs & Workplan Reviews. Info Notice Issued to Workplan reviewers.W/900207 Ltr ML19354E1631990-01-22022 January 1990 LER 89-036-00:on 891221,discovered That Surveillance Test Results Used for Declaring Diesel Generator 1B-B Operable Deficient.Caused by Instruction Not Including 60 Minute Run Time.Event Will Be Reviewed w/supervisors.W/900122 Ltr ML19354D8941990-01-16016 January 1990 LER 89-034-00:on 891215,leak Identified from Fitting on Vol Control Tank Level Transmitter & Auxiliary Bldg Evacuated, Preventing Fire Watch Patrol from Entering Bldg for Hourly Rounds.Fitting tightened.W/900116 Ltr ML19354D9061990-01-16016 January 1990 LER 89-033-00:on 891216,refueling Water Storage Tank Level Transmitters Failed High Due to Freezing from Extremely Cold Weather & Inappropriate Use of Calculations.Engineering Procedures Revised & Heating Installed in encl.W/900116 Ltr ML20005F8851990-01-0909 January 1990 LER 89-035-00:on 891210,turbine/reactor Trip Occurred from hi-hi Feedwater Level of 75% in Steam Generator 3.Caused by Failure of Loop 3 Main Feedwater Regulating Valve to Close. Equipment Adjusted & repaired.W/900109 Ltr ML20005E0801989-12-22022 December 1989 LER 89-032-00:on 891205,RHR Pumps Determined to Have Deadheading Problem,Per NRC Bulletin 88-004,resulting in Plant Operation Outside Design Basis.On 891128,RHR Pump Exceeded Head Criteria.Pumps started.W/891222 Ltr ML20005E0831989-12-22022 December 1989 LER 89-032-00:on 891201,discovered That Tech Spec Surveillance Requirement to Verify That Valves 1-67-748 & 2-67-748 in Open Position Not Met.Caused by Personnel Error.Correct Valve Position verified.W/891222 Ltr ML20005E1161989-12-22022 December 1989 LER 89-030-00:on 891204,fire Suppression Sys Deluge Valve Isolated More than 1 H W/O Required Continuous Fire Watch Establishment.Caused by Personal Communication Breakdown. Valve Opened & Foreman in Charge counseled.W/891222 Ltr 1994-05-09
[Table view] Category:RO)
MONTHYEARML20029E3351994-05-10010 May 1994 LER 94-006-00:on 940415,both Trains of CREVS Declared Inoperable.Caused by Tornado Warning & Sighting of Tornado Moving Toward Plant.Tornado Warnings downgraded.W/940510 Ltr ML20029E2021994-05-0909 May 1994 LER 94-004-00:on 940408,determined That TS Pressurizer Cooldown Limit Exceeded on 930618 & Not Restored within Required Timeframe.Caused by Unanticipated Sys Interaction. SI for Check Valve Opening Tests revised.W/940509 Ltr ML20029D8151994-05-0303 May 1994 LER 94-005-00:on 940403,inadvertent Fwis Occurred.Caused by Personnel Failure to Follow Work Document Instructions. Corrective Action:Individuals Were Counseled on Requirements to Follow Work Document Instruction steps.W/940503 Ltr ML20046B8351993-07-30030 July 1993 LER 93-017-00:on 930621,discovered 24-hour Telephone Notification Had Not Been Carried Out as Required by TS LCO 3.7.11.1 Action Statement (b)(2)(a) Due to Personnel Error. NRC Informed of Missed notification.W/930730 Ltr ML20046B8501993-07-30030 July 1993 LER 93-018-00:on 930704,DG Started Due to Improper WO Planning.Restored Power to 1BB Shutdown Board & Stopped Running DGs.W/930730 Ltr ML20046A4691993-07-19019 July 1993 LER 93-016-00:on 930619,Phase A,Auxiliary Bldg & Containment Isolations Manually Initiated as Result of Fuel Assembly Failing to Remain in Upright Position After Being Released. All Fuel Movement stopped.W/930719 Ltr ML20045J0111993-07-14014 July 1993 LER 93-015-00:on 930614,1A Start Bus Alternate Feeder Breaker Tripped Upon Start of Unit 1 RCP Which Resulted in Start of DG Due to Current Transformer Wired Incorrectly. Restored Offsite Power & Secured Final DG.W/930714 Ltr ML20045H0171993-07-12012 July 1993 LER 93-014-00:on 930611,determined That Inadequate Ventilation Design Resulted in Potential Inoperability of Vital Power Equipment.Design Being modified.W/930712 Ltr ML20045B9951993-06-15015 June 1993 LER 93-004-01:on 930222,determined That Blind Flange on Elevation 734 Personnel Airlock Outer Housing Leaking.Due to Improper Installation of Blind Flange.Evaluation Performed of Other 14 Double O-ring Blind flanges.W/930615 Ltr ML20045B9311993-06-10010 June 1993 LER 93-013-00:on 930514,fire Watch Was Not Performed within Time Frame Required by Tech Specs Due to Inadequate Supervision by Fire Protection Foreman.Fire Watch Patrol reestablished.W/930610 Ltr ML20045A7261993-06-0707 June 1993 LER 93-011-00:on 930507,discovered That Fire Barrier Breached W/O Proper Compensatory Measures Established.On 930505,door Leading to Room Housing Containment Spray HX 1A Breached.Roving Fire Watch Established & LCO 3.7.12 Entered ML20044H4501993-06-0303 June 1993 LER 93-012-00:on 930504,apparent Failure to Properly Identify & Plug SG Tube Determined to Exceed TS Plugging Limit.Caused by eddy-current Coordinator Not Ensuring Task requirements.Eddy-current Procedure revised.W/930603 Ltr ML20044H1561993-05-28028 May 1993 LER 93-010-00:on 930430,Westinghouse Identified Error in Development of Calculations for Cold Overpressure Mitigation Sys Setpoints.Caused by Vendor Failure to Consider Elevation Difference.Engineering Evaluation Performed ML20044E6341993-05-17017 May 1993 LER 93-009-00:on 930417,TS Surveillance Not Performed for Three Pipe Support Snubbers Because of Omission of Snubbers from Surveillance Instruction for Visual Insp.Snubbers Visually Inspected & Functionally tested.W/930517 Ltr ML20044B6751993-02-23023 February 1993 LER 93-001-00:on 930124,Unit 1 Ice Bed Temperature Recorder in MCR Declared Inoperable.Caused by Ineffective Communication.Appropriate Personnel Involved W/Event Have Been counseled.W/930223 Ltr ML20044B6141993-01-21021 January 1993 LER 92-026-00:on 921222,determined That Several ASME Section XI Pressure Tests Not Performed Due to Section XI Program Implementation Not Being well-defined,controlled or Documented.Test Expeditiously performed.W/930121 Ltr ML20024H2441991-05-22022 May 1991 LER 91-007-00:on 910422,LCO 3.0.3 Entered When Shaft of Train a Main Control Room Air Handling Unit Failed from Fatigue & Train B Out of Svc for Maint.Caused by Shaft Misalignment.New Shaft installed.W/910522 Ltr ML20029C1761991-03-21021 March 1991 LER 91-002-00:on 910211,unit Operated in Condition Prohibited by Tech Spec 3.3.3.8 Limiting Condition for Operation.Cause Under Investigation.Night Order Issued to Personnel Re Removal of Equipment from svc.W/910321 Ltr ML20029C1231991-03-18018 March 1991 LER 90-016-01:on 901117,determined That Calibr of Nuclear Instrumentation Sys intermediate-range Channels Set Nonconservatively.Caused by Lack of Operability Control for Rod Motion.Action Plan developed.W/910318 Ltr ML20029A6711991-02-25025 February 1991 LER 91-002-00:on 910124,LCOs 3.0.5 & 3.8.1.1 Entered When Both Trains of Emergency Gas Treatment Sys Declared Inoperable.Caused by Blown Fuse & Excessive Cycling of Air Start Sys.Fuse replaced.W/910225 Ltr ML20028H0331990-09-27027 September 1990 LER 90-019-00:on 900828,failure to Update P-250 Plant Computer Constants Resulted in Axial Flux Difference.Caused by Inadequate Procedures & Inappropriate Personnel Actions. Procedure 0-PI-NXX-092-001.0 revised.W/900927 Ltr ML20028G9201990-09-26026 September 1990 LER 90-020-00:on 900829,ventilation Sys Inoperable Due to Train B Diesel Generator Out of Svc.Caused by Stuck Microswitch Contacts on Pressure Switch 0-PS-311-172. Pressure Switch Adjusted & Returned to svc.W/900926 Ltr ML20044A9361990-07-0909 July 1990 LER 90-011-00:on 900608,determined That Actual Nuclear Instrumentation Sys Power Range Detector Currents Were 20% to 31% Lower than Predicted.Caused by Calibr Values Being Incorrectly Calculated.Channels corrected.W/900709 Ltr ML20044A3241990-06-25025 June 1990 LER 90-010-00:on 900526,limiting Condition for Operation Entered Because MSIV Failed to Close When Another MSIV Inoperable for Maint.Cause Attributed to Valve Stem & Valve Guide Binding.Operations Training Ltr issued.W/900625 Ltr ML20043H5091990-06-21021 June 1990 LER 90-009-00:on 900527,automatic Start of Auxiliary Feedwater Pumps Occurred When Both Main Feedwater Pumps Placed in Tripped Condition.Caused by Personnel Error.Trip Circuitry Reset & Operators counseled.W/900621 Ltr ML20043E5401990-06-0707 June 1990 LER 90-008-00:on 900514,two Control Room Isolations Occurred as Result of Spurious Spikes.Caused by Loose Terminations on Relay Socket.Loose Connections Properly terminated.W/900607 Ltr ML20043A4211990-05-16016 May 1990 LER 90-010-00:on 900416,containment Ventilation Isolation Occurred.Caused by Allowing Gaseous Radiation Level to Increase Too Close to Alarm Setpoint.Recovery from Isolation initiated.W/900516 Ltr ML20043A2261990-05-14014 May 1990 LER 90-009-00:on 900404,lower Containment Radiation Monitor Found Inoperable & Lower Containment Atmosphere Aligned to Upper Containment Radiation Monitor During Sampling.Caused by Personnel Error.Chemistry Training revised.W/900514 Ltr ML20043A2271990-05-14014 May 1990 LER 90-006-00:on 900414,auxiliary Bldg Isolation Occurred from Spent Fuel Pit Area Radiation Monitors 0-RM-90-102 & 103.Caused by Personnel Error.Training Ltr Issued to Instrument Mechanics & Operations personnel.W/900514 Ltr ML20043A2201990-05-14014 May 1990 LER 90-007-00:on 900413,discovered That Tech Spec Surveillance Requirement Not Performed within Required Interval.Caused by Personnel Error.Surveillance Successfully Performed Since missed.W/900514 Ltr ML20042G7861990-05-0909 May 1990 LER 90-005-00:on 900409,emergency Start of Four Emergency Diesel Generators Occurred While Attempting Transfer of Power.Caused by Personnel Error.Individuals Reprimanded, Training Initiated & Procedures revised.W/900509 Ltr ML20042G7931990-05-0909 May 1990 LER 90-008-00:on 900410,reactor Trip Occurred Resulting from General Warning Alarm on Both Trains of Solid State Protection Sys.Caused by Personnel Error.Individuals Disciplined & Site Wide Message distributed.W/900509 Ltr ML20042F3741990-05-0202 May 1990 LER 90-003-00:on 900404,control Room Ventilation Sys (CRVS) Transferred to Pressurization Mode.Caused by Electrical Transient in Vital Instrument Ac Bus PY-21A.CRVS Reset & Returned to Normal Operating modes.W/900502 Ltr ML20042E4191990-04-13013 April 1990 LER 90-007-00:on 900317 & 26,containment Ventilation Isolations Occurred During Purge Activities.Caused by Inadequate Procedural Guidance for Setpoint Determination. Alarm & Trip Setpoints increased.W/900413 Ltr ML20042E2021990-04-13013 April 1990 LER 90-005-00:on 900315,inadvertent Containment Vent Isolation Occurred While Preparing to Purge Containment. Caused by Lack of Attention to Detail by Operator.Operator Counseled & Received Administrative reprimand.W/900413 Ltr ML20012F5221990-04-0505 April 1990 LER 90-006-00:on 900307,containment Ventilation Isolation Occurred.Caused by Containment Particulate Level Too Close to Setpoint.Module Replaced.Radiation Alarm Setpoint Increased from 10% to 40% of Tech Spec limit.W/900406 Ltr ML20012D8611990-03-23023 March 1990 LER 90-004-00:on 900221,handswitches Controlling Operation of Isolation Valves on Steam Supply Line to Auxiliary Feedwater Pump Found in Manual Position.Cause Undetermined. Handswitches Placed in P-auto position.W/900323 Ltr ML20012C4271990-03-12012 March 1990 LER 90-003-00:on 900211,inadvertent Containment Vent Isolation Occurred.Caused by Lack of Attention to Detail in That Operator Did Not Look Closely Enough at Switch Designations.Personnel Involved counseled.W/900312 Ltr ML20011F7191990-03-0101 March 1990 LER 89-031-01:on 891205,RHR Pumps Determined to Have Deadheading Problem Identified by NRC Bulletin 88-004.Caused by Inadequate Technical Response to Bulletin.Training Ltr Issued to 10CFR50.59 reviewers.W/900301 Ltr ML20011F7421990-02-26026 February 1990 LER 90-002-00:on 900127,control Room Isolation Occurred When Circuit Breaker Opened Supplying Power to Radiation Monitor. Caused by Failure by Personnel to Exercise Sufficient Caution.Responsible Engineers reinstructed.W/900226 Ltr ML20011F7391990-02-26026 February 1990 LER 90-002-00:on 891122,value for Distance from Floor to Ctr Line of Level Switch 2-LS-87-21 Transposed in Variable Leg Calculation.Caused by Inattention to Detail.Procedure Revised to Replace Incorrect setpoint.W/900226 Ltr ML20006E3311990-02-0909 February 1990 LER 90-001-00:on 900112,Limiting Condition for Operation 3.0.3 Entered When Three of Four Lower Compartment Cooler Fan Motors Exceeded Lubrication Frequency.Caused by Personnel Error.Personnel counseled.W/900209 Ltr ML20006D5341990-02-0707 February 1990 LER 90-001-00:on 900108,discovered That Several ERCW Valves Not Being Periodically Verified to Be Correct.Caused by Personnel Error During Procedure Revs & Workplan Reviews. Info Notice Issued to Workplan reviewers.W/900207 Ltr ML19354E1631990-01-22022 January 1990 LER 89-036-00:on 891221,discovered That Surveillance Test Results Used for Declaring Diesel Generator 1B-B Operable Deficient.Caused by Instruction Not Including 60 Minute Run Time.Event Will Be Reviewed w/supervisors.W/900122 Ltr ML19354D8941990-01-16016 January 1990 LER 89-034-00:on 891215,leak Identified from Fitting on Vol Control Tank Level Transmitter & Auxiliary Bldg Evacuated, Preventing Fire Watch Patrol from Entering Bldg for Hourly Rounds.Fitting tightened.W/900116 Ltr ML19354D9061990-01-16016 January 1990 LER 89-033-00:on 891216,refueling Water Storage Tank Level Transmitters Failed High Due to Freezing from Extremely Cold Weather & Inappropriate Use of Calculations.Engineering Procedures Revised & Heating Installed in encl.W/900116 Ltr ML20005F8851990-01-0909 January 1990 LER 89-035-00:on 891210,turbine/reactor Trip Occurred from hi-hi Feedwater Level of 75% in Steam Generator 3.Caused by Failure of Loop 3 Main Feedwater Regulating Valve to Close. Equipment Adjusted & repaired.W/900109 Ltr ML20005E0801989-12-22022 December 1989 LER 89-032-00:on 891205,RHR Pumps Determined to Have Deadheading Problem,Per NRC Bulletin 88-004,resulting in Plant Operation Outside Design Basis.On 891128,RHR Pump Exceeded Head Criteria.Pumps started.W/891222 Ltr ML20005E0831989-12-22022 December 1989 LER 89-032-00:on 891201,discovered That Tech Spec Surveillance Requirement to Verify That Valves 1-67-748 & 2-67-748 in Open Position Not Met.Caused by Personnel Error.Correct Valve Position verified.W/891222 Ltr ML20005E1161989-12-22022 December 1989 LER 89-030-00:on 891204,fire Suppression Sys Deluge Valve Isolated More than 1 H W/O Required Continuous Fire Watch Establishment.Caused by Personal Communication Breakdown. Valve Opened & Foreman in Charge counseled.W/891222 Ltr 1994-05-09
[Table view] Category:TEXT-SAFETY REPORT
MONTHYEARML20212J6311999-10-0101 October 1999 SER Accepting Request for Relief from ASME Boiler & Pressure Vessel Code,Section Xi,Requirements for Certain Inservice Insp at Plant,Unit 1 ML20217G3721999-09-30030 September 1999 Monthly Operating Repts for Sept 1999 for Sequoyah Nuclear Plant.With ML20212F0831999-09-23023 September 1999 Safety Evaluation Granting Relief from Certain Weld Insp at Sequoyah Nuclear Plant,Units 1 & 2 Pursuant to 10CFR50.55a(a)(3)(ii) for Second 10-year ISI Interval ML20212F4761999-09-23023 September 1999 Safety Evaluation Supporting Amends 246 & 237 to Licenses DPR-77 & DPR-79,respectively ML20212C4761999-08-31031 August 1999 Monthly Operating Repts for Aug 1999 for Sequoyah Nuclear Plant.With ML20210L4361999-08-0202 August 1999 Cycle 9 12-Month SG Insp Rept ML20216E3781999-07-31031 July 1999 Monthly Operating Repts for July 1999 for Sequoyah Nuclear Plant,Units 1 & 2.With ML20210L4451999-07-31031 July 1999 Unit-2 Cycle 10 Voltage-Based Repair Criteria 90-Day Rept ML20210G6631999-07-28028 July 1999 Cycle 9 90-Day ISI Summary Rept ML20196H8621999-06-30030 June 1999 NRC Regulatory Assessment & Oversight Pilot Program, Performance Indicator Data, June 1999 Rept ML20209H3831999-06-30030 June 1999 Monthly Operating Repts for June 1999 for Sequoyah Nuclear Plant.With ML20211F9031999-06-30030 June 1999 Cycle 9 Refueling Outage ML20196J8521999-06-28028 June 1999 Safety Evaluation Authorizing Proposed Alternative to Use Iqis for Radiography Examinations as Provided for in ASME Section III,1992 Edition with 1993 Addenda,Pursuant to 10CFR50.55a(a)(3)(i) ML20195K2951999-05-31031 May 1999 Monthly Operating Repts for May 1999 for Sequoyah Nuclear Plant,Units 1 & 2.With ML20206Q8951999-05-0505 May 1999 Rev 0 to L36 990415 802, COLR for Sequoyah Unit 2 Cycle 10 ML20206R5031999-04-30030 April 1999 Monthly Operating Repts for April 1999 for Sequoyah Units 1 & 2.With ML20205P9811999-03-31031 March 1999 Monthly Operating Repts for Mar 1999 for Sequoyah Nuclear Plant,Units 1 & 2.With ML20204C3111999-02-28028 February 1999 Monthly Operating Repts for Feb 1999 for Sequoyah Nuclear Plant,Units 1 & 2.With ML20205B6631999-02-28028 February 1999 Underground Storage Tank (Ust) Permanent Closure Rept, Sequoyah Nuclear Plant Security Backup DG Ust Sys ML20203H7381999-02-18018 February 1999 Safety Evaluation of Topical Rept BAW-2328, Blended U Lead Test Assembly Design Rept. Rept Acceptable Subj to Listed Conditions ML20211A2021999-01-31031 January 1999 Non-proprietary TR WCAP-15129, Depth-Based SG Tube Repair Criteria for Axial PWSCC Dented TSP Intersections ML20198S7301998-12-31031 December 1998 Cycle 10 Voltage-Based Repair Criteria 90-Day Rept ML20199G3641998-12-31031 December 1998 Monthly Operating Repts for Dec 1998 for Sequoyah Nuclear Plant,Units 1 & 2.With ML20197J5621998-12-0303 December 1998 Unit 1 Cycle 9 90-Day ISI Summary Rept ML20197K1161998-11-30030 November 1998 Monthly Operating Repts for Nov 1998 for Sequoyah Nuclear Plant,Units 1 & 2.With ML20195F8061998-10-31031 October 1998 Monthly Operating Repts for Oct 1998 for Sequoyah Nuclear Plant.With ML20154H6091998-09-30030 September 1998 Monthly Operating Repts for Sept 1998 for Sequoyah Nuclear Plant,Units 1 & 2.With ML20154H6251998-09-17017 September 1998 Rev 0 to Sequoyah Nuclear Plant Unit 1 Cycle 10 Colr ML20153B0881998-08-31031 August 1998 Monthly Operating Repts for Aug 1998 for Sequoyah Nuclear Plant.With ML20239A0631998-08-27027 August 1998 SER Accepting Licensee Response to GL 95-07, Pressure Locking & Thermal Binding of Safety-Related Power-Operated Gate Valves, for Sequoyah Nuclear Plant,Units 1 & 2 ML20236Y2091998-08-0707 August 1998 Safety Evaluation Accepting Relief Requests RP-03,RP-05, RP-07,RV-05 & RV-06 & Denying RV-07 & RV-08 ML20237B5221998-07-31031 July 1998 Monthly Operating Repts for July 1998 for Snp ML20237A4411998-07-31031 July 1998 Blended Uranium Lead Test Assembly Design Rept ML20236P6441998-07-10010 July 1998 LER 98-S01-00:on 980610,failure of Safeguard Sys Occurred for Which Compensatory Measures Were Not Satisfied within Required Time Period.Caused by Inadequate Security Procedure.Licensee Revised Procedure MI-134 ML20236R0051998-06-30030 June 1998 Monthly Operating Repts for June 1998 for Sequoyah Nuclear Plant ML20249A8981998-05-31031 May 1998 Monthly Operating Repts for May 1998 for Sequoyah Nuclear Plant,Units 1 & 2 ML20247L5141998-04-30030 April 1998 Monthly Operating Repts for Apr 1998 for Sequoyah Nuclear Plant ML20217K4471998-04-27027 April 1998 Safety Evaluation Supporting Requests for Relief 1-ISI-2 (Part 1),2-ISI-2 (Part 2),1-ISI-5,2-ISI-5,1-ISI-6,1-ISI-7, 2-ISI-7,ISPT-02,ISPT-04,ISPT-06,ISPT-07,ISPT-8,ISPT-01 & ISPT-05 ML20217E2221998-03-31031 March 1998 Monthly Operating Repts for Mar 1998 for Sequoyah Nuclear Plant ML20248L2611998-02-28028 February 1998 Monthly Operating Repts for Sequoyah Nuclear Plant,Units 1 & 2 ML20199J2571998-01-31031 January 1998 Cycle 9 Voltage-Based Repair Criteria 90-Day Rept ML20202J7911998-01-31031 January 1998 Monthly Operating Repts for Jan 1997 for Sequoyah Nuclear Plant,Units 1 & 2 ML20199J2441998-01-29029 January 1998 Snp Unit 2 Cycle Refueling Outage Oct 1997 ML20199F8531998-01-13013 January 1998 ASME Section XI Inservice Insp Summary Rept for Snp Unit 2 Refueling Outage Cycle 8 ML20199A2931997-12-31031 December 1997 Revised Monthly Operating Rept for Dec 1997 for Sequoyah Nuclear Plant,Units 1 & 2 ML20198M1481997-12-31031 December 1997 Monthly Operating Repts for Dec 1997 for Sequoyah Nuclear Plant,Units 1 & 2 ML20197J1011997-11-30030 November 1997 Monthly Operating Repts for Nov 1997 for Sequoyah Nuclear Plant,Units 1 & 2 ML20199C2951997-11-13013 November 1997 LER 97-S01-00:on 971017,vandalism of Electrical Cables Was Observed.Caused by Vandalism.Repaired Damaged Cables, Interviewed Personnel Having Potential for Being in Area at Time Damage Occurred & Walkdowns ML20199C7201997-10-31031 October 1997 Monthly Operating Repts for Oct 1997 for Sequoyah Nuclear Plant L-97-215, SG Secondary Side Loose Object Safety Evaluation1997-10-23023 October 1997 SG Secondary Side Loose Object Safety Evaluation 1999-09-30
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, % I ' 'f TENNESSEE VALLEY AUTHORITY
', Chattanooga, Tennessee 6N 38A Lookout-Place March 12, 1990-U.S. Nuclear Regulattery Commission ATTN: Document Control Desk Washington, D.C. 20555 Gentlemen:
TENNESSEE VALLEY AUTHORITY - SEQUOYAH NUCLEAR PLANT UNIT 2 - DOCKET NO.
328 - FACILITY OPERATING LICENSE DPR LICENSEE EVENT REPORT (LER) 4 50-328/90003 s
The enclosed LER provides details of an event wherein an inadvertent containment vent isolation occurred on Unit 2 as a result of a lack of attention to detail by a reactor operator. This event is being reported in accordance with 10 CFR 50.73, paragraph a.2.1.v.
Very truly yours.
TENNESSEE VALLEY AUTHORITY R. Bynum .Vice President !
uclear Power Production Enclosure cc (Enclosure):
Regional Administration
- U.S. Nuclear Regulatory Commission ,
Office of Inspection and Enforcement }
Region II. l 101 Marietta Street, Suite 2900 Atlanta, Georgia 30323 INPO Records Center Institute of Nuclear Power Operations !
1100 Circle 75 Parkway, Suite 1500 Atlanta, Georgia' 30339 NRC Resident '1spector Sequoyah Nuclear Plant 2600 Igou Ferry Road Soddy Daisy, Tennessee 37379 ;
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l An Equal Opportunity Employer l
N' o- s NRC ORM 308 U.S NUCLitJ E.tIULATORY COMMlbl40N GROWD OMB NO 31 4 0104 EXPIRES 4f30/S2 ESTIMATED BURDEN f tR RE&PONSE TO COMPLY WTH THIS LICENSEE EVENT REPORT (LERI ENMtN?s'Uo*An'D Jo' ?i DtJEs'iiMITt TOL'R8C0 Di AND REPORTS MANAGEMENT BRANCH IP4301, U S NUCLE AR T PAPtHWO K Rf D Y ON R J 3 .' O IC OF MANAGEMENT AND BUDGE 1, WASHINGTON. DC 20603 ,
F ACILITV NAME til DOCRaf NUMBE R (2) PAGE G S;quoyah Nuclear Plant, Unit 2 0 l6 l 010 l 013 l 2 l8 1 l0F!013
'"Inadvertant containment vent isolation event resulting from a lack of attention to >
dstail while blocking a radiation monitor tVtNT DATE (St LER NUMetRqsl REPORT DAf t 171 OTHER F ACILITEt$ INVOLVED 18)
MONTH DAv. YtAR YEAR '
[y MONTH DAv vtAR 'aceLifvhauts Dock t 1 NUMet R(si n
0 15101010 1 11 0l 2 1l1 9 0 9l 0 0l 0l 3 0l0 0l3 1l2 9l 0 0 1 5 1 0 to1 0 1 1 I THIS REPORT IS SUDMITTED PUR8UANT TO THE RtOulREMENTS OF 10 CF R l (Ched one e, mom of the foueamf 81111 OPE R ATING MODE W 20 402tti 20 406tel X 50 73teH21Mi 73 711bl 1
R 20 408teH1 Hd 50 36teltil to.73teH2Hel 73 71tsi (10) 1l 01 0 to 40si.HiHe so34.Hn ani.H2}iai
_ OT,H8 g,.cygg to 406teH1Hm) 60 73tel12H4 60 73teH2HoulHAl J6eiA1 20 40GleH1Hevi 80,73ie H2 Hel to 73teH2Hv4iligt 20 4066aH1Hel 60.73u M2 Hed to 731aH2Hal LICENSEE CONT ACT POR THis Lin 1121 N1ut TELf PHONE NUM8tm AmtACODE Geof Ilipp, Compliance Licensing Engineer 6l115 814131-1717 i6 16 COMPLETE ONE LING FOR E ACH COMPONENT f AILUR8 OtSCRISED IN TH18 litPORT (13)
RE' L SYSTtM E RIP '
CAUSE OY ST E M COMPONENT yFAC g TONPR S CAUSE COMPONENT TO NPA 1 1 I I I I I I I I I I I I I I I I I I I I I I I l I I SUPPLEMENT AL REPORT EXPtCTED 114) MONTH DLv VIAR YES (19 v.s. comer.n EX9tCTED SUOMI53 TON DA rts f NO l l l t..mCTu-........,.-.--<.~,...,..,(i.,
On February 11, 1990, with both Unit I and Unit 2 at 100-percent power, an (nadvertent containment vent isolation (CVI) occurred on Unit 2. The reactor operators were preparing to purge containment, a process that includes source checking the containment vsnt exhaust radiation monitors to ensure operability. While attempting to block these Unit 2 radiation monitors prior to source checking, the equivalent Unit i radiation monitors were blocked instead. Consequently, when one of the Unit 2 radiation monitors w s source checked, a CVI was initiated. After determining the cause of the CVI, the op2rators initiated actions to recover from the CVI after which the containmeat purge wIs conducted. The root cause of this event has been attributed to a lack of attention to detail in that the operator did not look closely enough at the switch designations whsn blocking the containment purge radiation monitors. A contributing cause of the svant was that communication between the operators regarding which radiation monitors to block was not conducted in accordance with the established procedure. As correctivo action, the personnel involved have been counselled regarding the event and the importance of proper conduct of operation. In addition, this event has been placed in a training letter for distribution to licensed personnel.
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NRC FORM 346A . U.S. NUCLE A A t.tJULaTMY COwMi&SION W P EC OM$ NO. 0604 tX71%($ 4/30C2 p LICENSEE EVENT REPORT (LER) l$u"t'#lO'N"ERO"'APOj!/.#"l#,TRJ",#
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- 1 PAPER O RE U T ON J d0 1 OF MANAAEMENT AND Su73tf,W A$HINGTON,0C 20bv3.
F ACILii? NAMt n) DOCKif NUpmf LP (2)
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S2quoyah Nuclear Plant, Unit 2 ol5l010l0l312l8 191 0 -
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. Description of Event At 1246 Eastern standard time on February 11, 1990, with both Unit 1 and Unit 2 in Mode 1 (100-percent power, 2,235 pounds per square inch gauge, 578 degrees Fahrenheit),
an inadvertent B train containment vent isolation (CVI) (EIIS Code JM) occurred on Unit 2. The Unit 2 reactor operators (R0s) had been preparing to purge containment using Surveillance Instruction 410.2, " Containment (Upper, Lower) Purge." In preparation, the Unit 2 auxiliary building assistant unit operator (AUO) was verifying that radiation monitors (EIIS Code IL) 2-RM-90-130 and -131 were properly aligned to monitor the containment purge air exhaust using System Operating Instruction 90.1,
" Radiation Monitoring System." While the AUO was manipulating valves during this slignment, the 2-RM-90-130/131 instrument malfunction alarm annunciatst. as the result of a low flow condition The Unit 1 lead R0 acknowledged the alarm at Panel 0-M-12 and immediately notified the Unit 2 R0s of the alarm. (Panel 0-M-12 is closer'to the Unit 1 horseshoe than to the Unit 2 horseshoe.) Because of concern that a CVI might result from the AUO's clignment actions on Radiation Monitors 2-RM-90-130 and -131, the Unit 2 R0s directed the Unit 1 RO, who was still by Panel 0-M-12 to block the two radiation monitors. This operation requires turning two handswitches (HS-90-136Al and -136A2) clockwise to the appropriate radiation monitor position and pulling out the switches to eccomplish the blocking function. Tht. Unit 1 RO turned the switches to what he thought ware the Unit 2 containment purge radiation monitor (2-FM-90-130 and -131) positions, but which were in fact the equivalent Unit I radiation monitor positions (1-RM-90-130 and -131). When the Unit 1 RO completed the blocking process, he informed the Unit 2 R0s that the radiation monitors were blocked.
The Unit 2 R0s continued with the preparations to purge Unit 2 contcinment. Believing that Radiation Monitars 2-RM-90-130 and -131 had been blocked, the Unit 2 R0s directad the AU0 to source check the radiation monitors to ensure operability as required by SI-410.2. When the source check was performed on Radiation Monitor 2-RM-90-131, a high radiation alarm was received, and a B train CVI was initiated on Unit 2. Upon investigating the cause of the CVI, the Unit 1 RO discovered the incorrect radiation monitors had been blocked. The Unit 2 operator immediately reset the high radiation signal and initiated actions to recover from the CVI. After completing the CVI recovery, the alignment of the Unit 2 containment purge radiation monitors was raverified, 2nd the containment purge was initiated.
Cruse of Event The root cause of this event has been attributed to a lack of attentioa to detail in that the Unit 1 R0 did not look closely enough at the switch designations when blocking the containment purge radiation monitors. As a consequence, the Unit 2 radiation monitors were not blocked, which resulted in a CVI when one monitor was source checked.
A contributing caust of the event was that communication between the Unit 1 and the Unit 2 R0s was not conducted in accordance with Administrative Instruction 30, " Nuclear Plant Conduct of Operation." Repeat back and closed loop communication was not utilized in sufficient detail. The unit designation of the radiation monitors was not explicitly stated between the operators. If the words " Unit 2" had been communicated back and forth, it is poadible the Unit 1 RO might have caught his error before the CVI occurred.
NilC Psam 366A 5891
Y U.S NUCLEAM.liVLath..Y COMMi&SION ' ,,,;ovto cM ,Ng 3i$o419,
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LICENSEE EVENT REPORT (LER) - 28's*^MRAuM E,"OU!M,' .o f'f? ,T" ',"'!
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\ PAPE HWO RE TION d 600 0 IC OF MANAGEMENT AND SUDGET,n ASHINGTON. DC 20603-t ActLITV NAME tu DOCK 11 NUMeta 12) ggg gyMggg ggy pang (3) vi*a "#Ct' 0'JJ.D Saquoyah Nuclear Plant, Unit 2 0 l5 lo l010 l 312l 8 910 -
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0l0 0 l3 OF 0 l3 n muow,wau w.a.u=ea*r m ac w m nim An51ysis of Event This event is being reported in accordance with 10 CFR 50.73, paragraph a.2.1.v. as an cngineered safety feature (ESP) actuation that was not part of a preplanned sequence.
Ths containment purge ventila*: ion system is described in Section 9.4.7 of the SQN Updated Final Safety Analysis Report (UFSAR). The containment purge exhaust radiation
- monitors are described in Section 11.4.2.2.6 of the UFSAR.
Upon receipt of the CVI signal, the equipment required to actuate on a CVI signal parformed as desig;ned. Following the CVI, Operations personnel verified that an actual high radiation condition did not exist and took appropriate actions to recover from the CVI. If Unit i had been purging containment, the potential consequence of the intdvertent blocking of the Unit 1 containment purge exhaust radiation monitors could have been a radiological release that would normally have been detected and stopped by tha purge exhaust monitors. The probability of an extended release is minimal for two rcasons: (1) 1-RM-90-106 (lower containment) and -112 (upper containment) were still opsrable and would have initiated a CVI if a high radiation condition had exis;ed inside containnant, and (2) the alarm circuits were still functional on 1-RM-90-130 and -131 end would have alerted the control room operators of any high radiation condition in the purge exhaust. However, because Unit l was not purging containment and Unit 2 ESF equipment operated as designed, it can be concluded that there were to adverse consequences to the health and safety of plant personnel or the general public as a rsoult of this event.
Corrective Action The immediate action taken was to determine the cause of the CVI and to initiate actions for r;ecovery from-the CVI. As corrective action to prevent recurrence, the shift opsrations supervisor and the personnel involved have been counselled by the Operations Mar.ager regarding the event and the importance of proper conduct of operation. In eddition, this event has bean placed in a training letter for distribution to licensed parsonnel.
Additional Information There have been 50 previously reported occurrences of CVIs at SQN since 1984 Of these prsvious occurrences, 14 were the result of personnel errors that most frequently occurred during maintenance activities. No previous occurrences could be identified that'resulted froto blocking the incorrect radiation monitor.
Commitment None.
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