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Category:REPORTABLE OCCURRENCE REPORT (SEE ALSO AO
MONTHYEARML20012E9841990-03-29029 March 1990 Ro:On 900228,chamber Door of Primary Reactor Continous Air Monitors (CAM) Left Partially Open,Causing Filter to Be Several Centimeters Further from Detector than Normal. Backup CAM Will Be Wired Into Damper Isolation Sys ML20006G2261990-02-22022 February 1990 Ro:On 900126,reactor Room Sealing Dampers Did Not Fully Seal When in Closed Position During Triga Ventilation Sys Insp. Air Monitoring Sys Showed No Release of Fission Products or Release of Contaminants in Reactor Room.Dampers Repaired ML20006F1561990-02-0707 February 1990 Ro:On 900126,discovered That Reactor Room Sealing Dampers Did Not Fully Seal When in Closed Position During Insp of Ventilation Sys.Dampers Repaired & Returned to Svc on 900126 ML20006G2281988-11-0808 November 1988 Ro:On 881011,reactor Operator Left Console Unlocked While Tracing Electrical Circuit.Discovered by Another Operator Who Locked Console & Removed Key.Two Corrective Actions Were Taken to Prevent Recurrence.Operator Counseled ML20006G2311988-03-23023 March 1988 Ro:On 880229,reactor Room Primary Continuous Air Monitor Accidently Left in Test Mode During Operations.Two Sets of Corrective Actions Taken to Prevent Recurrence Including Flashing Visual Light Installed on Console in Control Room ML20040A9341981-12-29029 December 1981 Ro:On 811222 & 23,intermittently Changing But Fixed Vertical Position of Transient Control Rod Noted.Caused by Failure of Bolt That Secures Telescoping Section of Transient Connecting Rod.Section Removed & Secured W/Bolt ML20010B4051981-07-31031 July 1981 Ro:On 810730,operator Failed to Measure k-excess Prior to First Reactor Power Operation.Excess Reactivity,Measured on Daily Basis,Has Not Varied Outside Normal Operational Conditions.Internal Administrative Procedure Instituted ML19322E5831980-03-25025 March 1980 Ro:On 800315,scram Indicators on Reactor Control Console Were Illuminated,Indicating Power Failure or Outage of Console.Caused by Damaged Operational Amplifier.Circuit Board Replaced.Relay,Requiring Manual Reset,Installed 1990-03-29
[Table view] Category:LER)
MONTHYEARML20012E9841990-03-29029 March 1990 Ro:On 900228,chamber Door of Primary Reactor Continous Air Monitors (CAM) Left Partially Open,Causing Filter to Be Several Centimeters Further from Detector than Normal. Backup CAM Will Be Wired Into Damper Isolation Sys ML20006G2261990-02-22022 February 1990 Ro:On 900126,reactor Room Sealing Dampers Did Not Fully Seal When in Closed Position During Triga Ventilation Sys Insp. Air Monitoring Sys Showed No Release of Fission Products or Release of Contaminants in Reactor Room.Dampers Repaired ML20006F1561990-02-0707 February 1990 Ro:On 900126,discovered That Reactor Room Sealing Dampers Did Not Fully Seal When in Closed Position During Insp of Ventilation Sys.Dampers Repaired & Returned to Svc on 900126 ML20006G2281988-11-0808 November 1988 Ro:On 881011,reactor Operator Left Console Unlocked While Tracing Electrical Circuit.Discovered by Another Operator Who Locked Console & Removed Key.Two Corrective Actions Were Taken to Prevent Recurrence.Operator Counseled ML20006G2311988-03-23023 March 1988 Ro:On 880229,reactor Room Primary Continuous Air Monitor Accidently Left in Test Mode During Operations.Two Sets of Corrective Actions Taken to Prevent Recurrence Including Flashing Visual Light Installed on Console in Control Room ML20040A9341981-12-29029 December 1981 Ro:On 811222 & 23,intermittently Changing But Fixed Vertical Position of Transient Control Rod Noted.Caused by Failure of Bolt That Secures Telescoping Section of Transient Connecting Rod.Section Removed & Secured W/Bolt ML20010B4051981-07-31031 July 1981 Ro:On 810730,operator Failed to Measure k-excess Prior to First Reactor Power Operation.Excess Reactivity,Measured on Daily Basis,Has Not Varied Outside Normal Operational Conditions.Internal Administrative Procedure Instituted ML19322E5831980-03-25025 March 1980 Ro:On 800315,scram Indicators on Reactor Control Console Were Illuminated,Indicating Power Failure or Outage of Console.Caused by Damaged Operational Amplifier.Circuit Board Replaced.Relay,Requiring Manual Reset,Installed 1990-03-29
[Table view] Category:TEXT-SAFETY REPORT
MONTHYEARML20205B1161998-12-31031 December 1998 1998 Annual Rept of Afrri Triga Reactor. with ML20216H7451998-03-12012 March 1998 Ro:On 980224,SRO Left CR Leaving Key Unattended in Console. Caused by Personnel Error.Rso Was Reprimanded for Failing to Follow Procedures & Operators Participated in Special Training Class ML20217F0331997-12-31031 December 1997 1997 Annual Rept of Affri Triga Reactor ML20137H5161996-12-31031 December 1996 1996 Annual Rept of Afrri Triga Reactor ML20108A1291995-12-31031 December 1995 Corrected 1995 Annual Rept of Afrri Triga Reactor ML20107K1921995-12-31031 December 1995 Corrected Copy of 1995 Annual Rept of Affri Triga Reactor Facility. W/Undated Ltr ML20101D5791995-12-31031 December 1995 1995 Annual Rept of Afrri Triga Reactor. W/Undated Ltr ML20081K3101994-12-31031 December 1994 1994 Annual Rept of Afrri Triga Reactor ML20065A0221993-12-31031 December 1993 1993 Annual Rept of Afrri Triga Reactor ML20058F6191993-11-30030 November 1993 Ro:On 931105,during Radiation Measurements in Exposure Room One,Core Support Shroud Came in Contact W/Lead Shield Doors When Interlock Failed,Causing Subj Doors to Close.Caused by Lack of Communication.Operators Involved Reprimanded ML20056C0691992-12-31031 December 1992 1992 Annual Rept of Afrri Triga Reactor ML20106B4991992-09-25025 September 1992 Ro:On 920904,discovered Operating Anomaly on Console Which Would Drive Out of Core in Pulse Mode If Square Wave Button Pressed While Pressing Rod Drive Up Button.Caused by Failure to Remove Transient Rod.Second Switch Installed ML20091A8621991-12-31031 December 1991 Afrri Triga Reactor 1991 Annual Rept. W/Undated Ltr ML20070Q1571990-12-31031 December 1990 1990 Annual Rept,Armed Forces Radiobiology Research Inst, Reactor Facility ML20055J4821990-07-23023 July 1990 Safety Evaluation Supporting Amend 19 to License R-84 ML20042F0431990-05-0303 May 1990 Comparison & Correlation of Proposed & Current Emergency Plans. ML20042F0291990-04-30030 April 1990 Fuel Follower Control Rod Safety Analysis for Armed Forces Radiobiology Research Inst Triga Reactor Facility. ML20012E9841990-03-29029 March 1990 Ro:On 900228,chamber Door of Primary Reactor Continous Air Monitors (CAM) Left Partially Open,Causing Filter to Be Several Centimeters Further from Detector than Normal. Backup CAM Will Be Wired Into Damper Isolation Sys ML20006G2261990-02-22022 February 1990 Ro:On 900126,reactor Room Sealing Dampers Did Not Fully Seal When in Closed Position During Triga Ventilation Sys Insp. Air Monitoring Sys Showed No Release of Fission Products or Release of Contaminants in Reactor Room.Dampers Repaired ML20006F1561990-02-0707 February 1990 Ro:On 900126,discovered That Reactor Room Sealing Dampers Did Not Fully Seal When in Closed Position During Insp of Ventilation Sys.Dampers Repaired & Returned to Svc on 900126 ML20245G8781988-12-31031 December 1988 Reactor Facility Annual Rept 1988 ML20006G2281988-11-0808 November 1988 Ro:On 881011,reactor Operator Left Console Unlocked While Tracing Electrical Circuit.Discovered by Another Operator Who Locked Console & Removed Key.Two Corrective Actions Were Taken to Prevent Recurrence.Operator Counseled ML20196D2731988-07-0505 July 1988 New Reactor Control Console QA Program ML20196D2821988-05-11011 May 1988 Description of Old & New Reactor Instrumentation & Control Sys for Affri Mark F Reactor Facility ML20196D2531988-05-11011 May 1988 10CFR50.59 SER of New Reactor Instrumentation & Control Sys at Armed Forces Radiobiology Research Inst ML20006G2311988-03-23023 March 1988 Ro:On 880229,reactor Room Primary Continuous Air Monitor Accidently Left in Test Mode During Operations.Two Sets of Corrective Actions Taken to Prevent Recurrence Including Flashing Visual Light Installed on Console in Control Room ML20150E6021987-12-31031 December 1987 Reactor Facility Annual Rept Jan-Dec 1987 ML20140B8901985-12-31031 December 1985 Reactor Facility Annual Rept 1985 ML20100D0301984-12-31031 December 1984 Annual Rept for Armed Forces Radiobiology Research Inst Triga Mark-F Reactor ML20100D0521984-09-30030 September 1984 Revised SAR for Armed Forces Radiobiology Research Inst Triga Mark-F Reactor ML20082B0791983-10-31031 October 1983 Annual Rept,Oct 1982 - Sept 1983 ML20066C1541982-09-30030 September 1982 Annual Operating Rept for Armed Forces Radiobiology Research Inst for Oct 1981 - Sept 1982 ML20040A9341981-12-29029 December 1981 Ro:On 811222 & 23,intermittently Changing But Fixed Vertical Position of Transient Control Rod Noted.Caused by Failure of Bolt That Secures Telescoping Section of Transient Connecting Rod.Section Removed & Secured W/Bolt ML20038B2551981-08-26026 August 1981 General Atomic Triga Mark F (GA-TRIGA F). ML20010B4051981-07-31031 July 1981 Ro:On 810730,operator Failed to Measure k-excess Prior to First Reactor Power Operation.Excess Reactivity,Measured on Daily Basis,Has Not Varied Outside Normal Operational Conditions.Internal Administrative Procedure Instituted ML20009B0231981-05-12012 May 1981 SAR for Armed Forces Radiobiological Research Inst Triga Reactor Facility,License R-84 ML19345C8651980-12-0303 December 1980 Armed Forces Radiobiology Research Inst R-84,Annual Rept Oct 1980. ML19338E8641980-10-0303 October 1980 Eia Data for AFRRI-TRIGA Reactor. ML19338E8531980-10-0303 October 1980 Reactor Operator Requalification Program. ML19345C8661980-09-18018 September 1980 Section VI Safety Analysis of Fsar. ML19338E8501980-09-18018 September 1980 Safety Analysis of Hazard Summary Rept,Chapter 6 to Fsar. ML19338D0441980-09-17017 September 1980 Proposed Reactor Operator Requalification Program. ML19322E5831980-03-25025 March 1980 Ro:On 800315,scram Indicators on Reactor Control Console Were Illuminated,Indicating Power Failure or Outage of Console.Caused by Damaged Operational Amplifier.Circuit Board Replaced.Relay,Requiring Manual Reset,Installed ML19242C4621979-08-0101 August 1979 Deficiency Rept Re Malfunction of Fuel Element Temp Sensing Circuit.Grounding Strap Installed at Main Ground to Lock Signal & Sys Ground Together ML19242C4971979-07-31031 July 1979 Amended Deficiency Rept Re Malfunction of Pool Water Level Sensing Switch,Submitted by Defense Nuclear Agency.Switch Unit Replaced & Addl Sleeving Placed at Wear Point ML20062A4411978-10-0606 October 1978 Forwards AFRRI-TRIGA(R-084 Yae)Annual Rept 1998-03-12
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DEFENSE NUCLEAR AGENCY ARMED FORCES RAD 10 BIOLOGY RESE ARCH INSTITUTE BETHESDA, M ARYLAND P0814 6146 i
SIAJECT: Licensee Event Report 29 merch 1990 United States Nuclear Regulatory Commission Attn Document Centrol Desk Washington, D.C. 20665 Centlemen In accordance with 10 CFR 50.73, the attached Licensee Event Reports are subeltted for your consideretten. The point of contact for further information concerning these events is the Reector Facility Director, W.L. Moore, (301) -
296-1290. !
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& b. M -l CEOR E IRVING III Colonel,USAF,BhC Director
Enclosures:
es stated cc: USNRC - Region 1 - Project Engineer Division of Reactor Projects USNRC - Hoodquarters - Project Wene9er Nuclear Reactor Regulation f
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AFRRI TRIGA Reacter Facility t
Prepared by:
Waj James R. Felty Robert Coorge r
I Wr Wark Woore i i N Sth<)90 Reactor Facilitk/ Director f
Approved for Release: ,
(._GeorgeW.Irving,III htYfb . <4
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d' ' J Coldnel, USAF, BSC / t Director, AFRRI j Abstract On 28 february 1990 during a routine daily check of the Continuous Air Monitors (CAVs) it was discovered that the chamber door of the primary reactor .
CAM had inadvertently been left partially open during the daily startup. This !
CAM is used to monitor reactor room air for radioactive particulate material. ,
When this CAM detects a level of radioactive particulate material on its filter greater than a preset level, the alarm will sound and positive sealing dampers in the ventilation system will close thereby isolating the Reactor Room from :
the environment. A back up CAM in the reactor room was operating properly i during the early morning reactor operations and an analysis of the charts and r filter papers f rom both CAVs as well as pool mater samples shomed no release of f ission f ragments. Had there been a fission f ragment release, high efficiency particulate filters located in the ventilation exaust system would have backed l vp the dampers until the back up (AM alarm had prompted an operator to manually ,
close the dampers. -
Narrative Description of Event Backoround. The primary CAM is wired into the positive sealing dampers in the reactor room ventilation system such that af it alarms these dampers mill close to restrict airflom into and out of the reactor room The CAV samples particulate material from air by filtering it and and reading the counts from l decaying radioactive material that is trapped on the filter. luo CAVs are
c ] ,
'. located about twenty f eet f rom the Reactor dolly (the device v' sed to mose the l- , reactor across the pool). Both air intake hoses f rom the CAWS take their air l sample from above the reactor pool.
(. ,
! Event Description. The chamber door on the primary CAW mas inadvertently left l open. This caused the filter to be several centimeters further from the l l'
detector than normal. The primary CAM was still filtering reactor room air. !
However, the air sample was not being taken from directly over the pool. l 1
i Chronolony of Events. For 28 February 1990 <
0535 CAM mas checked during morning startup. Chamber door ,
inadvertently left open, :
i 0556 Startup is completed and rods are raised to measure reactor j excess reactivity.
0600 Reactor critical at 15 matts for eight minutes. ,
0614 Reactor Critical at 1 Wegamatt for tuenty two minutes. ;
i 0755 Reactor critical at 500 Kilowatt for three minutes. !
0826 Reactor critical at 500 Kilowatt for thirteen minutes. ;
0840 (Approximately) Primary Reactor CAW chamber door discovered open !
by Safety & Health Depart.mont representative. The Reactor i Operations Supervisor was immediatly notified of the situation. The ;
CAM filter was replaced and the chamber door was closed. :
f 0850 Reactor Facility Director mas notified. ,
0855 Filters for both CAWS mere taken to the radionnalysis lab and ;
analysed.
0900 Pool mater sample mas taken and analysed. j I
1045 Maj . J. R. Felty notifies Vr. Paul Kaufman of the NRC Region I.
1 March 1990 l L
1545 Fact sheet f axed to NRC Region I, Mr. Paul Kaufman, f Wethod of Discovery. The open door on the CAV mas discovered during the ;
routine daily check of the CAMS by a Safety and Health Department i representative. l Automatically Initiated Safety System Response. The primary CAV causes an air i damper system that regulates the ilow of air in*o and out of the reactor room }
to close whenever this CAM alarms. Because the door mas open, the collecting i response of the primary CAV mould probably have been delayed due to the tinie t for the fission products to travel to the filter as mell as the increased
- quantity that would have to be accumulated on the f ilter to initiate a responce of the primary CAV detector. The back up CAV mas operating properly. If a release of fission fragments had occured, the back up CAV mould have alarmed. >
r l
o This would have alerted the reactor operator of a problem and the operator would have scramed the reactor and investigated the alarm, i Assessment of Safety Consequences l The Absolute filters in the ventilation exaust system will stop 99.975 of !
partical material greater than 0.3 microns. These highly ef ficient exaust l filters would have removed much of the contamination f rom a fission f ragment j release. The back up CAW ,ohich was operating properly, would have alarmed and alerted the operator of a problem in the reactor room. By procedure, the [
operator would have scrammed the reactor and manually closed the air dampers by !
9 means of a smitch in the control room. Closing the dampers mould have sealed ,l the room thereby stoping the release of radioactive material from the reactor :
room. j Description of Corrective Actions i To ensure that the dampers mill close in the event of a release of radioactive l material in the reactor room, the backup CAM will be wired into the damper j isolation system, in parallel to the primary CAM. This corrective action provides for a backup system that is fully capable of functioning exactly like the primary system in the event that the primaty system is ever rendered [
inoperable, ,
Reference to any previous similar events i
None f Point of Contact f or any Elvestions I
~
Points of contact for further information are the Reactor Facility Director, Mr. Vark Moore and/or the Reactor Operations Supervisor, Maj. James Felty. ;
TeIephone Number: 301-295-1290 :
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b3W$ ? L, } W .
Geor W.Irving,III !'
Colonel, USAF, BSC Director r
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