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| Start date | Reporting criterion | Title | Event description | System | LER | |
|---|---|---|---|---|---|---|
| ENS 52338 | 29 October 2016 07:00:00 | Agreement State | Agreement State Report - Radiographer Dosimetry Left Near Exposure Device During Radiography Shot | This report was received by the State of Washington via email: During preparation of a radiography exposure, the radiographer and another radiation worker from Bechtel, attempted to untangle their dosimetry from the camera apparatus. In doing so, they left their dosimetry next to the camera during a shot. The radiographer exposed his TLD (Thermo Luminescent Dosimetry) and pocket dosimeter, as well as a client's electronic dosimeter during the exposure. Their dosimetry minus the radiographer's rate alarm was left next to the camera during the exposure. The radiographer wears dosimetry issued by Northwest Inspection and their client, Bechtel, sub contractor of the US Department of Energy. The radiographer's pocket dosimeter was off scale. Bechtel's electronic dosimeter showed an exposure dose of 300 mrem. The radiographer reported the incident to the RSO (Radiation Safety Officer). The radiographer's TLD was sent to the dosimetry processing facility. Additional training for the radiographer has already taken place. In view of the fact that no 'persons' were overexposed, a spare TLD will be issued to the radiographer and will be allowed to continue to work. The radiography camera is a QSA Model Number A424-9, Serial Number 32886G, containing an Ir-192 34.5 Ci source. Washington State Incident Number: WA-16-045 | ||
| ENS 44552 | 30 September 2008 14:00:00 | Agreement State | Agreement State Report - Radiography Source Disconnected from Control Cable | Washington state submitted the following report via e-mail: A licensee reported to the Department of Health (DOH) that an industrial radiography (IR) source had become disconnected from the control cable that prevented the retrieval of the source back into its safe shielded position. The exposure device is a QSA Global Sigma 880 with a 97 Curie Iridium-192 source. The source disconnect occurred at 7:00 AM 9/30/08 at a construction site three miles northeast of Moses Lake, Washington. The President and Radiation Safety Officer (RSO) of the licensed IR company are on scene with 12 company employees to correct the situation. The radiographer had previously made several exposures on pipe welds earlier in the day before the disconnect occurred. The source remained at the end of the guide tube, in the collimator, when the radiographer tried to retract it into the device. The radiographer tried this several times. A large area at the construction site has been secured by barricades and the IR personnel are guarding the radiation area. At present, it appears that personnel have not received any elevated or unusual exposure as a result of the disconnect. The IR company is working with the Office of Radiation Protection and the radiography device manufacturer to develop a plan to retrieve the source. DOH staff were sent to the location to assure radiation safety procedures are followed and independent measurements are made. Washington Report: WA080073
The following information was obtained from the State of Washington via email: DOH staff went to the incident site at 1:30 p.m. on the day of the event. They assisted the IR company RSO establish the planned special exposure recovery plan. About 2:30 p.m. the construction-site safety officers were briefed on the recovery plan. Materials and equipment needed for the plan were assembled and at 3:35 they began the recovery operation. The plan included using a site crane and operator to extricate the camera, guide tube, collimator with source from the work scaffolding. The IR equipment was moved to a better location in an area away from the construction site. At 4:26 p.m. the camera and source were placed into a lead lined steel skiff-box and lifted to an area between a high dirt bank and tall concrete retaining wall. The new location was roped off and secured by the IR personnel. The actual recovery began at about 6:30. The IR drive cable was modified as the manufacturer recommended by filing two sides of the attachment fitting. Several attempts were made to hook onto the source pigtail. At around 9:30 the source was successfully pulled back into and locked in the camera. Surveys indicated the source was successfully placed into the shielded position. Pocket dosimeter readings for the four IR employees that were directly involved with the recovery indicated 10, 45, and 52 mRem. None of the construction workers received an exposure above background. The camera, with the source and associated equipment involved with the disconnect, was sent to the manufacturer for evaluation to determine why the equipment failed to operate as designed. On October 1, 2008, the DOH Radioactive Materials' supervisor and the IR program lead staff went to the site to follow-up with the investigation and to close the event. While on site, they addressed an assembly of 800 craft construction workers. Several asked questions about the incident and voiced their concerns for the potential exposure they may have received. DOH staff also talked directly to several individuals before and after the briefing. A large majority of the construction workers seemed to understand that their health and safety had not been affected as a result of the incident. (The State) has subsequently heard that the manufacturer (QSA Global) had determined that the pigtail connector had an engineering defect that allowed that connection to part from the drive cable causing the disconnect. Notified FSME (Burgess) and R4DO (Deese) | ||
| ENS 40900 | 25 June 2004 07:00:00 | Agreement State | Agreement State Report Involving a Stolen/Recovered Radiography Camera | The following information was provided by the State of Washington to the NRC via email: This is notification of an event in Washington State as reported to or investigated by the WA Department of Health, Office of Radiation Protection. STATUS: new Licensee: Northwest Inspection City and State: Richland, Washington License Number: WN-IR065-1 Type of License: Industrial Radiography Date of Event: 25 June 2004 (reported July 26) Location of Event: Spokane, Washington ABSTRACT: (where, when, how, why; cause, contributing factors, corrective actions, consequences, Dept. of Health (DOH) on-site investigation; media attention): The licensee's radiation safety officer reported that they had had a radiography vehicle stolen, with a radiography exposure device secured inside (device and source information not yet known). The Radiographer, at the end of the day, had left the radiography vehicle unattended while that Radiographer entered a work-site office to complete paperwork. The Assistant Radiographer had left the work-site earlier when actual radiography had concluded. During the brief time the vehicle was unattended, reported to be about 2 minutes, the vehicle was taken. The Radiographer called the police and the radiation safety officer when the vehicle was noticed missing. A short time later, reported to be about 30 minutes, a Spokane area resident noticed the truck, stuck by the side of the road. The resident used licensee identification, from the outside of the vehicle, to contact the licensee. The licensee had the resident call local police. The police secured the vehicle. Later, the licensee recovered the vehicle. The locked camera storage/transportation container had not been disturbed. No Media attention noted. Notification Reporting Criteria: 10 CFR, Part 20.2201(a)(1)(ii) Isotope and Activity involved: Not yet known Overexposures? (number of workers/members of the public; dose estimate; body part receiving dose; consequence): None, N/A Lost, Stolen or Damaged? (mfg., model, serial number): Stolen (briefly), camera and source information is not yet known. Disposition/recovery: Recovered without additional incident. Leak test? Not yet known Vehicle: (description; placards; Shipper; package type; Pkg. ID number) The vehicle is a combination of pick-up truck with industrial trailer. The trailer serves as the darkroom and camera storage. No placards since package was a Yellow II. Type B package inside a convenience over-pack. Release of activity? None, N/A Event Report # WA-04-043
Status: Close (reported as new July 27, 2004) The licensee has provided the following additional information: The camera, INC Model IR-100 device, Serial Number 4694, DU leak test on 26 January 2004, test was negative. The source, Ir-192 (68 curies on 25 June 04), INC Model 32, Serial Number F959, sealed source leak test 11 May 2004, test was negative. Notified R4DO (Runyan) and NMSS (Holonich). |