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| Quarter | Site | Title | Description | |
|---|---|---|---|---|
| 05000302/FIN-2009005-01 | 2009Q4 | Crystal River | Failure to Follow a Plant Procedure Resulted in an Inoperable HPI System | A self-revealing Non-Cited Violation (NCV) of Improved Technical Specification (ITS) 5.6.1.1.a was identified for the failure to follow a plant procedure which resulted in a loss of a 480 volt engineered safeguards motor control center (ES MCC)-3B1. Concurrent with pre-existing conditions, the high pressure injection (HPI) system was declared inoperable and ITS 3.0.3 was entered for a period of one hour and 24 minutes. The licensee entered this issue into the corrective action program as nuclear condition report (NCR) 333515. The finding was more than minor since it affected the equipment availability attribute of the mitigating system cornerstone and resulted in ITS 3.0.3 entry for the HPI system being inoperable. The finding was evaluated against NRC Phase 1 Significance Determination Process (SDP) and Phase 2 SDP was required due to a loss safety function of the HPI system. A Regional Senior Reactor Analyst performed a Phase 3 SDP evaluation and concluded this finding was of very low safety significance (Green). The major assumptions of the evaluation were that the HPI function was out of service for exposure period (1 .5 hours) and there would be no recovery of the de-energized motor control center. The dominant accident sequence involved a support system failure of the Emergency Feedwater (EF) Indication and Control System rendering Main Feedwater and automatic control of EF unavailable, operators were unable to manually control EF flow causing its failure and with the HPI function lost due to the performance deficiency, core damage ensued. The inspectors determined the cause of the finding is related to the cross-cutting area of Human performance with a work practices aspect H.4 (c)). Specifically, work scope changes involving safety-related equipment did not receive the appropriate level management oversight resulted in a plant procedural violation |
| 05000302/FIN-2009005-03 | 2009Q4 | Crystal River | Licensee-Identified Violation | The following issue of very low safety significance (Green) was identified by the licensee and was a violation of NRC requirements. This issue met the criteria of Section VI of the NRC Enforcement Policy, NUREG-1600, for being dispositioned as a Non-Cited Violation. 10 CFR 26.205(d) requires, in part, that individuals subject to work hour controls do not exceed 26 work hours in any 48-hour period and 72 work hours in any 7-day period; requires a 34-hour break in any 9-day period; and a 10-hour break between successive work periods. During the period of October 12 to October 19, 2009, one worker exceeded 26 hours in a 48-hour period; nine workers exceeded 72 hours in a 7-day period; five workers did not have a 34-hour break in a 9-day period; and two workers did not have the required 10-hour break between successive work periods. The violation was limited to one work group, Florida Transmission Personnel, who were on-site to support outage work. The licensee determined that the Transmission personnel did not have a firm understanding of the revised 10 CFR Part 26 requirements. The finding was more than minor because, if left uncorrected, it would become a more significant safety concern. Specifically, the excessive work hours would increase the likelihood of human performance errors during plant maintenance activities that could affect equipment performance. The finding is of very low safety significance because no significant events or human performance issues were directly linked to personnel fatigue as a result of the hours worked. This issue was documented in the licensees corrective action program as NCR 361777 |
| 05000302/FIN-2009005-02 | 2009Q4 | Crystal River | Manual Reactor Trip Due to Group 7 Control Rods Insertion Caused by Inadequately Protected Test Jumper | A self-revealing NCV of Improved Technical Specification (ITS) 5.6.1.1.a was identified for the failure to follow the provisions of preventative maintenance procedure PM-126, Electrical Checks of CRD (Control Rod Drive) Power Train. Failure to follow PM-126 caused the failure of the Group 7 control rod programmer during maintenance and resulted in the unexpected insertion of the Group 7 control rods fully into the core. This unexpected insertion of these control rods into the core caused control room operations personnel to manually trip the reactor from 100 percent power. The licensee entered this issue into the corrective action program as NCR 351705. This finding was determined to be more than minor because it was associated with the initiating events cornerstone attribute of Human Performance, and adversely affected the cornerstone objective to limit the likelihood of those events that upset plant stability and challenge critical safety functions during at-power operations. The finding was evaluated using Phase 1 of the At-Power SDP, and was determined to be of very low safety significance (Green) because it did not contribute to both the likelihood of a reactor trip and the likelihood that mitigating equipment or functions were not available. The cause of this finding was directly related to the cross-cutting area of Human Performance with a work practices aspect (H.4 (b)). Specifically, the workers failed to follow the preventative maintenance procedure |