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#REDIRECT [[05000278/LER-1991-004-02, :on 910324,reactor Operator Failed to Initial Surveillance Test 5.3, Inoperable Valve Position Daily Log. Caused by Personnel Error Due to Failure to Follow Procedure.Operator Counselled]]
| number = ML20024G739
| issue date = 04/24/1991
| title = LER 91-004-00:on 910324,reactor Operator Failed to Initial Surveillance Test 5.3, Inoperable Valve Position Daily Log. Caused by Personnel Error Due to Failure to Follow Procedure.Operator counselled.W/910424 Ltr
| author name = Fray J, Fulvio A
| author affiliation = PECO ENERGY CO., (FORMERLY PHILADELPHIA ELECTRIC
| addressee name =
| addressee affiliation = NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
| docket = 05000278
| license number =
| contact person =
| document report number = CCN-14057, LER-91-004-02, NUDOCS 9104290150
| document type = LICENSEE EVENT REPORT (SEE ALSO AO,RO), TEXT-SAFETY REPORT
| page count = 4
}}
 
=Text=
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e                                        PHILADELPHIA ELECTRIC COMPANY PEACil BUFIDM A10MIC POWl:R STATION R D,1, llox 20fl
                                                  .-                                Delta, Itnnsylvania 17314 esuw mornw-tm rm an or a scossem .                                                    (717) 4 % 7014
                                                                                                                                              . April 24'1991 y
:y Docket No. 50-278 Document Control Desk U. S. Nuclear. Regulatory Commission Washington, DC 20555
                                                                                                                                                                                          .l
 
==SUBJECT:==
        ' Licensee-Event Report                                                                                                        '
Peach Bottom Atomic Power Station                                      : Unit 3                                              !
This LER concerns Prisaary Containment Isolation Valve logging _not being performed:as required by Technical Specifications due.to personnel errir.-
 
==Reference:==
-                Docket No. 50-278
                                                                                    -                                                                                                      i
                                            -Report _Humber:              3-91-004
;,                                          Revisio'n Number:-        -00                                                                                                                1 1                                            Event Date:              103/24/91                                                                                                        -!
Report Date:?                04/.?4/91 Facil_ity: -                Peacti Bottom Atomic Power Station
                                                                        'RD~1,-Box 208.-Delta, PA 17314                                                                                    ,
                              .. _ This LER is being: submitted 1 pursuant to-the requirements of 10 CFR 50.73(a)(2)(1)(B).-
                                                                                                                              ~ Sincerely,
                                                                                                                              ' jYf
                                                                                                                                          }                                                .
cc:l$1.iJ.Lyash,USHRC; Senior-ResidentInspector TO T.;tiartin,LUSNRC, Region I m;
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9104290150 910424                                        ^-
PDR          ADOCK'05000278                      mO'd33 4$D>    '
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L bec:    R. A. Burricelli, Public Service Electric & Gas Commitment Coordinato*
Correspondence Control Program T. M. Gerusky, Commonwealth of Pennsylvania INPO Records Center R. 1. McLean, State of Maryland C. A. McNeill, Jr. - S26-1 PECo President and C00 D. B. Miller, Jr. - SMO-1, Vice President - PBAPS Huclear Records - PBAPS H. C. Schwemm, VP - Atlantic Electric J. Urban, Delmarva Power l
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        % AVE                                                                                                                                            TE LkPHONE NVMBER akt A CUDE A. A. Fulvio ,                    Regulatory Engineer                                                                          j 1,7 7                4; 5 g 6    j ,7 i 0;l l 4 COMPLETI ONE LINI POR E ACH COMPONtNT F AILUni Dt%CRISED IN THl3 REPQRT (1)
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On 3/24/91 and 3/25/91, a Technical Specification (Tech Spec) violation occurred when the Unit 3 Reactor Operator (RO) failed to initial Surveillance Test (ST) 5.3,
            " Inoperable Isolation Valve Position Daily Log", signifying that he had verified containment penetrations containing inoperable isolation valves were isolated as required by Tech Specs. The cause of this event is personnel error due to failure to follow procedure.                      ST 5.3 requires the R0 to initial daily that he has verified the penetration is isolated. Corrective actions include routing the pertinent information from this LER to the appropriate Operations personnel and reviewing the l          on the job portion of the licensed operator training program. The R0 involved in this event was counselled and coached by Shift Management following the incident on the performance of administrative-tasks associated with the R0's responsibilities.
There were no safety consequences as a result of this event.
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* LICENSEE EVENT REPORT (LER) TEXT CONTINUATION                            maoveo ow so mom taPmis 811C FActLITY hAMt (1)                                                  DOCKit NUM8t h W            g g gg g 4                    gg y Peach Bottom Atomic Power Station
                                                                                                  "*"    " UO''        WJ.N 0 l5 l0 l0 l0 l 2l 7l8 9g1 __
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olo q2          oF  oj3 TEXT f# Fwe space a reeuwv4 use emporW MC Form 3tifA W (1M Requirements for the Report This report is being submitted pursuant to 10 CFR 50.73(a)(2)(i)(B) as a result of Technical Specification (Tech Spec) required inoperable isolation valve positions not being recorded daily.
Unit Conditions at Time of Event (3/24/91 and 3/25/91)
Power ascension was in progress on Unit 3 following a load drop for rod pattern adjustment and reactor feed pump maintenance. The mode switch was in the RUN position.            Reactor thermal power was between 74% to 99% during the time of the event.
Description of the Event On 3/24/91 and 3/25/91, a Tech Spec violation occurred when the Unit 3 Reactor Operator (RO) failed to initial Surveillance Test (ST) 5.3, " Inoperable Isolation Valve Position Daily Log", documenting that he had verified containment penetrations containing inoperable isolation valves were isolated. Tech Spec 4.7.D.2 requires that the position of at least one other valve in each line having an inoperable isolation valve be recorded daily. The inoperable isolation valves in question were solenoid valve (SV)-3671B 0xygen (02) Analyzer Sample valve and Motor Operated (MO)-
3-10-017 RHR Shutdown Cooling Suction valve. The SV-36178 penetration was isolated by hand valve (HV)-3-7D-50134 in the closed position under Shift Permit 3-90-192.
The Shutdown Cooling suction penetration was isolhted by H0-3-10-017 de-energized in the closed position and H0-3-10-018 maintained closed under Shift Permit 3-10-108.
The day shift R0 on 3/26/91 discovered that ST 5.3 had not been initialed on 3/24/91 and 3/25/91. The R0 on 3/26/91 was different from the R0 on 3/24/91 and 3/25/91.
The position of the valves in question were verified and it was verified that the penetrations had not been opened on the two days the ST had not been initialed. The R0 who missed the signoffs indicated that he had verified the position of the valves during shift turnovers but forgot to initial ST 5.3.
Cause of the Event The cause of this event was determined to be personnel error. The day shift R0 (Utility, Licensed) failed to record the position of the inoperable isolation valves daily as required by ST 5.3 and Tech Spec 4.7.0.2. The On The Job Training (0JT) portion of the Licensed Operator Training Program includes this Tech Spec requirement, however, it may have been less than effective.
    ,                                                                                                                                              I u
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0l0      O! 1 or    0l3 text is -, e-.    ,, < i,a .** , we som m si on Analysis of the Event No actual safety consequences occurred as a result of this event. Tech Spec 4.7,0.2 requires that the position of the vaJve used tc isolate a primary containment penetration containing an inoperable isolation valve be recorded daily. Per ST 5.3, if the position of the valve in question cannot be determined from the Contrcl Room, verifying that the Shift permit is still applied is adequate.                    Since the Shift Permits for both valves in question have red blocking tags, a Temporary Clearance would be required to reposition the valves. A review of the Shift Permits showed that neither Shift Permit has been temporarily cleared since applied. Therefore, although the position of the valves was not recorded, the penetrations did remain isolated on 3/24/91 and 3/25/91.
Corrective Actions The R0 involved in this event was counselled and coached by Shift Management following the incident on the performance of administrative tasks associated with the R0's responsibilities.
The pertinent information contained in this LER will be routed to the appropriate Operations personnel.
The 0JT portion of the Licensed Operator Training program will be reviewed for adequacy and corrective action taken as necessary.
Previcus Similar Events There were three previous similar events identified.              LER 2-89-027 concerned not logging the Suppression Pool temperature when required by Tech Specs. LER 3-90-009 concerned not logging the 'B' Recirculation loop temperature when required by Tech Specs. LER 3-90-015 concerned not logging Drywell sump flow readings as required by Tech Specs. Corrective actions could not have prevented this event since they mainly concerned informing appropriate Operations personnel of the specific events or other programmatic corrective actions pertaining to the events. The corrective action for this event concerning reviewing the OJT portion of the licensed operator training program is expected to more generically address data logging problems.
                                                                                                                    . . . . m, n.. m. u . m u, g ,mu}}

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