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Category:LICENSEE EVENT REPORT (SEE ALSO AO
MONTHYEARML17335A5641999-10-18018 October 1999 LER 99-024-00:on 990708,literal TS Requirements Were Not Met by Accumlator Valve Surveillance.Caused by Misjudgement Made in Conversion from Initial DC Cook TS to W Std Ts.Submitted License Amend Request.With 991018 Ltr ML17335A5531999-10-0707 October 1999 LER 99-023-00:on 990907,inadequate TS Surveillance Testing of ESW Pump ESF Response Time Noted.Caused by Inadequate Understanding of Plant Design Basis.Surveillance Tests Will Be Revised & Implemented ML17326A1291999-09-17017 September 1999 LER 99-022-00:on 990609,electrical Bus Degraded Voltage Setpoints Too Low for Safety Related Loads,Was Discovered. Caused by Lack of Understanding of Design of Plant.No Immediate Corrective Actions Necessary ML17326A1121999-08-27027 August 1999 LER 99-021-00:on 990728,determined That GL 96-01 Test Requirements Were Not Met in Surveillance Tests.Caused by Failure to Understand Full Extent of GL Requirements. Surveillance Procedures Will Be Revised or Developed ML17326A1011999-08-26026 August 1999 LER 99-020-00:on 990727,EDGs Were Declared Inoperable.Caused by Inadequate Protection of Air Intake,Exhaust & Room Ventilation Structures from Tornado Missile Hazards. Implemented Compensatory Measures in Form of ACs ML17326A0911999-08-16016 August 1999 LER 99-019-00:on 990716,noted Victoreen Containment Hrrms Not Environmentally Qualified to Withstand post-LOCA Conditions.Caused by Inadequate Design Control.Reviewing Options to Support Hrrms Operability in Modes 1-4 ML17326A0771999-08-0404 August 1999 LER 98-029-01:on 980422,noted That Fuel Handling Area Ventilation Sys Was Inoperable.Caused by Original Design Deficiency.Radiological Analysis for Spent Fuel Handling Accidents in Auxiliary Bldg Will Be Redone by 990830 ML17326A0741999-07-29029 July 1999 LER 99-018-00:on 990629,determined That Valve Yokes May Yield Under Combined Stress of Seismic Event & Static,Valve Closed,Stem Thrust.Caused by Inadequate Design of Associated Movs.Operability Determinations Were Performed for Valves ML17326A0661999-07-26026 July 1999 LER 99-017-00:on 990625,noted That Improperly Installed Fuel Oil Return Relief Valve Rendered EDG Inoperable.Caused by Personnel Error.Fuel Oil Return Valve Was Replaced with Valve in Correct Orientation.With 990722 Ltr ML17326A0651999-07-22022 July 1999 LER 98-014-03:on 980310,noted That Response to high-high Containment Pressure Procedure Was Not Consistent with Analysis of Record.Caused by Inadequate Interface with W. FRZ-1 Will Be Revised to Be Consistent with New Analysis ML17326A0491999-07-13013 July 1999 LER 99-016-00:on 990615,TS Requirements for Source Range Neutron Flux Monitors Not Met.Caused by Failure to Understand Design Basis of Plant.Procedures Revised.With 990713 Ltr ML17326A0331999-07-0101 July 1999 LER 99-004-01:on 971030,failure to Perform TS Surveillance Analyses of Reactor Coolant Chemistry with Fuel Removed Was Noted.Caused by Ineffective Mgt of Tss.Chemistry Personnel Have Been Instructed on Requirement to Follow TS as Written ML17326A0151999-06-18018 June 1999 LER 99-014-00:on 990521,determined That Boron Injection Tank Manway Bolts Were Not Included in ISI Program,Creating Missed Exam for Previous ISI Interval.Caused by Programmatic Weakness.Isi Program & Associated ISI Database Modified ML17325B6311999-06-0101 June 1999 LER 99-S03-00:on 990430,vital Area Barrier Degradation Was Noted.Caused by Inadequate Insp & Maint of Vital Area Barrier.Repairs & Mods Were Made to Barriers to Eliminate Degraded & Nonconforming Conditions ML17325B6421999-06-0101 June 1999 LER 99-013-00:on 990327,safety Injection & Centrifugal Charging Throttle Valve Cavitation During LOCA Could Have Led to ECCS Pump Failure.Caused by Inadequate Original Design Application of Si.Throttle Valves Will Be Developed ML17325B6351999-05-28028 May 1999 LER 99-S02-00:on 990428,vulnerability in Safeguard Sys That Could Allow Unauthorized Access to Protected Area Was Noted. Caused by Inadequate Original Plant Design.Mods Were Made to Wall Opening to Eliminate Nonconforming Conditions ML17265A8231999-05-24024 May 1999 LER 98-037-01:on 990422,determined That Ice Condenser Bypass Leakage Exceeds Design Basis Limit.Caused by Pressure Seal Required by Revised W Design Not Incorporated Into Aep Design.Numerous Matl Condition Walkdowns & Assessments Made ML17325B6001999-05-20020 May 1999 LER 99-012-00:on 990420,concluded That Auxiliary Bldg ESF Ventilation Sys Not Capable of Maintaining ESF Room Temps post-accident.Caused by Inadequate Control of Sys Design Inputs.Comprehensive Action Plan Being Developed ML17325B5861999-05-10010 May 1999 LER 99-002-00:on 990415,discovered That TS 4.0.5 Requirements Were Not Met Due to Improperly Performed Test. Caused by Incorrect Interpretation of ASME Code.App J Testing Will Be Completed & Procedures Will Be Revised ML17325B5811999-05-0404 May 1999 LER 99-011-00:on 990407,air Sys for EDG Will Not Support Long Operability.Caused by Original Design Error.Temporary Mod to Supply Makeup Air Capability in Modes 5 & 6 Was Prepared ML17325B5771999-05-0303 May 1999 LER 99-010-00:on 990401,RCS Leak Detection Sys Sensitivity Not in Accordance with Design Requirements Occurred.Caused by Inadequate Original Design of Containment Sump Level. Evaluation Will Be Performed to Clearly Define Design ML17325B5581999-04-16016 April 1999 LER 99-006-00:on 990115,personnel Identified Discrepancy Between TS 3.9.7 Impact Energy Limit & Procedure 12 Ohp 4030.STP.046.Caused by Lack of Design Basis Control.Placed Procedure 12 Ohp 4030.STP.046 on Administrative Hold ML17325B5471999-04-12012 April 1999 LER 99-009-00:on 990304,as-found RHR Safety Relief Valve Lift Setpoint Greater than TS Limit Occurred.Cause Investigation for Condition Has Not Been Completed.Update to LER Will Be Submitted,Upon Completion of Investigation ML17325B5321999-04-0707 April 1999 LER 99-S01-00:on 990308,discovered That Lock for Vital Gate Leading to Plant 4KV Switchgear Area Was Nonconforming & Vulnerable to Unauthorized Access.Caused by Inadequate Gate Design & Inadequate Procedures.Mods Are Being Made to Gate ML17325B5161999-04-0101 April 1999 LER 99-007-00:on 981020,calculations Showed That Divider Barrier Between Upper & Lower Containment Vols Were Overstressed.Engineers Are Currently Working on Analyses of Loads & Stress on Enclosures ML17325B5221999-03-29029 March 1999 LER 99-001-00:on 960610,degraded Component Cooling Water Flow to Containment Main Steam Line Penetrations,Identified on 990226.Caused by Inadequate Understanding of Design Basis.Additional Investigations Ongoing ML17325B4801999-03-18018 March 1999 LER 99-004-00:on 971030,failure to Perform TS Surveillance Analyses of Rc Chemistry with Fuel Removed Was Noted.Cause of Event Is Under Investigation.Corrected Written Job Order Activities Used to Control SD Chemistry Sampling ML17325B4741999-03-18018 March 1999 LER 99-005-00:on 940512,determined That Rt Breaker Manual Actuations During Rod Drop Testing Were Not Previously Reported.Caused by Lack of Training.Addl Corrective Actions,Including Preventative Actions May Be Developed ML17325B4571999-02-24024 February 1999 LER 99-003-00:on 990107,CR Pressurization Sys Surveillance Test Did Not Test Sys in Normal Operating Condition.Caused by Failure to Recognize Door 12DR-AUX415 as Part of CR Pressure Boundary.Performed Walkdown of Other Doors ML17335A5171999-02-11011 February 1999 LER 99-002-00:on 990112,determined That RCS Pressurizer PORVs Had Not Been Tested,Per Ts.Caused by Inadequate Scheduling Controls Allowing Personnel Error.Surveillance Procedure Was Completed & Updated LER Will Be Submitted ML17335A5141999-02-10010 February 1999 LER 99-001-00:on 990106,noted That GE Hfa Relays Installed in EDGs May Not Meet Seismic Qualification.Caused by Operating Experience Info Incorrectly Dispositioned in 1985. Updated LER Will Be Submitted by 990405 ML17335A5011999-02-0101 February 1999 LER 98-060-00:on 981231,identified That Rt Sys Response Time Testing Did Not Comply with TS Definition.Caused by Inadequate Procedures.Corrective Actions Will Be Developed & Update to LER Will Be Submitted by 990415.With 990201 Ltr ML17335A4951999-01-29029 January 1999 LER 98-059-00:on 981230,interim LER -single Failure in Containment Spray Sys Could Result in Containment Spray Ph Outside Design Occurred.Investigation Into Condition Continuing.Update Will Be Submitted by 990514 Ltr ML17335A4961999-01-27027 January 1999 LER 98-057-00:on 981228,discovered That AFW Valves Were Not Tested IAW Inservice Testing Program.Caused by Failure to Recognize Design Bases Features Re Afws by Personnel. Updated LER Will Be Submittted by 990415.With 990127 Ltr ML17335A4921999-01-19019 January 1999 LER 98-052-01:on 981128,no Analysis for NSR Sc Manual Loader for Tdafwp Could Be Found in Original Design.Cause Due to All Failure Modes Not Considered When Compressed Air Sys Originally Designed.Performed Review of Components ML17335A4721999-01-0606 January 1999 LER 98-055-00:on 981207,potential for Condition Outside of Design Bases for Rod Control Sys Was Noted.Caused by Calibration Error Coupled with Single Rod Failure.Condition Rept Investigation Is Ongoing ML17335A4691999-01-0606 January 1999 LER 98-056-00:on 981211,hot Leg Nozzle Gaps Resulted in Plant Being in Unanalyzed Condition.Analyses Are Being Performed by W to Resolve Problem.Updated LER Will Be Submitted by 990211.With 990106 Ltr ML17335A4661999-01-0505 January 1999 LER 98-049-00:on 981020,emergency Boron Injection Flow Path Was Inoperable.Caused by Original Design Deficiency. Engineering Evaluation of Event Is Continuing ML17335A4631999-01-0404 January 1999 LER 98-054-00:on 981202,discovered That at Least One MSSV Had Not Been Reset as Required by Ts.Engineering Is Continuing Review of Extent of Condition for Event.Updated LER Will Be Submitted by 990129.With 990104 Ltr ML17335A4481998-12-30030 December 1998 LER 98-053-00:on 981130,discovered Use of Inoperable Substitute Subcooling Margin Monitor.Caused by Condition Existing Since Installation of Plant Process Computer in 1992.Updated LER Will Be Submitted.With 981230 Ltr ML17335A4581998-12-28028 December 1998 LER 98-052-00:on 981128,turbine Driven AFW Pump Speed Controller Failure Mode Occurred.Caused Because Not All Failure Modes Were Considered When Compressed Air Sys Was Originally Designed.Verified Current Design Change Process ML17335A4281998-12-22022 December 1998 LER 98-051-00:on 981122,reactor Trip Signal from Manual Safety Injection Not Verified as Required by TS Surveillance,Was Discovered.Maintenance Currently Evaluating Significance & Cause of Event ML17335A4111998-12-17017 December 1998 LER 98-047-00:on 981117,potential for Increase Leakage from Reactor Coolant Pump Seals Was Identified.Util Is Working with W to Resolve Issue.Current Expectations Are to Submit Update to LER by 990215.With 981217 Ltr ML17335A4141998-12-16016 December 1998 LER 98-058-00:on 981216,postulated High Line Break Could Result in Condition Outside Design Bases for AF Occurred. Caused by Deficiencies Associated with Administration of HELB Program.Analysis of AF Will Be Completed by 990122 ML17335A4181998-12-16016 December 1998 LER 98-050-00:on 980814,ancillary Equipment Installed in Ice Condenser Was Not Designed to Withstand Design Basis Accident/Earthquake Loads.Caused by Lack of Established Design Criteria.Developed Design Criteria ML17335A3871998-12-11011 December 1998 LER 98-031-01:on 980610,potential Common Mode Failure of RHR Pumps Were Noted.Caused by Inaccurate Values.Accurate Miniflow Numbers Have Been Determined by Flow Testing ML17335A3821998-12-0808 December 1998 LER 98-039-01 Re EOP Step Conflicts with Small Break LOCA Analysis.Ler 98-039-00 Has Been Canceled.With 981208 Ltr ML17335A3781998-12-0707 December 1998 LER 98-007-00:on 981106,high Energy Line Break Effects in Auxiliary FW Sys Was Noted.Cause of Event Is Under Investigation & Will Be Completed by 990220.Updated LER Will Be Submitted by 990310.With 981207 Ltr ML17335A3771998-12-0303 December 1998 LER 98-046-00:on 981103,determined That Afs Was Unable to Meet Design Flow Requirements During Special Test.Caused by Failure to Consider All Aspects of Sys Operation in Design of Suction Basket Strainers.Sys Will Be Redesigned ML17335A3741998-12-0202 December 1998 LER 97-011-02:on 970822,operation Was Noted Outside Design Bases for ECCS & CSP for Switchover to Recirculation Sump Suction.Caused by Ineffective Change Mgt.Revised Procedure for Switchover 01(02) Ohp 4023.ES-1.3 1999-09-17
[Table view] Category:RO)
MONTHYEARML17335A5641999-10-18018 October 1999 LER 99-024-00:on 990708,literal TS Requirements Were Not Met by Accumlator Valve Surveillance.Caused by Misjudgement Made in Conversion from Initial DC Cook TS to W Std Ts.Submitted License Amend Request.With 991018 Ltr ML17335A5531999-10-0707 October 1999 LER 99-023-00:on 990907,inadequate TS Surveillance Testing of ESW Pump ESF Response Time Noted.Caused by Inadequate Understanding of Plant Design Basis.Surveillance Tests Will Be Revised & Implemented ML17326A1291999-09-17017 September 1999 LER 99-022-00:on 990609,electrical Bus Degraded Voltage Setpoints Too Low for Safety Related Loads,Was Discovered. Caused by Lack of Understanding of Design of Plant.No Immediate Corrective Actions Necessary ML17326A1121999-08-27027 August 1999 LER 99-021-00:on 990728,determined That GL 96-01 Test Requirements Were Not Met in Surveillance Tests.Caused by Failure to Understand Full Extent of GL Requirements. Surveillance Procedures Will Be Revised or Developed ML17326A1011999-08-26026 August 1999 LER 99-020-00:on 990727,EDGs Were Declared Inoperable.Caused by Inadequate Protection of Air Intake,Exhaust & Room Ventilation Structures from Tornado Missile Hazards. Implemented Compensatory Measures in Form of ACs ML17326A0911999-08-16016 August 1999 LER 99-019-00:on 990716,noted Victoreen Containment Hrrms Not Environmentally Qualified to Withstand post-LOCA Conditions.Caused by Inadequate Design Control.Reviewing Options to Support Hrrms Operability in Modes 1-4 ML17326A0771999-08-0404 August 1999 LER 98-029-01:on 980422,noted That Fuel Handling Area Ventilation Sys Was Inoperable.Caused by Original Design Deficiency.Radiological Analysis for Spent Fuel Handling Accidents in Auxiliary Bldg Will Be Redone by 990830 ML17326A0741999-07-29029 July 1999 LER 99-018-00:on 990629,determined That Valve Yokes May Yield Under Combined Stress of Seismic Event & Static,Valve Closed,Stem Thrust.Caused by Inadequate Design of Associated Movs.Operability Determinations Were Performed for Valves ML17326A0661999-07-26026 July 1999 LER 99-017-00:on 990625,noted That Improperly Installed Fuel Oil Return Relief Valve Rendered EDG Inoperable.Caused by Personnel Error.Fuel Oil Return Valve Was Replaced with Valve in Correct Orientation.With 990722 Ltr ML17326A0651999-07-22022 July 1999 LER 98-014-03:on 980310,noted That Response to high-high Containment Pressure Procedure Was Not Consistent with Analysis of Record.Caused by Inadequate Interface with W. FRZ-1 Will Be Revised to Be Consistent with New Analysis ML17326A0491999-07-13013 July 1999 LER 99-016-00:on 990615,TS Requirements for Source Range Neutron Flux Monitors Not Met.Caused by Failure to Understand Design Basis of Plant.Procedures Revised.With 990713 Ltr ML17326A0331999-07-0101 July 1999 LER 99-004-01:on 971030,failure to Perform TS Surveillance Analyses of Reactor Coolant Chemistry with Fuel Removed Was Noted.Caused by Ineffective Mgt of Tss.Chemistry Personnel Have Been Instructed on Requirement to Follow TS as Written ML17326A0151999-06-18018 June 1999 LER 99-014-00:on 990521,determined That Boron Injection Tank Manway Bolts Were Not Included in ISI Program,Creating Missed Exam for Previous ISI Interval.Caused by Programmatic Weakness.Isi Program & Associated ISI Database Modified ML17325B6311999-06-0101 June 1999 LER 99-S03-00:on 990430,vital Area Barrier Degradation Was Noted.Caused by Inadequate Insp & Maint of Vital Area Barrier.Repairs & Mods Were Made to Barriers to Eliminate Degraded & Nonconforming Conditions ML17325B6421999-06-0101 June 1999 LER 99-013-00:on 990327,safety Injection & Centrifugal Charging Throttle Valve Cavitation During LOCA Could Have Led to ECCS Pump Failure.Caused by Inadequate Original Design Application of Si.Throttle Valves Will Be Developed ML17325B6351999-05-28028 May 1999 LER 99-S02-00:on 990428,vulnerability in Safeguard Sys That Could Allow Unauthorized Access to Protected Area Was Noted. Caused by Inadequate Original Plant Design.Mods Were Made to Wall Opening to Eliminate Nonconforming Conditions ML17265A8231999-05-24024 May 1999 LER 98-037-01:on 990422,determined That Ice Condenser Bypass Leakage Exceeds Design Basis Limit.Caused by Pressure Seal Required by Revised W Design Not Incorporated Into Aep Design.Numerous Matl Condition Walkdowns & Assessments Made ML17325B6001999-05-20020 May 1999 LER 99-012-00:on 990420,concluded That Auxiliary Bldg ESF Ventilation Sys Not Capable of Maintaining ESF Room Temps post-accident.Caused by Inadequate Control of Sys Design Inputs.Comprehensive Action Plan Being Developed ML17325B5861999-05-10010 May 1999 LER 99-002-00:on 990415,discovered That TS 4.0.5 Requirements Were Not Met Due to Improperly Performed Test. Caused by Incorrect Interpretation of ASME Code.App J Testing Will Be Completed & Procedures Will Be Revised ML17325B5811999-05-0404 May 1999 LER 99-011-00:on 990407,air Sys for EDG Will Not Support Long Operability.Caused by Original Design Error.Temporary Mod to Supply Makeup Air Capability in Modes 5 & 6 Was Prepared ML17325B5771999-05-0303 May 1999 LER 99-010-00:on 990401,RCS Leak Detection Sys Sensitivity Not in Accordance with Design Requirements Occurred.Caused by Inadequate Original Design of Containment Sump Level. Evaluation Will Be Performed to Clearly Define Design ML17325B5581999-04-16016 April 1999 LER 99-006-00:on 990115,personnel Identified Discrepancy Between TS 3.9.7 Impact Energy Limit & Procedure 12 Ohp 4030.STP.046.Caused by Lack of Design Basis Control.Placed Procedure 12 Ohp 4030.STP.046 on Administrative Hold ML17325B5471999-04-12012 April 1999 LER 99-009-00:on 990304,as-found RHR Safety Relief Valve Lift Setpoint Greater than TS Limit Occurred.Cause Investigation for Condition Has Not Been Completed.Update to LER Will Be Submitted,Upon Completion of Investigation ML17325B5321999-04-0707 April 1999 LER 99-S01-00:on 990308,discovered That Lock for Vital Gate Leading to Plant 4KV Switchgear Area Was Nonconforming & Vulnerable to Unauthorized Access.Caused by Inadequate Gate Design & Inadequate Procedures.Mods Are Being Made to Gate ML17325B5161999-04-0101 April 1999 LER 99-007-00:on 981020,calculations Showed That Divider Barrier Between Upper & Lower Containment Vols Were Overstressed.Engineers Are Currently Working on Analyses of Loads & Stress on Enclosures ML17325B5221999-03-29029 March 1999 LER 99-001-00:on 960610,degraded Component Cooling Water Flow to Containment Main Steam Line Penetrations,Identified on 990226.Caused by Inadequate Understanding of Design Basis.Additional Investigations Ongoing ML17325B4801999-03-18018 March 1999 LER 99-004-00:on 971030,failure to Perform TS Surveillance Analyses of Rc Chemistry with Fuel Removed Was Noted.Cause of Event Is Under Investigation.Corrected Written Job Order Activities Used to Control SD Chemistry Sampling ML17325B4741999-03-18018 March 1999 LER 99-005-00:on 940512,determined That Rt Breaker Manual Actuations During Rod Drop Testing Were Not Previously Reported.Caused by Lack of Training.Addl Corrective Actions,Including Preventative Actions May Be Developed ML17325B4571999-02-24024 February 1999 LER 99-003-00:on 990107,CR Pressurization Sys Surveillance Test Did Not Test Sys in Normal Operating Condition.Caused by Failure to Recognize Door 12DR-AUX415 as Part of CR Pressure Boundary.Performed Walkdown of Other Doors ML17335A5171999-02-11011 February 1999 LER 99-002-00:on 990112,determined That RCS Pressurizer PORVs Had Not Been Tested,Per Ts.Caused by Inadequate Scheduling Controls Allowing Personnel Error.Surveillance Procedure Was Completed & Updated LER Will Be Submitted ML17335A5141999-02-10010 February 1999 LER 99-001-00:on 990106,noted That GE Hfa Relays Installed in EDGs May Not Meet Seismic Qualification.Caused by Operating Experience Info Incorrectly Dispositioned in 1985. Updated LER Will Be Submitted by 990405 ML17335A5011999-02-0101 February 1999 LER 98-060-00:on 981231,identified That Rt Sys Response Time Testing Did Not Comply with TS Definition.Caused by Inadequate Procedures.Corrective Actions Will Be Developed & Update to LER Will Be Submitted by 990415.With 990201 Ltr ML17335A4951999-01-29029 January 1999 LER 98-059-00:on 981230,interim LER -single Failure in Containment Spray Sys Could Result in Containment Spray Ph Outside Design Occurred.Investigation Into Condition Continuing.Update Will Be Submitted by 990514 Ltr ML17335A4961999-01-27027 January 1999 LER 98-057-00:on 981228,discovered That AFW Valves Were Not Tested IAW Inservice Testing Program.Caused by Failure to Recognize Design Bases Features Re Afws by Personnel. Updated LER Will Be Submittted by 990415.With 990127 Ltr ML17335A4921999-01-19019 January 1999 LER 98-052-01:on 981128,no Analysis for NSR Sc Manual Loader for Tdafwp Could Be Found in Original Design.Cause Due to All Failure Modes Not Considered When Compressed Air Sys Originally Designed.Performed Review of Components ML17335A4721999-01-0606 January 1999 LER 98-055-00:on 981207,potential for Condition Outside of Design Bases for Rod Control Sys Was Noted.Caused by Calibration Error Coupled with Single Rod Failure.Condition Rept Investigation Is Ongoing ML17335A4691999-01-0606 January 1999 LER 98-056-00:on 981211,hot Leg Nozzle Gaps Resulted in Plant Being in Unanalyzed Condition.Analyses Are Being Performed by W to Resolve Problem.Updated LER Will Be Submitted by 990211.With 990106 Ltr ML17335A4661999-01-0505 January 1999 LER 98-049-00:on 981020,emergency Boron Injection Flow Path Was Inoperable.Caused by Original Design Deficiency. Engineering Evaluation of Event Is Continuing ML17335A4631999-01-0404 January 1999 LER 98-054-00:on 981202,discovered That at Least One MSSV Had Not Been Reset as Required by Ts.Engineering Is Continuing Review of Extent of Condition for Event.Updated LER Will Be Submitted by 990129.With 990104 Ltr ML17335A4481998-12-30030 December 1998 LER 98-053-00:on 981130,discovered Use of Inoperable Substitute Subcooling Margin Monitor.Caused by Condition Existing Since Installation of Plant Process Computer in 1992.Updated LER Will Be Submitted.With 981230 Ltr ML17335A4581998-12-28028 December 1998 LER 98-052-00:on 981128,turbine Driven AFW Pump Speed Controller Failure Mode Occurred.Caused Because Not All Failure Modes Were Considered When Compressed Air Sys Was Originally Designed.Verified Current Design Change Process ML17335A4281998-12-22022 December 1998 LER 98-051-00:on 981122,reactor Trip Signal from Manual Safety Injection Not Verified as Required by TS Surveillance,Was Discovered.Maintenance Currently Evaluating Significance & Cause of Event ML17335A4111998-12-17017 December 1998 LER 98-047-00:on 981117,potential for Increase Leakage from Reactor Coolant Pump Seals Was Identified.Util Is Working with W to Resolve Issue.Current Expectations Are to Submit Update to LER by 990215.With 981217 Ltr ML17335A4141998-12-16016 December 1998 LER 98-058-00:on 981216,postulated High Line Break Could Result in Condition Outside Design Bases for AF Occurred. Caused by Deficiencies Associated with Administration of HELB Program.Analysis of AF Will Be Completed by 990122 ML17335A4181998-12-16016 December 1998 LER 98-050-00:on 980814,ancillary Equipment Installed in Ice Condenser Was Not Designed to Withstand Design Basis Accident/Earthquake Loads.Caused by Lack of Established Design Criteria.Developed Design Criteria ML17335A3871998-12-11011 December 1998 LER 98-031-01:on 980610,potential Common Mode Failure of RHR Pumps Were Noted.Caused by Inaccurate Values.Accurate Miniflow Numbers Have Been Determined by Flow Testing ML17335A3821998-12-0808 December 1998 LER 98-039-01 Re EOP Step Conflicts with Small Break LOCA Analysis.Ler 98-039-00 Has Been Canceled.With 981208 Ltr ML17335A3781998-12-0707 December 1998 LER 98-007-00:on 981106,high Energy Line Break Effects in Auxiliary FW Sys Was Noted.Cause of Event Is Under Investigation & Will Be Completed by 990220.Updated LER Will Be Submitted by 990310.With 981207 Ltr ML17335A3771998-12-0303 December 1998 LER 98-046-00:on 981103,determined That Afs Was Unable to Meet Design Flow Requirements During Special Test.Caused by Failure to Consider All Aspects of Sys Operation in Design of Suction Basket Strainers.Sys Will Be Redesigned ML17335A3741998-12-0202 December 1998 LER 97-011-02:on 970822,operation Was Noted Outside Design Bases for ECCS & CSP for Switchover to Recirculation Sump Suction.Caused by Ineffective Change Mgt.Revised Procedure for Switchover 01(02) Ohp 4023.ES-1.3 1999-09-17
[Table view] Category:TEXT-SAFETY REPORT
MONTHYEARML17335A5641999-10-18018 October 1999 LER 99-024-00:on 990708,literal TS Requirements Were Not Met by Accumlator Valve Surveillance.Caused by Misjudgement Made in Conversion from Initial DC Cook TS to W Std Ts.Submitted License Amend Request.With 991018 Ltr ML17335A5531999-10-0707 October 1999 LER 99-023-00:on 990907,inadequate TS Surveillance Testing of ESW Pump ESF Response Time Noted.Caused by Inadequate Understanding of Plant Design Basis.Surveillance Tests Will Be Revised & Implemented ML17335A5631999-09-30030 September 1999 Monthly Operating Rept for Sept 1999 for DC Cook Nuclear Plant,Unit 1.With 991012 Ltr ML17335A5621999-09-30030 September 1999 Monthly Operating Rept for Sept 1999 for DC Cook Nuclear Plant,Unit 2.With 991012 Ltr ML17335A5481999-09-30030 September 1999 Non-proprietary DC Cook Nuclear Plant Units 1 & 2 Mods to Containment Sys W SE (Secl 99-076,Rev 3). ML17335A5451999-09-28028 September 1999 Rev 1 to Containment Sump Level Design Condition & Failure Effects Analysis for Potential Draindown Scenarios. ML17326A1291999-09-17017 September 1999 LER 99-022-00:on 990609,electrical Bus Degraded Voltage Setpoints Too Low for Safety Related Loads,Was Discovered. Caused by Lack of Understanding of Design of Plant.No Immediate Corrective Actions Necessary ML17326A1481999-09-17017 September 1999 Independent Review of Control Rod Insertion Following Cold Leg Lbloca,Dc Cook,Units 1 & 2. ML17326A1211999-08-31031 August 1999 Monthly Operating Rept for Aug 1999 for Cook Nuclear Plant, Unit 2.With 990915 Ltr ML17326A1201999-08-31031 August 1999 Monthly Operating Rept for Aug 1999 for Cook Nuclear Plant, Unit 1.With 990915 Ltr ML17326A1121999-08-27027 August 1999 LER 99-021-00:on 990728,determined That GL 96-01 Test Requirements Were Not Met in Surveillance Tests.Caused by Failure to Understand Full Extent of GL Requirements. Surveillance Procedures Will Be Revised or Developed ML17326A1011999-08-26026 August 1999 LER 99-020-00:on 990727,EDGs Were Declared Inoperable.Caused by Inadequate Protection of Air Intake,Exhaust & Room Ventilation Structures from Tornado Missile Hazards. Implemented Compensatory Measures in Form of ACs ML17326A0911999-08-16016 August 1999 LER 99-019-00:on 990716,noted Victoreen Containment Hrrms Not Environmentally Qualified to Withstand post-LOCA Conditions.Caused by Inadequate Design Control.Reviewing Options to Support Hrrms Operability in Modes 1-4 ML17326A0771999-08-0404 August 1999 LER 98-029-01:on 980422,noted That Fuel Handling Area Ventilation Sys Was Inoperable.Caused by Original Design Deficiency.Radiological Analysis for Spent Fuel Handling Accidents in Auxiliary Bldg Will Be Redone by 990830 ML17335A5461999-08-0202 August 1999 Rev 0 to Evaluation of Cook Recirculation Sump Level for Reduced Pump Flow Rates. ML17326A0871999-07-31031 July 1999 Monthly Operating Rept for July 1999 for DC Cook Nuclear Plant,Unit 1.With 990812 Ltr ML17326A0861999-07-31031 July 1999 Monthly Operating Rept for July 1999 for DC Cook Nuclear Plant,Units 2.With 990812 Ltr ML17326A0741999-07-29029 July 1999 LER 99-018-00:on 990629,determined That Valve Yokes May Yield Under Combined Stress of Seismic Event & Static,Valve Closed,Stem Thrust.Caused by Inadequate Design of Associated Movs.Operability Determinations Were Performed for Valves ML17326A0661999-07-26026 July 1999 LER 99-017-00:on 990625,noted That Improperly Installed Fuel Oil Return Relief Valve Rendered EDG Inoperable.Caused by Personnel Error.Fuel Oil Return Valve Was Replaced with Valve in Correct Orientation.With 990722 Ltr ML17326A0651999-07-22022 July 1999 LER 98-014-03:on 980310,noted That Response to high-high Containment Pressure Procedure Was Not Consistent with Analysis of Record.Caused by Inadequate Interface with W. FRZ-1 Will Be Revised to Be Consistent with New Analysis ML17326A0491999-07-13013 July 1999 LER 99-016-00:on 990615,TS Requirements for Source Range Neutron Flux Monitors Not Met.Caused by Failure to Understand Design Basis of Plant.Procedures Revised.With 990713 Ltr ML17326A0331999-07-0101 July 1999 LER 99-004-01:on 971030,failure to Perform TS Surveillance Analyses of Reactor Coolant Chemistry with Fuel Removed Was Noted.Caused by Ineffective Mgt of Tss.Chemistry Personnel Have Been Instructed on Requirement to Follow TS as Written ML17326A0511999-06-30030 June 1999 Monthly Operating Rept for June 1999 for DC Cook Nuclear Plant,Unit 2.With 990709 Ltr ML17326A0501999-06-30030 June 1999 Monthly Operating Rept for June 1999 for DC Cook Nuclear Plant,Unit 1.With 990709 Ltr ML17326A0151999-06-18018 June 1999 LER 99-014-00:on 990521,determined That Boron Injection Tank Manway Bolts Were Not Included in ISI Program,Creating Missed Exam for Previous ISI Interval.Caused by Programmatic Weakness.Isi Program & Associated ISI Database Modified ML17325B6421999-06-0101 June 1999 LER 99-013-00:on 990327,safety Injection & Centrifugal Charging Throttle Valve Cavitation During LOCA Could Have Led to ECCS Pump Failure.Caused by Inadequate Original Design Application of Si.Throttle Valves Will Be Developed ML17325B6311999-06-0101 June 1999 LER 99-S03-00:on 990430,vital Area Barrier Degradation Was Noted.Caused by Inadequate Insp & Maint of Vital Area Barrier.Repairs & Mods Were Made to Barriers to Eliminate Degraded & Nonconforming Conditions ML17326A0061999-05-31031 May 1999 Monthly Operating Rept for May 1999 for Dcp.With 990609 Ltr ML17326A0071999-05-31031 May 1999 Monthly Operating Rept for May 1999 for DC Cook Nuclear Plant,Unit 2.With 990609 Ltr ML17325B6351999-05-28028 May 1999 LER 99-S02-00:on 990428,vulnerability in Safeguard Sys That Could Allow Unauthorized Access to Protected Area Was Noted. Caused by Inadequate Original Plant Design.Mods Were Made to Wall Opening to Eliminate Nonconforming Conditions ML17265A8231999-05-24024 May 1999 LER 98-037-01:on 990422,determined That Ice Condenser Bypass Leakage Exceeds Design Basis Limit.Caused by Pressure Seal Required by Revised W Design Not Incorporated Into Aep Design.Numerous Matl Condition Walkdowns & Assessments Made ML17325B6001999-05-20020 May 1999 LER 99-012-00:on 990420,concluded That Auxiliary Bldg ESF Ventilation Sys Not Capable of Maintaining ESF Room Temps post-accident.Caused by Inadequate Control of Sys Design Inputs.Comprehensive Action Plan Being Developed ML17325B5861999-05-10010 May 1999 LER 99-002-00:on 990415,discovered That TS 4.0.5 Requirements Were Not Met Due to Improperly Performed Test. Caused by Incorrect Interpretation of ASME Code.App J Testing Will Be Completed & Procedures Will Be Revised ML17325B5811999-05-0404 May 1999 LER 99-011-00:on 990407,air Sys for EDG Will Not Support Long Operability.Caused by Original Design Error.Temporary Mod to Supply Makeup Air Capability in Modes 5 & 6 Was Prepared ML17325B5771999-05-0303 May 1999 LER 99-010-00:on 990401,RCS Leak Detection Sys Sensitivity Not in Accordance with Design Requirements Occurred.Caused by Inadequate Original Design of Containment Sump Level. Evaluation Will Be Performed to Clearly Define Design ML17335A5301999-04-30030 April 1999 Monthly Operating Rept for Apr 1999 for DC Cook Nuclear Plant,Unit 1.With 990508 Ltr ML17335A5291999-04-30030 April 1999 Monthly Operating Rept for Apr 1999 for DC Cook Nuclear Plant,Unit 2.With 990508 Ltr ML17325B5581999-04-16016 April 1999 LER 99-006-00:on 990115,personnel Identified Discrepancy Between TS 3.9.7 Impact Energy Limit & Procedure 12 Ohp 4030.STP.046.Caused by Lack of Design Basis Control.Placed Procedure 12 Ohp 4030.STP.046 on Administrative Hold ML17325B5471999-04-12012 April 1999 LER 99-009-00:on 990304,as-found RHR Safety Relief Valve Lift Setpoint Greater than TS Limit Occurred.Cause Investigation for Condition Has Not Been Completed.Update to LER Will Be Submitted,Upon Completion of Investigation ML17325B5321999-04-0707 April 1999 LER 99-S01-00:on 990308,discovered That Lock for Vital Gate Leading to Plant 4KV Switchgear Area Was Nonconforming & Vulnerable to Unauthorized Access.Caused by Inadequate Gate Design & Inadequate Procedures.Mods Are Being Made to Gate ML17325B5161999-04-0101 April 1999 LER 99-007-00:on 981020,calculations Showed That Divider Barrier Between Upper & Lower Containment Vols Were Overstressed.Engineers Are Currently Working on Analyses of Loads & Stress on Enclosures ML17325B5491999-03-31031 March 1999 Monthly Operating Rept for Mar 1999 for DC Cook Nuclear Plant Unit 2.With 990408 Ltr ML17325B5441999-03-31031 March 1999 Monthly Operating Rept for Mar 1999 for DC Cook Nuclear Plant,Unit 1.With 990408 Ltr ML17325B5221999-03-29029 March 1999 LER 99-001-00:on 960610,degraded Component Cooling Water Flow to Containment Main Steam Line Penetrations,Identified on 990226.Caused by Inadequate Understanding of Design Basis.Additional Investigations Ongoing ML17325B4801999-03-18018 March 1999 LER 99-004-00:on 971030,failure to Perform TS Surveillance Analyses of Rc Chemistry with Fuel Removed Was Noted.Cause of Event Is Under Investigation.Corrected Written Job Order Activities Used to Control SD Chemistry Sampling ML17325B4741999-03-18018 March 1999 LER 99-005-00:on 940512,determined That Rt Breaker Manual Actuations During Rod Drop Testing Were Not Previously Reported.Caused by Lack of Training.Addl Corrective Actions,Including Preventative Actions May Be Developed ML17325B5671999-03-0202 March 1999 Summary of Unit 1 Steam Generator Layup Chemistry from 980101 to 990218. ML17325B4631999-02-28028 February 1999 Monthly Operating Rept for Feb 1999 for DC Cook Nuclear Power Station,Unit 2.With 990308 Ltr ML17325B4621999-02-28028 February 1999 Monthly Operating Rept for Feb 1999 for DC Cook Nuclear Plant,Unit 1.With 990308 Ltr ML17325B4571999-02-24024 February 1999 LER 99-003-00:on 990107,CR Pressurization Sys Surveillance Test Did Not Test Sys in Normal Operating Condition.Caused by Failure to Recognize Door 12DR-AUX415 as Part of CR Pressure Boundary.Performed Walkdown of Other Doors 1999-09-30
[Table view] |
Text
1
!ndiana Michigan Power Company Cook Nuc!ear P!ant
".ne Cook Place Bridgman. Ml ~9106 616 465 5901 diag INDIANJL NlCHlG4N POWER May 20, 1992 United States Nuclear Regulatory Commission Document Control Desk Rockville, Maryland 20852 Operating Licenses DPR-58 Docket No. 50-315 Document Control Manager:
ln accordance with the criteria established by 10 CFR 50.73 entitled Licensee Event Re ort S stem the following report is being submitted:
92-004-00 Sincerely, A. A. Blind Plant Manager
/sb Attachment c D. H. Williams, Jr.
tA. B.. Davis., Region~?
E. Fitzpatrick Q'.
P. A. Barrett B. F. Henderson R. F. Kroeger B. Walters Ft. Wayne NRC Resident Inspector J. F. Stang NRC J. G. Keppler M. R. Padgett G. Charnoff, Escr.
D. Hahn XNPO S. J. Brewer/B. P. Lauzau B. A. Svensson gAN g 61SR Q'c Oyga
NRC FORM 366 V S. NUCLEAR REGULATORY COMMISSION (649) APPROVED 0MB NO. 3150410C EXPIRES: C/30I92 ESTIMATED BURDEN PER RESPONSE TO COLIPLY WTH THIS INFORMATION COLLECTION REOUEST. 500 HRS. FORWARD LICENSEE EVENT REPORT (LER) COMMENTS REGARDING BURDEN ESTIMATE TO THE RECORDS AND REPORTS MANAGEMFNT BRANCH (F630), U.S. NUCLEAR REGULATORY COMMISSION, WASHINGTON. DC 20555, AND TO THE PAPERWORK REDUCTION PROJECT (31$ 0C)10el. OFFICE OF MANAGEMENTAND BUDGET, WASHINGTON. DC 20503.
FACILITY NAME lll DOCKET NUMBER (2) PA E 3 D. C. Cook Nuclear Plant Unit 1 0 5 0 0 0 3 1 5 1 OF 0 4 TITLE Icl Missed Surveillance on Boric Acid Flow Path due to Personnel Error During Procedure Review Process EVENT OATK (5) LER NUMBER LSI REPORT DATE (7) OTHER FACILITIES INVOLVED (4)
SEOVENTIAL REVOKE FACILITYNAMES DOCKET NUMBFR(SI MONTH OAY YEAR YEAR NVMSEII NVMSEII MON)'H OAY YEAR 0 5 0 0 0 04209292 0 0 4 0 0 0 5 THIS REPORT IS SUBMITTED PURSUANT T0 THE R SOU(A EMENTS OF 10 2 0 9 2 C FR (): IC>rrCC Onr Or mrrr Of tnr fOIIOwinpl (11 0 5 0 0 0 OPERATING MODE (4) 20A02(SI 20AOS(cl 50.73(el(2IGrl 73.71(SI POWER 20A05(e) ()Ill) 50M(el)1) 60.73(el(2) (r I 73.7((c)
LEYEL, cR ~ 'ro"'C 8 9 9 20A054)(1l(EI 20AOS(e) (I ) (IIII 50.34(c)(2) 50.73(e)(2) lll 50.7 3 4l(2Hrii) 60.73(e)12) (rill)I Al OTHER ISorc>fy >n Aottrrct Oelow rnrf In Fret, HAC Form SSSA>
V 20A05 4) (1 ) tlrl 60 7 34) l2) (9) 50.73 4 I (2 I 4lil ) I 5 I
)O; r . carr.@ 20.4054)(1 I (rl 50.73 Iel(2)(lli) 50,7S( ~ ) IS)(el LICENSEE CONTACT FOR THIS LER (12)
NAME TELEPHONE NUMBER AREA CODE J. R. Sampson, Operations Department COMPLETE ON! LINE FOR EACH COIAPONENT FAILURE DESCRIBED IH THIS REPORT IIS) 616465-5901 CAUSE SYSTEM COMPONENT MANUFAC.
TUAER FPOATABLF.
TO NPAOS
~~Xo .. r;rl CAUSE SYSTEM COMPONENT MANUFAC.
TUREA EPOATABL TO NPAOS k~m c
@o~5 SUPPLEMENTAL REPORT EXPECTED IICI MONTH DAY YEAR EXPECTED SUBMISSION DATE (15)
YES llfyrt, compirtr EXPECPEI> SVSMISSION DATEI NO ABSTRACT l(,lmit to tc00 torcrL I r., rpproelmrtrly lilrrrn tinplr tprtr tyPrwnttrn linwl l14)
On 4-20-92, contrary to Technical Specification (TS) 4.1.2.2.a.l, the seven-day test to prove the operability of the boration flow paths from the refueling water storage tank and the boric acid storage tank was not performed as scheduled. The test is accomplished by cycling each testable power-operated or automatic valve in the flow path through at least one complete cycle of full travel. The missed surveillance was identified on 4-24-92. The surveillance procedure was immediately performed. All test acceptance criteria were met. The missed surveillance occurred as a result of personnel error during the review process.
The findings of this event were reviewed with the involved personnel by their supervisors.
NRC Form 344 (649)
NRC FORM 3rrSA (689)
LICENSEE EVE TEXT CONTINUATION U.S. NUCLEAR REGULATORY COMMISSION REPORT (LERI t APPROVED OMB NOr 31504104 EXPIRES: rU30/92 ESTIMATED BURDEN PER RESPONSE TO COMPLY WTH THIS INFORMATION COLLECTION REQUEST: 500 HRS. FORWARD COMMENTS RFGARDING BURDEN ESTIMATE TO THE RECORDS ANO REPORTS MANAGEMENT BRANCH (P430). U.S. NUCLEAR REGULATORY COMMISSION, WASHINGTON, OC 20555, ANO TO 1NE PAPERWORK REDUCTION PROJECT (3)500104), OFFICE OF MANAGEMENTANO BUDGET, WASHINGTON. DC 20503.
FACILITY NAME (1) DOCKET NUMBKR (2) PAGE (3)
LER NUMBER (Sl YEAR II SKDUKNTIAL;~REVISION NUMSSR NVMISII D. C. Cook Nuclear Plant - Unit 1 3 1 5 9 2 0 0 40 0 0 2 OF 0 4 TEXT (Ifmore speceis rer)rrirer( Iree aAiiriorreiiVRC Form JSSAK) (IT)
Conditions Prior to Occurrence Unit one (U-1) in mode one at 89.9X power.
Unit two (U-2) in mode six at OX power.
Descri tion of Event On 4-20-92, the 1-OHP 4030.STP.002V (Boration System Valve Position Verification and Testing) surveillance procedure was not performed to satisfy the Technical Specification (TS) surveillance requirement 4.1.2.2.a.l for TS 3.1.2.2 (Reactivity Control Systems Flow Paths - Operation). TS 4.1.2.2.a.l requires at least once per seven days that the boration flow paths from the refueling water storage tank (RWST) (EIIS/CB-TK) and the boric acid storage tank (BAST) (EIIS/CB-TK) be proven operable by cycling each testable power-operated or automatic valve in the flow path through at least one complete cycle of full travel.
The missed surveillance procedure was discovered by an Operations Department Engineer on 4-24-92, The surveillance test was last performed on 4-13-92.
The TS action statement was entered at 1255 hours0.0145 days <br />0.349 hours <br />0.00208 weeks <br />4.775275e-4 months <br /> and the 1-OHP 4030.STP.002V surveillance procedure was started, completed, and reviewed by 1314 hours0.0152 days <br />0.365 hours <br />0.00217 weeks <br />4.99977e-4 months <br /> on 4-24-92. A review of the completed surveillance noted that the surveillance acceptance criteria were satisfied and the action statement was exited at this time.
On 4-20-92, the involved Unit Supervisor (Senior Reactor Operator) reviewed the 1-OHP 4030.STP.002V paperwork completed during his shift. Following this review, the Unit Supervisor recorded the completed sections of the 1-OHP 4030.STP.002V surveillance procedure in the Master Surveillance Schedule.
While recording the completed sections of the surveillance procedure just reviewed, the Unit Supervisor incorrectly recalled that the weekly surveillance section of the procedure had been completed and signed off the weekly surveillance procedure as complete.
Following the performance of the surveillances listed on the schedule, the Operations Department Engineering Section conducts a review of the completed surveillance paperwork. During this surveillance paperwork review, the engineers identified on 4-21-92 that the 1-OHP 4030.STP.002V weekly surveillance procedure sheets were missing. Upon discovering that NRC Form 36SA (689)
)AC FORM 3nSA U.S. NUC(.EAR REGULATORY COMMISSION APPROVEQ 0MB NO. 31500104 (64)9)
EXPIRES: 4/30/92 ES ATED BURDEN PER RESPONSE TO COMPLY WTH THIS LICENSEE EVE REPORT (LER) INFORMATION COLLECTION REOUESTI 500 HRS. FORWARD COMMENTS REGARDING BURDEN ESTIMATE TO THE RECORDS TEXT CONTINUATION AND REPORTS MANAGEMENT BRANCH (PJ)301. U.S. NUCLEAR REGULATORY COMMISSION. WASHINGTON, DC 20555, AND TO 1'HE PAPERWORK REDUCTION PROJECT (3(500(041, OFFICE OF MANAGEMENTAND BUDGET, WASHINGTON. DC 20503.
. FACILITY NAME (1) DOCKET NUMBER (2) LER NUMBER (6) PAGE (3I YEAR 'jul SEQUENTIAL,g>I(g NUMBSR '..: REVISION MUAISSR D. C. Cook Nuclear TEXT /// more epeoe Ls Je)rrie(L oee ~ Plant - Unit NRC Forrlr 36SA'4) l)7) 1 3 1 5 9 2 0 0 4 0 0 P 30F p the weekly surveillance procedure sheets were missing, the engineers documented that the weekly surveillance procedure was in grace by recording the status in the grace section of the Surveillance Status Summary Report.
Although the engineers identified that the weekly surveillance was apparently in grace due to the missing paperwork, the engineers did not pursue further why the surveillance procedure had not been completed. This was based on the engineers'ast experience had shown that the control room operators also track incomplete surveillances and pursue the completion of a surveillance before the grace period expires.
Cause of Event The cause for the missed surveillance was personnel error. The Unit Supervisor developed a mind set during the surveillance review that the surveillance was completed and therefore signed off the surveillance procedure as complete on the schedule.
In addition, the engineers had a mind set that control room operators record and track surveillances in grace and that the control room operators were aware that the surveillance had not been completed, or that the paperwork must have been routed to the engineers and had not arrived. Therefore, the engineers did not pursue further the completion of the surveillance.
A~nal sls Technical Specification (TS) 4.1.2.2.a.l (Reactivity Control Systems Flow Paths - Operating) requires at least once per seven days the boration flow paths from the refueling water storage tank (RWST) and the boric acid storage tank (BAST) to be proven operable by cycling each testable power-operated or automatic valve in the flow path through at lease one complete cycle of full travel. The failure to perform the surveillance is a violation of Technical Specification 3.1.2.2 and is reportable under 10 CFR 50.73 (a)(2)(i)(B).
Following the identification of the missed surveillance, the 1-OHP 4030.STP.002V surveillance procedure was performed to satisfy the requirements of TS 4.1.2.2.a.l. A review of the completed surveillance noted that the requirements of the surveillance procedure were met. Therefore, it is concluded that the valves tested by the surveillance procedure would have performed their safety function if required during the time period from the last completed surveillance procedure on 4-13-92 and the surveillance procedure performed on 4-24-92.
NR 0 Form 366A (6419)
I/RC FOR)4 A V.S. NUCLEAR REGULATORY COMMISSION (64) 9) APPAOVED OMB NO. 31500104 EXP)RES: 4/30/92 ES i ATED BURDEN PER RESPONSE TO COMPLY WTH THIS LICENSEE EVE REPORT (LER) INFORMATION COLLECTION REQUEST: 508) HAS. FORWARD COMMENTS REGARDING BURDEN ESTIMATE TQ TH'E RECORDS TEXT CONTINUATION AND REPORTS MANAGEMENT BRANCH (PB30). V.S. NUCLEAR REGULATORY COMMISSION. WASHINGTON. OC 20555. AND TO 1ME PAPERWORK AEDUCTION PAO/ECT (315041041. OFFICE OF MANAGEMENTANO BUDGET, WASHINGTON. DC 20503.
FACILITY NAME I 1) DOCKET NUMBER (2) LER NUMBER (6) PAGE (3)
YEAR SEQUENTIAL REVISION PIN NUMBER <I'A NUMBER D. C. Cook Nuclear Plant Unit 1 3 1 5 9 2 0 0 4 0 0 0 4 OF 0 4 TEXT //I IINee epeee le /eeIeeN/ Bee ~ ////Bone/HRC Fem) 366A'4) (17)
Based upon the above analysis, the failure to perform the surveillance procedure within the grace period is not considered to have created a significant safety concern, nor did the missed surveillance create a significant hazard to the health and safety of the general public.
Corrective Action
- 1. Following the identification that the portion of the 1-OHP 4030.STP.002V surveillance procedure had not been performed, the 1-OHP 4030.STP.002V surveillance procedure was satisfactorily completed.
The Shift Supervisor reviewed The finding of this investigation with the involved Unit Supervisor. This review included a discussion of the Unit Supervisor responsibility and accountability for the performance and documentation of surveillance procedures.
The Operations Department Production Supervisor reviewed the finding of this investigation with the engineers involved.
Previous Simila Events A review of the License Event Reports did not identify a similar event.
NRC FomI 366A (64)9)
~ ~ ~
/6
ACCELERATED DIS RIBUTION DEMONS TION SYSTEM REGULATORY INFORMATION DISTRIBUTION SYSTEM (RIDS)
ACCESSION NBR:9205270001 DOC.DATE: 92/05/20 NOTARIZED: NO DOCKET FACIL:50-315 Donald C. Cook Nuclear Power Plant, Unit 1, Indiana M 05000315 AUTH. NAME AUTHOR AFFILIATION SAMPSON,J.R. Indiana Michigan Power Co. (formerly Indiana 6 Michigan Ele BLIND,A.A. Indiana Michigan Power Co. (formerly Indiana 6 Michigan Ele RECIP.NAME RECIPIENT AFFILIATION
SUBJECT:
LER 92-004-00:on 920420,7-day test to prove operability of boration flow paths from refueling water storage 6 boric D acid storage tanks not performed as scheduled. Caused by personnel error. Test successfully performed.W/920520 ltr.
DISTRIBUTION CODE: IE22T COPIES RECEIVED:LTR I ENCL J SIZE: S TITLE: 50.73/50.9 Licensee Event Report (LER), Incident Rpt, etc.
NOTES:
RECIPIENT COPIES RECIPIENT COPIES D ID CODE/NAME LTTR ENCL ID CODE/NAME LTTR ENCL PD3-1 LA 1 1 PD3-1 PD 1 1 D STANG,J 1 1 INTERNAL'CNW 2 2 AEOD/DOA 1 1 AEOD/DS P/TPAB 1 1 AEOD/ROAB/DSP 2 2 NRR/DET/EMEB 7E 1 1 NRR/DLPQ/LHFB10 1 1 NRR/DLPQ/LPEB10 1 1 NRR/DOEA/OEAB 1 1 NRR/DREP/PRPB11 2 2 NRR/DST/SELB SD 1 1 NRR/DST/SICBSH3 1 1 NRR S DPLBSD1 1 1 NRR/DST/SRXB SE 1 1 G~EF ILE 02 1 1 RES/DSIR/EIB 1 1 RGN3 01 1 1 EXTERNAL EGGG BRYCE g J ~ H 3 3 L ST LOBBY WARD 1 1 NRC PDR 1 1 NSIC MURPHY,G.A 1 1 NSIC POOREgW ~ 1 1 NUDOCS FULL TXT 1 1 D
D D
NOTE TO ALL "RIDS" RECIPIENTS:
PLEASE HELP US TO REDUCE WASTE! CONTACT THE DOCUMENT CONTROL DESK, ROOM Pl-37 (EXT. 20079) TO ELMINATEYOUR NAME FROM DISTRIBUTION LISTS FOR DOCUMENTS YOU DON'T NEED!
FULL TEXT CONVERSION REQUIRED TOTAL NUMBER OF COPIES REQUIRED: LTTR 30 ENCL 30
Indiana Michigan Power Company Cook Nuclear Plant One Cook Place
~
Bridgman, Ml 49106 616 465 5901 INDUNA POPOVER NICMGAM May 20, 1992 United States Nuclear Regulatory Commission Document Control Desk Rockville, Maryland 20852 Operating Licenses DPR-58 Docket No. 50-315 Document Control Manager:
In accordance with the criteria established by 10 CFR 50.73 entitled Licensee Event Re ort S stem the following report is being submitted:
92-004-00 Sincerely, A. A. Blind Plant Manager
/sb Attachment c: D. H. Williams, Jr.
A.
E.
B. Davis, Region E. Fitzpatrick III P. A. Barrett B. F. Henderson R. F. Kroeger B. Walters Ft. Wayne NRC Resident Inspector J. F. Stang NRC J. G. Keppler M. R. Padgett G. Charnoff, Esq.
D. Hahn INPO S. J. Brewer/B. P. Lauzau B. A. Svensson 920527000i 920520 PDR ADOCK 05000315 S PDR
NRC FORM 346 (64)9)
LICENSEE EVENT REPORT (LER)
V.S. NUCLEAR REGULATORY COMMISSION t APPROVED OMB NO. 31504)104 EXPIRES: 4I30192 ESTIMATED BURDEN PEA RESPONSE TO COMPLY WTH THIS INFORMATION COLLECTION AEOUESTt 50.0 HRS. FORWAAD COMMENTS REGARDING BURDEN ESTIMATE TO THE RECORDS AND REPORTS MANAGEMENT BRANCH (PPr30), U.S. NUCLEAR REGULATORY COMMISSION, WASHINGTON, DC 20555, AND TO THE PAPERWORK REDUCTION PROJECT (31500104), OFFICE OF MANAGEMENTAND BUDGET) WASHINGTON, DC 20503.
FACILITYNAME (I) DOCKET NUMBER l2) PAGE. 3 D. C. Cook Nuclear Plant Unit 1 0 5 0 0 0 3 ] 5 1 OF 0 4 TITLE (4)
Missed Surveillance on Boric Acid Flow Path due to Personnel Error During Procedure Review Process EVENT DATE(5) LER NUMBER (6) REPORT DATE (7) OTHER FACILITIES INVOLVED (4)
MONTH OAY YEAR YEAR SEOVENTIAL opn MONTH DAY YEAR FACILITYNAMES DOCKET NUMBER(SI NVMSEA NVMSESI 0 5 0 0 0 0 4 2 0 9 2 9 2 0 0 4 0 0 0 5 2 0 9 2 0 5 0 0 0 THIS REPORT IS SUBMITTED PURSUANT TO THE REOUIREMENTS OF 10 CFR g: (Cn<<4 onr or morr of tnr IollowinPI (11)
OPERATING MODE (Sl j 20802(S) 20AOS(c) 50.73(e) (2) liv) 73.71(S)
POWE R 20.4061 ~ ) Ill(il 50.34(cl(1) 50.73( ~ )(2)(vl 73.71(cl LEYEL 8 9 9 20.405(e I (1 l(ii) 50.34(cl(2) S0,73( ~ ) LE I(viil DTHER (speedy sn Aostrrct Orlrvvrmlin Trit, NRC Form 20.406( ~ )(1)(15) X 60.73( ~ )(2)ill 60.73(e) (2) (viii)(A) 388AI 20AOS(el(1 l(ivt 50,73(e)(2) liil 50.73(el(2)(viiil(BI
))Wv@~< 20.405(el(1) lvl 50.73(e)(2((iil) 60.73 ( ~ I (2) (el LICENSEE CONTACT FOR THIS LEA (12I NAME TELEPHONE NUMBER AREA CODE J. R. Sampson, Operations Department COMPLETE ONE LINE FOR EACH COMPONENT FAILURE DESCRIBED IN THIS AEPOAT 113) 616465-5901 MANUFAC. EPORTABLE MANUFAC-CAUSE SYSTEM COMPONENT CAUSE SYSTEM COMPONENT TVRER TO NPADS aI(SI~BP; TIJRER
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SVPPLEMENTAL REPORT EXPECTED (14) MONTH DAY YEAR EXPECTED SUBMISSION DATE (15)
YES llf yrs, complrtr EXPECTED SIIEMISSIOII DATEJ NO ABsTRAcT (Limit to f400 sprees, I r., rppioxlmrtrlp liltrrn slnclr spree tvprwri ttrn linrsl (14)
On 4-20-92, contrary to Technical Specification (TS) 4.1.2.2.a.l, the seven-day test to prove the operability of the boration flow paths from the refueling water storage tank and the boric acid storage tank was not performed as scheduled. The test is accomplished by cycling each testable power-operated or automatic 'valve in the flow path through at least one complete cycle of full travel. The missed surveillance was identified on 4-24-92. The surveillance procedure was immediately performed. All test acceptance criteria were met. The missed surveillance occurred as a result of personnel error during the review process.
The findings of this event were reviewed with the involved personnel by their supervisors.
NRC Fosses 346 (64)9)
NRC FORM 366A (64)9)
LICENSEE EVENT REPORT (LER)
TEXT CONTINUATION U.S. NUCLEAR REGULATORY COMMISSION t APPROVED OMB NO. 31504104 EXPIRES: 4/30/92 ESTIMATED BURDEN PER RESPONSE TO COMPLY WTH THIS INFORMATION COLLECTION REQUEST: 50.0 HRS. FORWARD COMMENTS REGARDING BURDEN ESTIMATE TO THE RECORDS AND REPORTS MANAGEMENT BRANCH (P.530), U.S. NUCLEAR REGULATORY COMMISSION, WASHINGTON. DC 20555, AND TO 1'HE PAPERWORK REDUCTION PROJECT (31500104), OFFICE OF MANAGEMENTAND BUDGET, WASHINGTON, DC 20503.
FACILITY NAME (1) DOCKET NUMBER (2) LER NUMBER (6) PAGE (3)
SEQUENTIAL REVISION YEAR NUMBER NVMBER D. C. Cook Nuclear Plant Unit 1 0 5 0 0 0 3 ] 5 9 0 0 4 0 0 0 2 QF 0 TEXT ///moro 4O4co /4 roqo/rod, IrJo odds/orM/HRC Form 36649/ (17)
Conditions Prior to Occurrence Unit one (U-1) in mode one at 89.9X power.
Unit two (U-2) in mode six at OX power.
Descri tion of Event On 4-20-92, the 1-OHP 4030.STP.002V (Boration System Valve Position Verification and Testing) surveillance procedure was not performed to satisfy the Technical Specification (TS) surveillance requirement 4.1.2.2.a.l for TS 3.1.2.2 (Reactivity Control Systems Flow Paths - Operation). TS 4.1.2.2.a.l requires at least once per seven days that the boration flow paths from the refueling water storage tank (RWST) (EIIS/CB-TK) and the boric acid storage tank (BAST) (EIIS/CB-TK) be proven operable by cycling each testable power-operated or automatic valve in the flow path through at least one complete cycle of full travel.
The missed surveillance procedure was discovered by an Operations Department Engineer on 4-24-92. The surveillance test was last performed on 4-13-92.
The TS action statement was entered at 1255 hours0.0145 days <br />0.349 hours <br />0.00208 weeks <br />4.775275e-4 months <br /> and the 1-OHP 4030.STP.002V surveillance procedure was started, completed, and reviewed by 1314 hours0.0152 days <br />0.365 hours <br />0.00217 weeks <br />4.99977e-4 months <br /> on 4-24-92. A review of the completed surveillance noted that the surveillance acceptance criteria were satisfied and the action statement was exited at this time.
On 4-20-92, the involved Unit Supervisor (Senior Reactor Operator) reviewed the 1-OHP 4030.STP.002V paperwork completed during his shift. Following this review, the Unit Supervisor recorded the completed sections of the 1-OHP 4030.STP.002V surveillance procedure in the Master Surveillance Schedule.
While recording the completed sections of the surveillance procedure just reviewed, the Unit Supervisor incorrectly recalled that the weekly surveillance section of the procedure had been completed and signed off the weekly surveillance procedure as complete.
Following the performance of the surveillances listed on the schedule, the Operations Department Engineering Section conducts a review of the completed surveillance paperwork. During this surveillance paperwork review, the engineers identified on 4-21-92 that the 1-OHP 4030.STP.002V weekly surveillance procedure sheets were missing. Upon discovering that NR C Form 366A (64)9)
NRC FORM 366A U IL NUCLEAR REGULATORY COMMISSION APPROVED OMB NO. 31500104 (64)9) EXPIRESI 4/30/92 ESTI ED BURDEN PER RESPONSE TO COMPLY WTH THIS LICENSEE EVEN EPORT (LER) INFORMATION COLLECTION REQUEST: 50.0 HAS, FORWARD COMMENTS REGARDING BURDEN ESTIMATE TO THE RECORDS TEXT CONTINUATION AND REPORTS MANAGEMENT BRANCH (P-530). V.S. NVCI.EAR REGULATORY COMMISSION, WASHINGTON. DC 20555, AND TO 1'HE PAPERWORK REDUCTION PROJECT (31500104), OFFICE OF MANAGEMENTAND BUDGET, WASHINGTON, DC 20503.
FACILITY NAME (1) DOCKET NUMBER (2) LER NUMBER (6) PAGE (3)
SEOVENTIAL REVISION YEAR NUMSER NUMBER D. C. Cook Nuclear Plant Unit 1 0 5 0 0 0 3 ] 5 9 2 0 0 4 0 0 0 3 QF 0 TEXT /l/ moro Epoco /1 rorlur)od, uro oddldooo/ NRC Form 3664 9/ 07) the weekly surveillance procedure sheets were missing, the engineers documented that the weekly surveillance procedure was in grace by recording the status in the grace section of the Surveillance Status Summary Report.
Although the engineers identified that the weekly surveillance was apparently in grace due to the missing paperwork, the engineers did not pursue further why the surveillance procedure had not been completed. This was based on the engineers'ast experience had shown that the control room operators also track incomplete surveillances and pursue the completion of a surveillance before the grace period expires.
Cause of Event The cause for the missed surveillance was personnel error. The Unit Supervisor developed a mind set during the surveillance review that the surveillance was completed and therefore signed off the surveillance procedure as complete on the schedule.
In addition, the engineers had a mind set that control room operators record and track surveillances in grace and that the control room operators were aware that the surveillance had not been completed, or that the paperwork must have been routed to the engineers and had not arrived. Therefore, the engineers did not pursue further the completion of the surveillance.
A~nal sis Technical Specification (TS) 4.1.2.2.a.l (Reactivity Control Systems Flow Paths - Operating) requires at least once per seven days the boration flow paths from the refueling water storage tank (RWST) and the boric acid storage tank (BAST) to be proven operable by cycling each testable power-operated or automatic valve in the flow path through at least one complete cycle of full travel. The failure to perform the surveillance is a violation of Technical Specification 3.1.2.2 and is reportable under 10 CFR 50s73 (a)(2)(i)(B).
Following the identification of the missed surveillance, the 1-OHP 4030.STP.002V surveillance procedure was performed to satisfy the requirements of TS 4.1.2.2.a.l. A review of the completed surveillance noted that the requirements of the surveillance procedure were met. Therefore, it is concluded that the valves tested by the surveillance procedure would have performed their safety function if required during the time period from the last completed surveillance procedure on 4-13-92 and the surveillance procedure performed on 4-24-92.
NAC Form 366A (84)9)
NRC FORM 366A U.S. NUCLEAR REGULATORY COMMISSION APPROVED OMB NO. 31504(04 (64) 9)
EXPIRESI 4/30/02 ESTI FD BURDEN PER RESPONSE TO COMPLY WTH THIS LICENSEE EVEN EPORT (LER) INFORMATION COLLECTION REQUEST: 500 HRS. FORWARD COMMENTS REGARDING BURDEN ESTIMATE TO THE RECORDS TEXT CONTINUATION AND REPORTS MANAGEMENT BRANCH (P430), U.S. NUCLEAR REGULATORY COMMISSION, WASHINGTON, DC 20555, AND TO THE PAPERWORK REDUCTION PROJECT (31500104), OFFICE OF MANAGEMENTAND BUDGET, WASHINGTON, DC 20503.
FACILITY NAME (1) ~ DOCKET NUMBER (2) LER NUMBER (6) PAGE (3)
YEAR SEQUENTIAI. 5+( REVISION NUMBER NUMBER D. C. Cook Nuclear Plant Unit 1 3 1 5 9 2 0 0 4 0 0 0 40F 0 TEXT N mort trrtct is ttqur)td, u>> 4ddrrr'ootr HRC Form 3664'tl l)7)
Based upon the above analysis, the failure to perform the surveillance procedure within the grace period is not considered to have created a significant safety concern, nor did the missed surveillance create a significant hazard to the health and safety of the general public.
Corrective Action Following the identification that the portion of the 1-OHP 4030.STP.002V surveillance procedure had not been performed, the 1-OHP 4030 STP.002V ~
surveillance procedure was satisfactorily completed.
- 2. The Shift Supervisor reviewed The finding of this investigation with the involved Unit Supervisor. This review included a discussion of the Unit Supervisor responsibility and accountability for the performance and documentation of surveillance procedures.
- 3. The Operations Department Production Supervisor, reviewed the finding of this .investigation with the engineers involved.
Previous Similar Events A review of the License Event Reports did not identify a similar event.
NRC Form 366A (64)B)