05000254/FIN-2011003-02
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Finding | |
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| Title | Wrong Limit Error During Surveillance |
| Description | A self-revealed finding of very low safety significance and associated NCV of 10 CFR 50, Appendix B, Criterion V, Instructions, Procedures. and Drawings, was identified on May 4, 2011, when instrument technicians caused a control room alarm on Unit 2 after receiving permission from the Unit 1 unit supervisor to perform the test on Unit 1. Immediate actions included termination of the surveillance and restoration of the equipment to the correct lineup for plant conditions. The issue was entered into the corrective action program as IR 1211933. Inspectors determined that the licensees failure to follow the procedure as written resulted in Unit 2 surveillance procedure steps being performed on Unit 1 safety-related equipment; therefore, this was a performance deficiency. The inspectors answered the more than minor screening questions of IMC 0612, Appendix B, Figure 2, Block 9, question 2.a, indicating the performance deficiency could be viewed as a precursor to a significant event, and the finding was, therefore, more-than-minor. Inspectors determined that performing procedural action on the wrong unit would impact the Initiating Event Cornerstone objective of limiting the likelihood of upsetting plant stability and challenging critical safety functions during power operations. Specifically, the objective attributes of configuration control equipment performance were negatively impacted. Inspectors performed the SDP phase I screening using IMC 0609, Attachment 4, Table 4a for transient initiators in the Initiating Events Cornerstone column and answered the question No. The issue was screened as Green or very low safety significance. Inspectors concluded that the finding had a cross-cutting aspect in Human Performance-Work Practices, in that, licensee staff involved in the event failed to utilize human performance error prevention techniques commensurate with the risk of the assigned task to prevent impact to the station. |
| Site: | Quad Cities  |
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| Report | IR 05000254/2011003 Section 4OA2 |
| Date counted | Jun 30, 2011 (2011Q2) |
| Type: | NCV: Green |
| cornerstone | Initiating Events |
| Identified by: | Self-revealing |
| Inspection Procedure: | IP 71152 |
| Inspectors (proximate) | M Mitchell M Ring D Jones J Mcghee B Cushman J Draper R Murray C Mathews |
| CCA | H.12, Avoid Complacency |
| INPO aspect | QA.4 |
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Finding - Quad Cities - IR 05000254/2011003 | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Quad Cities) @ 2011Q2
Self-Identified List (Quad Cities)
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