05000280/FIN-2010005-02
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Finding | |
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Title | Failure to Follow Procedure Results in Inadvertent Actuation of Safety Injection |
Description | A self-revealing Green NCV of TS 6.4, Unit Operating Procedures and Programs, was identified for the failure to follow procedure 1-OPT-ZZ-001, ESF Actuation with Undervoltage and Degraded Voltage 1H Bus. Specifically, on October 26, 2010, a test lead was incorrectly installed in the Unit 1 relay room for the logic circuit associated with the A train of Consequence Limiting Safeguards (CLS). This resulted in an inadvertent safety injection, isolated component cooling water supply to the standby residual heat removal (RHR) train, and automatically initiated several safety-related components including emergency diesel generator (EDG) #1. Operators entered AP- 10.20, Response To Spurious Safety Injection With RCS Temperature Less Than 350F, and terminated the safety injection in approximately three minutes. The licensee entered this issue into the CAP (CR 400908). Failure to install the test leads as required by procedure 1-OPT-ZZ-001, is a performance deficiency. The finding is more than minor because it is associated with the configuration control attribute of the Initiating Events Cornerstone and adversely affected the cornerstones objective to limit the likelihood of those events that upset plant stability and challenge critical safety functions during shutdown as well as power operations. The finding, evaluated in accordance with NRC Inspection Manual Chapter (IMC) 0609, Appendix G, Shutdown Operations Significance Determination Process, Attachment 1, Checklist 3, identified the finding is of very low safety significance (Green) because the finding did not lead to a loss of decay heat removal. This finding has a cross cutting aspect in the work practices component in the Human Performance area, because human error prevention techniques were not properly used commensurate with the risk significance of the assigned task (H.4(a)). (Section 1R22 |
Site: | Surry |
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Report | IR 05000280/2010005 Section 1R22 |
Date counted | Dec 31, 2010 (2010Q4) |
Type: | NCV: Green |
cornerstone | Initiating Events |
Identified by: | Self-revealing |
Inspection Procedure: | IP 71111.22 |
Inspectors (proximate) | R Hamilton J Nadel L Lake R Chou C Welch J Dodson E Lea G Mccoy G Kolcum |
CCA | H.12, Avoid Complacency |
INPO aspect | QA.4 |
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Finding - Surry - IR 05000280/2010005 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Surry) @ 2010Q4
Self-Identified List (Surry)
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