ML17251A537

LER 89-002-00:on 890506,safeguards 480 Volt Bus 14 Tripped During Offsite Power Mod Relay Testing.Caused by Typo in Mod Test Procedure That Called for Wrong Terminal Block to Be Opened.Error corrected.W/890605 Ltr

ML17251A537
Person / Time
Site:	Ginna
Issue date:	06/05/1989
From:	Backus W, Mecredy R ROCHESTER GAS & ELECTRIC CORP.
To:	NRC OFFICE OF INFORMATION RESOURCES MANAGEMENT (IRM)
References
LER-89-002, LER-89-2, NUDOCS 8906140291
Download: ML17251A537 (16)

Text

~AC CELE P<TED Dl STMBt'T1 0%DEMO~STRXT104&ZTEk REGULATORY INFORMATION DISTRIBUTION SYSTEM (RIDS)ACCESSION NBR:8906140291 DOC.DATE: 89/06/05 NOTARIZED:

NO FACIL:50-244 Robert Emmet Ginna Nuclear Plant, Unit 1, Rochester G AUTH.NAME AUTHOR AFFILIATION BACKUS,W.H.

Rochester Gas&Electric Corp.MECREDY,R.C.

Rochester Gas&Electric Corp.RECIP.NAME RECIPIENT AFFILIATION DOCKET g 05000244

SUBJECT:

LER 89-002-00:on 890506,safeguards bus undervoltage during relay testing due to inadequate procedure review.W/8 DISTRIBUTION CODE: IE22T COPIES RECEIVED:LTR ENCL SIZE: TITLE: 50.73/50.9 Licensee Event Report (LER), Incident Rpt, etc.NOTES:License Exp date in accordance with 10CFR2,2.109(9/19/72).

05000244 RECIPIENT ID CODE/NAME'D1-3,LA JOHNSON,A INTERNAL: ACRS MICHELSON ACRS WYLIE AEOD/DSP/TPAB DEDRO NRR/DEST/ADE 8H NRR/DEST/CEB 8H NRR/DEST/ICSB 7 NRR/DEST/MTB 9H NRR/DEST/RSB 8E NRR/DLPQ/HFB 10 NRR/DOEA/EAB 11 NUDOCS-ABSTRACT RES/DSIR/EIB RGN1 FILE 01 EXTERNAL: EG&G WILLIAMS, S L ST LOBBY WARD NRC PDR NSIC MURPHYIG A COPIES LTTR ENCL 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1-1 1 1 1 4'4 1 1 1 1 1 1 RECIPIENT ID CODE/NAME PD1-3 PD ACRS MOELLER AEOD/DOA AEOD/ROAB/DSP IRM/DCTS/DAB NRR/DEST/ADS 7E NRR/DEST/ESB 8D NRR/DEST/MEB 9H NRR/DEST/PSB 8D NRR/DEST/SGB 8D NRR/DLPQ/PEB 10 REB/RPB 10 EG F 02 PRAB FORD BLDG HOY,A LPDR NSIC MAYS,G COPIES LTTR ENCL 1 1 2 2 1 1 2 2 1 1 1 0 1 1.1 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1 1 1 1 1 D S D S NOrE'IO ALL>>RIDS>>RECZPZZNrS:

PLEASE HELP US K)REDUCE WASTE!CGNZACT'IHE DCKX>~r CXÃZK)L DESK, RXN Pl-37 (EXr.20079)K)ELIMINATE YOUR NAME~DIBTRIBVTION LISTS R)R DOCUMENIS YOU DON'T NEED!~TOTAL NUMBER OF COPIES REQUIRED: LTTR 43 ENCL 42 D D S

ROCHESTER GAS AND ELECTRIC CORPORATION

~89 EAST AVENUE, ROCHESTER, N.Y.14649.0001 June 5, 1989 U.S.Nuclear Regulatory Commission Document Control Desk Washington, DC 20555

Subject:

LER-89-002, Safeguards Bus Undervoltage During Relay Testing Due To Inadequate Procedure Review Causes the"A" Emergency Diesel Generator To Automatically Start and Accept Load R.E.Ginna Nuclear Power Plant.Docket No.50-244 In accordance with 10 CFR 50.73, Licensee Event Report System, item (a)(2)(iv) which requires a report of,"any event or condition that resulted in manual or automatic actuation of any Engineered Safety Feature (ESF)including the Reactor Protection System (RPS)", the attached Licensee Event Report LER-89-002 is hereby submitted.

This event has in no way affected the public's health and safet:y.XC: V ery truly yours, Robert C.Mecre General Manager Nuclear Production U.S.Nuclear Regulatory Commission Region I 475 Allendale Road King of Prussia, PA 19406 Ginna USNRC Senior Resident Inspector 890614029k 890605 PDR ADOCK 05000244 PDC 0

eeAC terre 200 I04)I LICENSEE EVENT REPORT (LER)US.NVCLCAA ACOULATO1Y COMMlSEION AttAOVCO OMO HO.2(50 0(Ore EX4150 0/Er/05 FACILITY NAME lll R.E.Ginna Nuclear Power Plant OOCXCT NVMOCA Ql 060004410F06 a egu s us n ervo tage During Re ay Testing Due To Inadequate Procedure Review Causes The NAN Emer enc Diesel Generator To Start and Acce CVCIIT CATE I~I LCA NVMEEA (4 ACFOAT OATC III OTNC1 FACILITIEC INVOLVCO III MOHTre OAY YEA)I YEAN 550UlNTIAL ee" ACVAIOee NUM051 rh reUeeetA MONTH OAY YEAN~ACILITY reAULO OOCXCT HVMOCA(5)0 5 0 0 0 0 5 0 6 8 9 8 9 0 02 00 60589 0 5 0 0 0 Ot 5 A AT INC MOOC (0)FOIYC1 LcvcL 0 0 0'CHIC t)CFOIIT IC CUOMITTCO W15VAHT T 00.)24)4 Illrl~OQ24IQIlrl

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~OQ24)(l)(rW I IOI 50.)l(~)Q)I~I 20.e00(el 00 J4(el()i~OM(e)QI 00.224IQII4 50,224)QI(0) 50.7 2 4 I 4 I I Wl 10.002 (0)20.000(e)ll)IO 20.400 ie)I)I I 5 I SO.COO 4)I)l(WI 20 ACE 4)(l)(H)2O.COE 4)II l le I LICCHCCE CONTACT tOll'TNIC LEA Ill)0 THC hlovIACMCNTC Ot 10cth fj:/crete rer ee errer el IIee leIIeeeeet/

Ill 22.)1(01 TS.T I (e)OTHCA/Stecrry Ie AArrrect terra rert Ie TrrL HAC teeter JCOA/NAME Wesley H.Backus Technical Assistant to the Operations Mana er At(CA COOC 315 TCLCFHOHC HUMEEA COMtLCTC ONE LINC tOA CACN COMFONENT FAILU15 OCCCAIECO IN THIS ACFOAT Ill)CAV5E 5YCTCM CO UFO H CHT MAHUFA('e TUACA EtOrll'AEI,C 4,'~yec+jgt@COMFOHEN'T MANVFAC TVAEA EFOATAOL IP;44%~@y+<4 EUttLCMCNTAL ACFOAT CXFECTCO (l4 YCC/I/yre, cterterre CXFCCTCO SVSMISSIOH OATS/HO AJCTAACT IL/eUt ce taxi terra, tr..rtteererrere/y IIIHar rletrretecr tytear1He Here)IIOI Axe x)yh.MONTH CAY YCAA EXFCCTCO LUI M<$5)ON CATE IIII On May 6, 1989 at 0946 EDST with the reactor in the Cold/Refueling Shutdown Condition, safeguards 480 volt Bus 14 tripped during offsite power modification relay testing.This caused the QAQ Emergency Diesel Generator to automatically start and connect to safeguards 480 volt Bus 14.The underlying cause of the event was due to a typographical error in the Modification Test Procedure that called for the wrong terminal block to be opened for blocking the above bus trip.This typographical error was due to inadequate proofread-ing of last minute changes to the procedure.

Corrective action taken was to identify and correct the procedure error and to restore safeguards 480 volt Bus 14 to its normal power supply.NAC Freer 200 (&45)

fj HAC Farm SSSA lslsl LICENSEE EVENT REPORT ILER)TEXT CONTINUATION U.S.IIUCLSA+IIlOULATOIY COMMISSIOM AFFIIOYSO OMs IIO SISO&IOo SXFIASS SISIISS FACILITY SIAM@III R.E.Ginna Nuclear Power Plant: TxxT/IF more AMoe e leeveee.Vee eoebFoneF HEMIC foml~'ll I ITS o s o o o 244 89 LSII IIUMSSII LSI SSQVSHTIAL MVM SA 002 ASYISION MVM Se-0 0 020~0 6 I~PRE-EVENT PLANT CONDITIONS The unit was in cold/refueling shutdown for the Annual Refueling Maintenance Outage.An offsite power reconfigura-tion modification was in progress per ERR-4525.DESCRIPTION OP EVENT'.DATES AND APPROXIMATE TIMES FOR MAJOR OCCURRENCES:

o May 6, 1989, 0946 EDST: Event date and time.'May 6, 1989, 0946 EDST: Discovery date and time.o May 6, 1989, 0952 EDST: Safeguards Bus 14 Normal Power Supply Restored.o May 6, 1989, 0952 EDST: Safeguards Bus 14"A" Emergency Diesel Generator Power Supply Terminated and"Bss Emergency Diesel Generator Stopped and Lined Up for Auto Standby.B.EVENT: On May 6, 1989 at 0946 EDST, the reactor was in the cold/refueling shutdown condition.

Relay testing was in progress on 4160 volt safeguards Bus 12A per step 6.2.5.1.1 of station modification procedure SM-4525.15.During the performance of relay testing on 12A, differential relay 87B/12A operated lockout bus relay 86B/12A, which tripped the station service transformer breaker (14SS-4160V) causing an under-voltage condition on 480 volt safeguards Bus 14.The"A" Emergency Diesel Generator Automatically started, as required, due to the undervoltage condition on 480 volt safeguards Bus 14 and sub-sequently connected to Bus 14 as required.'vAC FOAM SSSA IS4SI 4

NRC tat~2SSA I 0421 LICENSEE EVENT REPORT (LER)TEXT CONTINuATION U.S, NUCLCAR RlOULATORY COMMISSION AttROVCO OMS NO 2150MI04 Txt>RSS SISICSS tACILITY NAME III OOCKCT NUM02R 12I LSR NUM02R ISI*SSOVSNTIAL NUM SR RSVOlON NUM SR tAOI I21 R.E.Ginna Nuclear Power Plant T29cT Ilf ecece Nwce e~eee acccRAeMI NJIC Fcecn~'el IITI o s o o o 244 8 9 002-00 03OF06 C.D.E.INOPERABLE STRUCTURES t COMPONENTS t OR SYSTEMS THAT CONTRIBUTED TO THE EVENT: None.OTHER SYSTEMS OR SECONDARY FUNCTIONS AFFECTED: None.METHOD OF DISCOVERY:

The event was immediately apparent due to alarms and indications in the Control Room.F.OPERATOR ACTION: Following the Bus 14 undervoltage and"ATI Emergency-Diesel Generator Automatic Start and the Tie Breaker Closure to Bus 14, the Control Room Operators immed-iately verified proper voltage on Bus 14 and that the"A" Emergency Diesel Generator displayed proper voltage and frequency.

G.SAFETY SYSTEM RESPONSES:

The"A" Emergency Diesel Generator automatically started and tied into 480 volt safeguards Bus 14 due to a valid undervoltage signal on Bus 14.IZZ.CAUSE OP A.IMMEDIATE CAUSE: The automatic actuation of the"A" Emergency Diesel Generator and subsequent tie into Bus 14 was due to a valid undervoltage signal from the Bus 14 undervoltage monitoring system.wRc foRM ssee<942 I

NIIC FaNN S~SA 10451 LICENSEE EVENT REPORT ILER)TEXT CONTINUATION U.S.NUCLSAII IISOULATOIIT COMMISSION AFFAOVEO OMS NO 315OWIOI SKFIIISS SISIISS FACILITY NAMS 111 R.E.Ginna Nuclear Power Plant'fQ(T IJT maat t 5 tt it Itt~K att~)YACC FaaIII JC54'll (171 OOCKST NUMSEII Ill o s o o o 24 489 LSII NUMSSII I~I 5 5 0 V 5 N'I I A L H V M t I II 0 0 2 hl VISION NVMtta 0 0 0 40i0 6 B.INTERMEDIATE CAUSE: The valid undervoltage signal was due to an operation of 86B/12A lock-out relay during Bus 12A relay testing which inadvertently tripped the station service transformer breaker (14SS-4160V) to Bus 14.The 86B/12A lock-out relay trip contacts for breaker (14SS-4160V) were not blocked from operating prior to testing because of a typographical error in the SM-4525.15 procedure which called for the wrong terminal block to be opened for blocking the trip (i.e.TFH-10 was opened and TFF-10 should have been opened).C.ROOT CAUSE: The root cause of the event was an inadequate technical.proofreading review of a retyped version of SM-4525.15 subsequent to some last minute changes.This led to the typographical error that caused the event not being identified and corrected prior to the procedures use.ANALYSIS OF EVENT The event is reportable in accordance with 10 CFR 50.73, Licensee Event Report System, item (a)(2)(iv), which requires reporting of,"any event or condition that resulted in manual or automatic actuation of any Engineered Safety Feature (ESF)including the Reactor Protection System (RPS)".The starting of the"A" Emergency Diesel Generator was an automatic actuation of an ESF system.An assessment was performed considering both the safety consequences and implications of this event with the following results and conclusions:

NIIC FOSM SC A 5 ll

NIIC farm 554A 10411 LICENSEE EVENT REPORT ILER)TEXT CONTINUATION U.S.NUCLfAII ASOULATONY COMMISSION AffIIOVfO OMS NO SISOWIOS f X~Illf 5 llSI/55 5 AC I LITT N AM 5 I 1 I OOCIIfT NUMlfll If)Lfll NUMOflI ISI SSQVSHTIIL

>>VLI 5 1 rr 5 v rs ro N rrV>>SA fAOf ISI R.E.Ginna NUclear'Power Plant>get IIf more N>>ce>>reer>>ee.r>>e osrv>>reI HlIC forrrr~5 I IITI o s o o o 2 4 4 8 9-0 0 2 0005 OF 0 6 There were no operational or safety consequences or implications attributed to the starting of the"A" Emergency Diesel Generator and subsequent tie breaker closure to Bus 14 because: 0 0 The"A" Emergency Diesel Generator and tie-breaker closure to Bus 14 operated as designed.Bus 14 normal power was restored in approximately 6 minutes.0 The other train of safeguards power was energized and available at all times.0 Offsite power was available throughout the event.V.CORRECTIVE ACTION A.ACTION TAKEN TO RETURN AFFECTED SYSTEMS TO PRE-EVENT NORMAL STATUS: 0.The error in the procedure was identified and changed.The terminal blocks were then changed to their required positions.

0 Normal power was restored to Bus 14 and the"A" Emergency Diesel Generator was stopped and'ealigned for automatic standby.N II C f 0 Ir rrr 554 L IS 551

N(IC rrrM 555A 19r151 LICENSEE EVENT REPORT ILER)TEXT CONTINUATION U.5.NUCLCAII (15QULA'IOIIY COMMISSION ATTIIOVSO OMO NO, 5190WIOS 5XI'1155 e(SI(55 SACILITY NAMC 111 R.E.Ginna Nuclear Power Plant 55XT ((I'rr(re rr neaeeC wt rrMMSAS((Y(IC Feme~'r(117)OOCI(5T NU~SII 111 o 5 o o o 24 489 Llll NUMOlll I~I SSOUSNTIAL NUM Sw-0 0 2 iSVISIOH NUM~A-0 rAOS 151 0 6 0 6 B.ACTION TAKEN OR PLANNED TO PREVENT RECURRENCE' The existing station policy and guidance on procedure change proofreading and technical review was re-evaluated and is adequate.The need for adherence to this policy was re-inforced by issuance of a letter to the appro-priate groups by the modification support coordinator.

0 The consequences of the inadequate technical review will be reviewed again with those respon-sible for preparing modification test procedures, prior to the 1990 Annual Refueling and Maintenance Outage.0 Meaningful cut-off dates will be established for engineering design outputs for the l990 outage, to ensure adequate review of all required tests, and prevent"last minute requirements from being inserted into test procedures without adequate technical review." VI.ADDITIONAL INFORMATION:

A.B.FAILED COMPONENTS:

None.PREVIOUS LERs ON SIMILAR EVENTS: A similar LER event historical search was conducted with the following results: No documentation of similar LER events with the same root cause at Ginna Station could be identified.

C.SPECIAL COMMENTS: None.NAC rOklM'SSSA

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