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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
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Text
~ct."Z~~TKR>>A@@RQXRK>>~%7P&<R*@'~~M ACCESSION NBR:8808160353 DOC.DATE: 88/08/05 NOTARIZED: NO DOCKET FACIL:50-316 Donald C. Cook Nuclear Power Plant, Unit 2, Indiana a 05000316 AUTH. NAME AUTHOR AFFILIATION BAKERiK.R. Indiana Michigan Power Co. (formerly Indiana a Michigan Ele SMITHgW.G. Indiana Michigan Power Co. (formerly Indiana & Michigan Ele RECIP.NAME RECIPIENT AFFILIATION
SUBJECT:
LER 88-008-00:on 880719,fire door was made inoperable due to placement of hose for a hydrostatic test.W/880805 ltr.
W/8 DISTRIBUTION CODE: IE22D COPIES RECEIVED:LTR ENCL SIZE:
TITLE: 50.73 Licensee Event Report (LER), Incident Rpt, etc.
NOTES:
RECIPIENT COPIES RECIPIENT COPIES ID CODE/NAME LTTR ENCL ID CODE/NAME LTTR ENCL PD3-1 LA 1 1 PD3-1 PD 1 1 STANG,J 1 1 INTERNAL: ACRS MICHELSON 1 1 ACRS MOELLER 2 2 AEOD/DOA 1 1 AEOD/DSP/NAS 1 1 AEOD/DSP/ROAB 2 2 AEOD/DSP/TPAB 1 1 ARM/DCTS/DAB 1 1 DEDRO 1 1 NRR/DEST/ADS 7E 1 0 NRR/DEST/CEB SH 1 1 NRR/DEST/ESB 8D 1 1 NRR/DEST/ICSB 7 1 1 NRR/DEST/MEB 9H 1 1 NRR/DEST/MTB 9H 1 1 NRR/DEST/PSB SD 1 1 NRR/DEST/RSB SE 1 1 NRR/DEST/SGB SD 1 1 NRR/DLPQ/HFB 10 1 1 NRR/DLPQ/QAB 10. 1 1 NRR/DOEA/EAB 11 1 1 NRR/DREP/RAB 10 1 1 NRR/DREP/RPB 10 2 2 NRR D S SIB 9A 1 1 NUDOCS-ABSTRACT 1 1 IL 02 1 1 RES TELFORDgJ 1 1 DSXR DEPY 1 1 RES/DSXR/EIB 1 1 RES/DSR DEPY 1 1 RGN3 FXLE 01 1 EXTERNAL: EG6G WILLIAMSiS 4 4 FORD BLDG HOYgA 1 1 H ST LOBBY WARD 1 1 LPDR 1 1 NRC PDR 1 1 NSIC HARRISiJ 1 1 NSIC MAYSiG 1 1 S
D S
TOTAL NUMBER OF COPIES REQUIRED: LTTR 46 ENCL 45
NRC Form 388 U.S. NUCLEAR REOULATORY COMMISSION (8413)
APPROVED OMB NO. 31604101 LICENSEE EVENT REPORT (LER) EXPIRES: dl31(88 FACILITY NAME (I) DOCKET NUMBER (2) PA E D. C. Cook Nuclear Plant, Unit 2 0 5 0 0 0 3 1 6 1 OF 0 5
,Fire Door Inoperable Without Required Continuous Fire Watch Due to Labeling Problem and Personnel Error EVENT DATE (6) LER NUMBER (6) REPORT DATE (7) OTHER FACILITIES INVOLVED (8)
MONTH DAY YEAR YEAR err&: SBOUENZIAL RE vrsroN FACILITYNAMES DOCKFT NUMBER(6)
NUMBER 'r NUMBER MONTH DAY YEAR D. C. Cook, Unit 1 0 5 0 0 0 3 ] 5 0719 8 8 88 00 8 0 0 08 058 8 0 5 0 0 0 THIS REPORT IS SUBMITTED PURSUANT T0 THE REOUIREMENTS OF 10 CFR ()r (Check one or more of the follorrflnp/ (11)
OPERATINO MODE (8) 6 20.402(B) 20A05(cl 60.73(s) (2)(iv) 73.71(b)
POWER 20.406 (e) (I) (I) 50M(c)(II 50.73(ea2)(vl 7%7)(c)
LEVEL (10) 20.405(e)(1)(8) 50.38(c) (2) 50.'73(e) (2)(ill) OTHER (Specify In Abrtrect below enrf In Trit, IIRC Form 20A05(sl(1)(III) 50.73(e) (2) (I I 50.73(s) (2)(vill)(Al JSSAI 20.405(e) (1l(lv) 50,73(el(2)(ll) 50.73(s) (2) (el 8 I (8) 20.406(s)ll)(v) 60.73(s) (2)(ill) 50.73(e) (2) (iI LICENSEE CONTACT FOR THIS LER (12)
NAME TELEPHONE NUMBER AREA CODE K. R. Baker, Operations Superintendent 616 () 6 5901 CAUSE SYSTEM COMPONENT MANUFAC TURER EPORTABLE TO NPRDS
~X ..
COMPLETE ONE LINE FOR EACH COMPONENT FAILURE DESCRIBED IN THIS REPORT (13)
X r ': CAUSE SYSTEM COMPONENT MANUFAC.
TURER TO NPRDS X
r'PORTABLE eX' r~jj rr.
r4 X....r:. ÃS.
SUPPLEMENTAL REPORT EXPECTED l14) MONTH DAY YEAR EXPECTED SUBMISSION DATE (15)
YES Ilf yer, compleN EXPECTED SUBhtISSIDII DATEI X NO ABSTRACT (Llmlt to 1400 rpecer, I.r., epproilmetrly flltrrn slnpleepetr tyPrwrlttrn liner) (18)
On 07/19/88 at approximately 1500, the roll up fire door to the West Motor Driven Auxiliary Feedwater Pump (WMDAFP) room was made inoperable when a hose was placed through the doorway for a hydrostatic test. The door was then closed down on the hose and the sliding missile door (uninhibited by the hose) was closed over the hose. Due to inadequate labeling of the fire door and the fact that the missile door was previously the fire door until a design change installed the roll up door; the involved persons did not recognize the inoperability and no fire watch was posted.
At 1715 on 07/19/88, a routine fire protection tour identified the hose through the doorway of the WMDAFP roll up fire door and a roving fire watch was subsequently established. The fire door was restored to an operable status at 1206 on 07/21/88 when the hose was removed. It was subsequently identified that a continuous fire watch should have been posted. The failure to post a continuous fire watch was caused by personnel error.
The door labeling problem has been corrected. A guidance letter was issued to persons involved with fire watch postings to stress the importance of positively identifying whether a roving or continuous fire watch is required whenever they are involved with an inoperable fire door.
880816 PDR '353 ADQCK 880805 0500031~
PNU I'E ~/ f NRC Form Sdd (04)3)
NRC form 355A US. NUCLEAR REGULATORY COMMISSION (5 83)
LICENSEE EVENT REPORT (LER) TEXT CONTINUATION APPROVEO OMB NO. 3)50-0104 EXPIRES: 8/31/58 FACILITY NAME (11 COCKET NUMBER (3) LER NUMBER (5) PAGE (3)
YEAR r'p'COVSNTIAI ??<
",'P NVMSdtr 'rrrr REV SA NVMOdtr D. C. Cook Nuclear Plant, Unit 2 0 5 0 0 0 ] 6 8 8 008 00 0 2 oF 0 5 TEXT ///moro trroto it r/r/r/wtd, oto oddro'orro/ HRC Form 355A'tl (IT)
Conditions Prior to Occurrence Unit 1 was in Mode 1 (Power Operation) at 90 percent.
Unit 2 was in Mode 6 (Refueling) with the fuel off loaded.
Desci tion of Event At approximately 1500 on 07/19/88, a jumper hose was placed through the doorway to the West Motor Driven Auxiliary Feedwater Pump (WMDAFP) (ElIS/
BA-MDP) in preparation for a hydrostatic test. The Contractor pipe fitter who placed the hose then closed the Technical Specification roll up fire.
door (EIIS/DR) down on the hose and then closed the sliding missile protection door over the hose. The closing of the sliding door was not inhibited by the hose due to the gap beneath the door.
Prior to completing the connection of hydrostatic test .hoses to the East Motor Driven Auxiliary Feedwater pump (EMDAFP) and the Turbine Driven Auxiliary Feedwater pump (TDAFP) (EIIS/BA-TRBP) the pipefitter was preparing to call for a fire watch for the EMDAFP and TDAFP room fire doors when the contractor hydrostatic test supervisor arrived in the area. The supervisor and the pipefitter discussed the WMDAFP room door and it was agreed that since the hose did not obstruct the closing of the missile door, which they thought was the fire door, then no fire watch was required. .The supervisor then proceeded to call for fire watches for the EMDAFP and TDAFP rooms.
At 1715 on 07/19/88, a routine fire protection tour identified the hose in the doorway of the WMDAFP. The fire watch supervisor was called and he came to the door. A discussion was held between the fire watch supervisor and a Quality Control technician who happened to be passing by the area.
From this discussion it was 'concluded that the door should be considered inoperable and added to the roving fire watch patrol.
It was identified during unrestored the investigation of this event that a continuous fire watch should have been posted in accordance with T.S. 3.7.10 which requires a continuous fire watch when there are no operable fire detectors (EIIS/IC-DET) on either side of the door.
The WMDAFP fire door was to operable status at 1206 on 07/21/88 when the hose was removed from the doorway. The total time of non-compliance to the action statement of T.S. 3.7.10 was approximately forty-four hours.
Other than the WMDAFP fire door, there were no inoperable structures, components or systems which contrib'uted to this event.
N/IC CD/IM Sddk (5831
NRC Folln 3SSA US. NUCLEAR REOULATCRY COMMISSION (BW3>
LICENSEE EVENT REPORT ILER) TEXT CONTINUATION APPROVED OMB ND. 3150&104 EXPIRES: 8/31/88 FACILITY NAME (11 DOCKET NUMBER (2) LER NUMBER (d) PACE (3)
YEAR SEOVENTIAI. REVISION NVM ER NVMSER D. C. Cook Nuclear Plant, Unit TEXT llfmoro FPF Fo /F FFEVFod, IIM F ddt'oIM/ NRC /Foml Jd(LE'F I (17) 2 o 5 o o o 316 88 0 0 8 0 0 0 3 oF 0 Cause of Event There are two areas of concern in this event. The first being the failure to initially identify that a T.S. fire door was made inoperable and the second being the posting of a roving fire watch instead of the required continuous fire watch.
A. Failure to initially identify the inoperability of the WMDAFP fire door.
- 1. The roll up.door for the WHDAFP was installed in late 1984 when it was determined that the sliding, missile door could not meet the requirements for a fire door. Both the pipefitter and the supervisor were unaware that the sliding missile door was no longer the fire door. The pipefitter thought, the roll,up door had been installed for noise reduction.
- 2. The supervisor did not know that the roll up fire door existed.
When he arrived in the area, the missile door had already been closed and the roll up door was hidden from view.
- 3. The T.S. fire door designation for the roll up door is on the door hood which is above eye level. When wearing a hard hat, the sign is not visible unless a person looks up. With the sliding missile door closed, the T.S. fire door designation cannot be seen.
The human factors problems with the identification of the T.S. fire door coupled with the mind set caused by the sliding missile door previously being the fire door; is considered to be the root cause for the failure to initially identify the inoperability of the WMDAFP fire door.
B. Posting of a roving fiie watch instead of the required continuous fire watch.
- 1. The Quality Control technician who assisted the fire watch supervisor, although qualified to do so, -does not normally work with the establishment of fire watches and did not realize that the fire watch supervisor was relying on his determination of actions needed. The fire watch supervisor on the other hand, believed that the technician had made the final determination on actions required.
NRC FORM SESA (883)
NRC form 3SSA ~ US. NUCLEAR REOULATORY COMMISSION (943)
LICENSEE EVENT REPORT (LER) TEXT CONTINUATION APPROVED OMB NO. 3150W104 EXPIRES: 8/31/88 PACILITY NAME (11 DOCKET NUMBER (3) LER NUMBER (8) PACE (31 YEAR SEOUENTIAI. REV IS ION NUM ER rory NUM ER D. C. Cook Nuclear Plant, Unit 2 0 5 0 0 0 3 0 0 80 0 4 OF 0 5 TEXT ///moro tootoit o)ir/)od, oto oddro'orro/HRC forrrr 3NA't/ IIT)
- 2. In order to positively determine which fire rated assemblies have associated fire detectors, drawings must be used. For doors which are frequently made inoperable, a decision on the type of fire watch required is sometimes made based on previous. experience with the door rather than sorting through the drawings. In this event the technician made the decision based on his previous experience with other auxiliary feedwater (AFW) pump room doors instead of positively identifying the type of fire watch required.
- 3. There are fire detectors in the corridor=for the EMDAFP and TDAFP rooms. Therefore a roving fire watch is satisfactory for those rooms. The majority of the AFW pump room fire watch postings in the recent past have been for the EMDAFP and TDAFP rooms. This contributed to a mind set that an inoperable AFW pump room door only requires a roving fire watch.
The misunderstanding between the fire watch supervisor and the Quality Control technician as to who was making the final determination on fire watch requirements coupled with the mind set concerning AFW pump room fire doors, contributed to the personnel error which resulted in the posting of a roving fire watch instead of the required continuous fire watch.
Anal sis of Event This event is considered reportable pursuant to 10 CFR 50.73 (a)(2)(iB).
At the time of this event the WMDAFP was not required to be operable.
Since the WMDAFP was not required, any damage to the pump which could have been caused by a fire would not have posed a significant safety problem as defined in 10 CFR 50."59.
Corrective Actions
- 1. Signs have been placed at. the entrance to the Unit 1 and Unit 2 WMDAFP rooms to identify the Technical Specification roll up fire door which is behind the sliding missile .door.
- 2. A memorandum was issued to affected 'Quality Control personnel to stress the importance of positively identifying whether a roving or continuous fire watch is. needed whenever they are involved with an inoperable'ire door.
NRC tORM ESSA (983)
NRC For rr 3SSA U.S. NUCLEAR REOULATCRY COMMISSION (943)
LICENSEE EVENT REPORT (LER) TEXT CONTINUATION APPROVED OMB NO. 3150&(04 EXPIRES: 9/31/SS FACILITYNAME (1) DOCKET NUMSER 12) LER NUMBER (S) PACE (3)
YEAR SEOVENTIAL IIEVISION NVMSER NVM ER D. C. Cook Nuclear Plant, Unit 2 '316 88 008 00 05 oF 0 TEXT ///more sosse is rer/v/rerL ose edChr/orM/HRC %%dnn 3SSr('s/ l(7)
Failed Com onent Identificati'on None Previous Similar Events LER 50"315/82-026 LER 50-316/82-049 LER 50"316/82-052 LER 50-315/82-064 LER 50-315/83-012 LER 50-315/84-003 LER 50-315/84-006 LER 50-315/85-009 LER 50-315/85-051 These previous events basically involved persons blocking open doors and failing to establish a fire watch due to unfamilarity with the requirements for a blocked door. This event is different in that the persons were knowledgeable of the requirements, but did not know that a T.S. fire door was being blocked. No previous events of posting a roving fire watch instead of a continuous fire watch were identified.
NRC FORM 3ES*
(983)
Indiana Michigan Power Company
~
Cook Nucfear Plant P.O. Box 458 Z
Bridgrnan. Mi 49106 616 465 590I INDIANA NICHIGAR POWER August 5, 1988 United States Nuclear Regulatory Commission Document Control Desk Washington, D.C. 20555 Operating License DPR-58 Docket No. 50-316 Document Control Manager:
In accordance with the criteria established by 10 CFR 50.73 entitled Licensee Event Re ortin S stem, the following report is being submitted:
88-008-00 Sincerely, W. G. Smith, Jr.
Plant Manager WGS:clw Attachment cc: D. H. Williams, Jr.
A. B. Davis, Region M. P. Alexich III P. A. Barrett J. E. Borggren R. F. Kroeger NRC Resident Inspector J. F. Stang, NRC R. C. Callen G. Charnoff, Esq.
Dottie Sherman, ANI Library D. Hahn INPO PNSRC A. A. Blind S. J. Brewer/B. P. Lauzau