05000298/FIN-2008003-05
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Finding | |
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Title | Failure to Follow Work Control Program Procedures |
Description | A self-revealing Green finding was identified associated with the licensees failure to follow Administrative Procedure 0.40, Work Control Program, requirements that would have ensured the 4160 Volt bus breaker fuse maintenance would not trip reactor recirculation Pump B. Implementation of inadequate maintenance instructions resulted in an unexpected trip of the reactor recirculation Pump B and an unplanned reduction in reactor power. Specifically, the licensee failed to perform a thorough review of the electrical drawings required to fully understand the consequences of pulling fuses for maintenance in the 4160 Volt breaker cubicle. The licensee entered this issue into their corrective action program as Condition Report CR-CNS-2008-4400. This finding was more than minor since it affected the Initiating Events Cornerstone and affected the cornerstone objective to limit the likelihood of events that upset plant stability during power operations. Based on the results of a Significance Determination Process, Phase 1 Evaluation, the finding was determined to have very low safety significance since it did not contribute to the likelihood of a loss-of-coolant accident, did not contribute to a loss-of-mitigation equipment, and did not increase the likelihood of a fire or internal or external flood. The cause of this finding is related to the human performance crosscutting component of Work Practices because personnel did not effectively use self-checking techniques while determining the plant impact of the proposed fuse removal H.4(a) |
Site: | Cooper |
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Report | IR 05000298/2008003 Section 4OA3 |
Date counted | Jun 30, 2008 (2008Q2) |
Type: | Finding: Green |
cornerstone | Initiating Events |
Identified by: | Self-revealing |
Inspection Procedure: | IP 71153 |
Inspectors (proximate) | N Taylor B Baca G Miller W Sifre M Chambers M Bloodgood E Holcomb |
CCA | H.12, Avoid Complacency |
INPO aspect | QA.4 |
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Finding - Cooper - IR 05000298/2008003 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Cooper) @ 2008Q2
Self-Identified List (Cooper)
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