05000316/FIN-2016004-02
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Finding | |
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| Title | Moisture Separator Reheater Rupture |
| Description | Green. A self-revealed finding of very low safety significance (Green), occurred on July 6, 2016, when a portion of the Unit 2 Right Moisture Separator Reheater (MSR) B bellows assembly ruptured, causing a steam leak which damaged the adjacent turbine building wall. There were no associated violations of regulatory requirements since the piping was non-safety-related. Reacting to the rupture, operators tripped the reactor and isolated the leak by shutting the Main Steam Isolation Valves. While addressing a number of issues with the MSRs that occurred following a re-design of the internals in 2010, the licensee changed the design of the rods that hold the bellows assembly on each MSR pipe together. The design change called for tack welds to only be used on the end nuts of the rod. Contrary to the design change (EC51875), tack welds were placed on other nuts as well. The tack welds were determined to have changed the material properties of the rod in the vicinity of the welds, which caused cracking to initiate during operation. Eventually, the cracks grew to a point where two rods completely severed, causing the bellows to tear and rupture. Following the safe shutdown, the licensee repaired the bellows, inspected other rods, and restarted the plant. The issue was entered into their Corrective Action Program (CAP) as Action Request (AR)20167865. The issue was more than minor because it adversely affected the Design Control Attribute of the Initiating Events cornerstone because it resulted in a reactor trip and Unusual Event. Per the Significance Determination Process, a detailed risk evaluation was required because during the rupture operators had to close the Main Steam Isolation Valves, which isolated the main condenser (the preferred post-trip decay heat removal path). An NRC Regional Senior Reactor Analyst performed the evaluation and concluded the finding was of very low risk significance (Green). The inspectors determined the finding had an associated cross-cutting aspect in the Human Performance Area, specifically, H.12, Avoid Complacency. Specifically, site personnel did not plan for the possibility of mistakes, latent issues, and inherent risk, even while expecting successful outcomes. |
| Site: | Cook  |
|---|---|
| Report | IR 05000316/2016004 Section 4OA2 |
| Date counted | Dec 31, 2016 (2016Q4) |
| Type: | Finding: Green |
| cornerstone | Initiating Events |
| Identified by: | Self-revealing |
| Inspection Procedure: | IP 71152 |
| Inspectors (proximate) | G Edwards J Ellegood J Neurauter K Riemer M Garza P Smagacz R Fernandes T Go T Taylor V Meghani |
| CCA | H.12, Avoid Complacency |
| INPO aspect | QA.4 |
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Finding - Cook - IR 05000316/2016004 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Cook) @ 2016Q4
Self-Identified List (Cook)
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