05000293/FIN-2016004-05
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Finding | |
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| Title | |
| Description | Green. A self-revealing Green finding was identified for the inadequate implementation of a work order on the A feedwater regulating valve (FRV) encoder as required by ENWM- 102. Specifically, Entergy did not install a wire assembly on the A FRV encoder as required by the work instructions located in the vendor manual. The wire loosened, resulting in the A FRV failing open and the operators inserting a manual scram. In response to the loose connection, Entergy added a sealant to the connector to ensure all wires remain in place on both FRVs. Entergy entered the issue into the corrective action program (CAP) under condition report (CR) 2016-6635. The inspectors determined that the finding is more than minor because it is associated with the equipment performance attribute of the Initiating Events cornerstone and adversely affected the cornerstone objective to limit the likelihood of events that upset plant stability and challenge critical safety functions during a shutdown as well as power operations. Specifically, the performance deficiency affected the reliability and capability of the A FRV which led to a plant scram, tripping of the reactor feed pumps, and closure of the main steam isolation valves (MSIVs). The inspectors evaluated this finding using IMC 0609.04, Initial Characterization of Findings, issued October 7, 2016, and IMC 0609, Appendix A, Exhibit 1, Initiating Events Screening Questions, issued June 19, 2012, and determined a detailed risk evaluation was required because the A FRV failure caused a reactor trip and partial loss of feedwater (power conversion system). A Region I senior reactor analyst (SRA) used the Standardized Plant Analysis Risk (SPAR) model for Pilgrim, Version 8.24, and SAPHIRE, Version 8.1.4, to complete the detailed risk evaluation. The estimated increase in core damage frequency (CDF) was calculated to be 4E-7/year, or very low safety significance (Green). For issues resulting in an increase in CDF > 1E-7, IMC 0609 requires an evaluation of large early release frequency (LERF) using the guidance of NUREG-1765, Basis Document for LERF Significance Determination Process, and IMC 0609, Appendix H, Containment Integrity Significance Determination Process, issued May 6, 2004. The performance deficiency associated with the failure of the A FRV and resultant reactor trip would be considered a Type A finding and, as such, the calculated increase in CDF value is used in conjunction with an appropriate LERF factor (multiplier) to determine the estimated increase in LERF associated with the issue. In the absence of early core damage sequences for this event, LERF is not a significance risk contributor and the safety significance of this performance deficiency is defined by the estimated increase in CDF (4E-7/year) or Green. This finding has a cross-cutting aspect of Human Performance, Work Management, in that Entergy did not adequately implement the process of planning, controlling, and executing work activities such that nuclear safety is the overriding priority. Specifically, maintenance staff were provided a work order that did not meet station requirements to ensure the work could be adequately performed. Specific steps of the vendor manual were not used to direct work by staff and led to an installation error. The work planning process also did not implement the engineering recommendation to perform a practice installation on the equipment prior to installing equipment in the field. [H.5] |
| Site: | Pilgrim |
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| Report | IR 05000293/2016004 Section 4OA3 |
| Date counted | Dec 31, 2016 (2016Q4) |
| Type: | Finding: Green |
| cornerstone | Initiating Events |
| Identified by: | Self-revealing |
| Inspection Procedure: | IP 71153 |
| Inspectors (proximate) | A Burritt B Deboer B Dionne B Pinson E Carfang J Deboer J Nicholson J Vasquez N Embert P Cataldo P Ott |
| CCA | H.5, Work Management |
| INPO aspect | WP.1 |
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Finding - Pilgrim - IR 05000293/2016004 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Finding List (Pilgrim) @ 2016Q4
Self-Identified List (Pilgrim)
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