05000397/FIN-2018003-01
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Finding | |
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| Title | Failure to Follow Radiologically Controlled Area Procedures |
| Description | The inspectors reviewed a self-revealed Green, non-cited violation of Technical Specification 5.4.1(a) when the licensee failed to implement radiation control procedures. On June 1, 2017, a supplemental health physics technician (HPT) entered a posted locked high radiation area without a functioning electronic dosimeter (ED). Although the area was posted as a locked high radiation area (LHRA), there were no measured dose rates in excess of 1 rem per hour during this entry. The HPT logged on to Radiation Work Permit (RWP) 30003852 and entered the radiologically controlled area (RCA) to cover a job to add additional shielding in the travelling in-core probe (TIP) Mezzanine room. The HPT entered the RCA through the HP swing gate near the RCA exit point, in order to obtain survey instruments for the job coverage. The HPT proceeded to the dress out area and then to the TIP Mezzanine room, where he entered with a survey meter. After about 10 minutes in the room, the HPT looked at his ED and noticed that it was in pause mode (i.e., not functioning). The HPT informed the worker he was covering, and they both left the LHRA. During the RWP logging process, there was an error when the HPTs ED was being programmed that went unnoticed. As a result, the HPT was signed-on to the RWP, but the ED was not programmed and active. Because the HPT used the HP swing gate at the RCA exit rather than the normal access point with electronic turnstiles that verify ED function, this errant condition was not identified. The swing gate used was intended for HPTs assigned to assist workers with contamination alarms at the RCA exit, not as an RCA entry point to perform work or cover a job. Licensee Procedure GEN-RPP-04, Entry Into, Conduct In, and Exit From Radiologically Controlled Areas, Section 4.13 Dosimetry and Log-in, paragraph (e), requires workers to ensure that electronic dosimetry is on immediately before entering the RCA. The HPT neither used the electronic turnstiles nor checked to see if the ED was on prior to entering the RCA.Additionally, licensee Procedure 11.2.7.3 High Radiation Area, Locked High Radiation Area, and Very High Radiation Area Controls, Section 3.2.4 Coverage and Monitoring of Work, paragraph (d), describes conducting a peer-check prior to LHRA entries, by the job coverage HPT, to verify that workers are wearing an active ED (i.e., not in pause mode) in the appropriate location on the body. The job coverage HPT checked to see that workers had an ED appropriately placed, but did not check the ED setpoints or if the ED was active.Multiple barriers that could have prevented this situation from occurring were either ineffective or not used. Had the error reduction/prevention measures been used, the ED programming error during RWP log on would have been identified.Corrective Action(s): An immediate corrective action, in addition to the HPT being restricted from the RCA, was a stand down conducted with radiation protection personnel about this incident and coaching on use of the procedures related to the verification of dosimetry and peer-checking prior to entry into LHRAs. Corrective Action Reference: AR 00366701 |
| Site: | Columbia  |
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| Report | IR 05000397/2018003 Section 2RS1 |
| Date counted | Sep 30, 2018 (2018Q3) |
| Type: | NCV: Green |
| cornerstone | Or Safety |
| Identified by: | Self-revealing |
| Inspection Procedure: | IP 71124.01 |
| Inspectors (proximate) | G Kolcum L Brandt R Alexander N Hernandez J O'Donnell M Haire |
| Violation of: | Technical Specification - Procedures |
| CCA | H.12, Avoid Complacency |
| INPO aspect | QA.4 |
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Finding - Columbia - IR 05000397/2018003 | |||||||||||||||||||||||||||||||||||||||
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Finding List (Columbia) @ 2018Q3
Self-Identified List (Columbia)
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