Event Notification Report for June 15, 2011
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
06/14/2011 - 06/15/2011
EVENT NUMBERS
46964469604696146975
Power Reactor
Event Number: 46964
Facility: FITZPATRICK
Region: 1 State: NY
Unit: [1] [] []
RX Type: [1] GE-4
NRC Notified By: EUGENE DORMAN
HQ OPS Officer: PETE SNYDER
Region: 1 State: NY
Unit: [1] [] []
RX Type: [1] GE-4
NRC Notified By: EUGENE DORMAN
HQ OPS Officer: PETE SNYDER
Notification Date: 06/16/2011
Notification Time: 12:14 [ET]
Event Date: 06/15/2011
Event Time: 14:00 [EDT]
Last Update Date: 06/16/2011
Notification Time: 12:14 [ET]
Event Date: 06/15/2011
Event Time: 14:00 [EDT]
Last Update Date: 06/16/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
21.21 - UNSPECIFIED PARAGRAPH
10 CFR Section:
21.21 - UNSPECIFIED PARAGRAPH
Person (Organization):
JUDY JOUSTRA (R1DO)
PART 21 GROUP (EMAI)
JUDY JOUSTRA (R1DO)
PART 21 GROUP (EMAI)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 100 | Power Operation | 100 | Power Operation |
ROSEMOUNT MODEL 710 TRIP UNITS WOULD NOT TURN ON DURING TESTING
"On June 15, 2011, the Site Vice President was notified that the 10 CFR 21 evaluation of Rosemount Model 710 trip units supplied under purchase order 10174727 determined that the reporting criteria of 10 CFR 21.21 (d)(1) are met.
"During pre-installation testing, it was found that 3 of 4 Rosemount Model 710 trip units would not turn on. The units were returned to Rosemount for failure analysis and it was determined that a resistor in the start-up circuit for the trip unit was failed. This prevented the trip unit from starting. Based on engineering analysis, some of the applications for the trip unit require it to energize to perform the associated safety functions. Therefore, the identified failure mechanism could have represented a substantial safety hazard if the components had been installed, and the condition is reportable.
"The condition had no actual safety consequences as the deficiency was identified during pre-installation testing and if installed without pre-installation testing, the system could not have passed post maintenance testing. The three failed units were returned to Rosemount. This notification is made pursuant to 10 CFR 21(d)(ii)(3)(i)."
The licensee notified the NRC Resident Inspector.
"On June 15, 2011, the Site Vice President was notified that the 10 CFR 21 evaluation of Rosemount Model 710 trip units supplied under purchase order 10174727 determined that the reporting criteria of 10 CFR 21.21 (d)(1) are met.
"During pre-installation testing, it was found that 3 of 4 Rosemount Model 710 trip units would not turn on. The units were returned to Rosemount for failure analysis and it was determined that a resistor in the start-up circuit for the trip unit was failed. This prevented the trip unit from starting. Based on engineering analysis, some of the applications for the trip unit require it to energize to perform the associated safety functions. Therefore, the identified failure mechanism could have represented a substantial safety hazard if the components had been installed, and the condition is reportable.
"The condition had no actual safety consequences as the deficiency was identified during pre-installation testing and if installed without pre-installation testing, the system could not have passed post maintenance testing. The three failed units were returned to Rosemount. This notification is made pursuant to 10 CFR 21(d)(ii)(3)(i)."
The licensee notified the NRC Resident Inspector.
Power Reactor
Event Number: 46960
Facility: FERMI
Region: 3 State: MI
Unit: [2] [] []
RX Type: [2] GE-4
NRC Notified By: MARK EGHIGIAN
HQ OPS Officer: HOWIE CROUCH
Region: 3 State: MI
Unit: [2] [] []
RX Type: [2] GE-4
NRC Notified By: MARK EGHIGIAN
HQ OPS Officer: HOWIE CROUCH
Notification Date: 06/15/2011
Notification Time: 11:10 [ET]
Event Date: 06/15/2011
Event Time: 08:35 [EDT]
Last Update Date: 06/15/2011
Notification Time: 11:10 [ET]
Event Date: 06/15/2011
Event Time: 08:35 [EDT]
Last Update Date: 06/15/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
LAURA KOZAK (R3DO)
DENNIS ALLSTON (ILTA)
SCOTT MORRIS (IRD)
LAURA KOZAK (R3DO)
DENNIS ALLSTON (ILTA)
SCOTT MORRIS (IRD)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 2 | N | Y | 100 | Power Operation | 100 | Power Operation |
BODY DISCOVERED IN THE OWNER CONTROLLED AREA
"A deceased individual was discovered this morning along the shoreline of the Fermi-2 property, outside of the Protected Area. Specifically, at 0835 (EDT), the Main Control Room was notified by Security that a body had been found on the shoreline, north of the cooling towers. The Monroe County Sheriff and the US Coast Guard were notified and were on-site. The identity of the body has not yet been determined. The body has been removed from site by the US Coast Guard helicopter, and all local law enforcement officials have left site.
"A press release is not planned at this time."
The licensee has notified the NRC Resident Inspector.
"A deceased individual was discovered this morning along the shoreline of the Fermi-2 property, outside of the Protected Area. Specifically, at 0835 (EDT), the Main Control Room was notified by Security that a body had been found on the shoreline, north of the cooling towers. The Monroe County Sheriff and the US Coast Guard were notified and were on-site. The identity of the body has not yet been determined. The body has been removed from site by the US Coast Guard helicopter, and all local law enforcement officials have left site.
"A press release is not planned at this time."
The licensee has notified the NRC Resident Inspector.
Power Reactor
Event Number: 46961
Facility: INDIAN POINT
Region: 1 State: NY
Unit: [2] [] []
RX Type: [2] W-4-LP,[3] W-4-LP
NRC Notified By: FRANCIS MULLEK
HQ OPS Officer: MARK ABRAMOVITZ
Region: 1 State: NY
Unit: [2] [] []
RX Type: [2] W-4-LP,[3] W-4-LP
NRC Notified By: FRANCIS MULLEK
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 06/15/2011
Notification Time: 17:10 [ET]
Event Date: 06/15/2011
Event Time: 15:30 [EDT]
Last Update Date: 06/15/2011
Notification Time: 17:10 [ET]
Event Date: 06/15/2011
Event Time: 15:30 [EDT]
Last Update Date: 06/15/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
JUDY JOUSTRA (R1DO)
JUDY JOUSTRA (R1DO)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 2 | N | Y | 100 | Power Operation | 100 | Power Operation |
EVENT NOTIFICATION SYSTEM PHONE INOPERABLE
"The NRC Event Notification System phone in the Unit 2 CCR [Control Room] and the EOF [Emergency Operations Facility] at IPEC [Indian Point Energy Center] has failed. Entergy's telecommunications department and Verizon have commenced troubleshooting. This constitutes a loss of emergency notification system as required by 10CFR50.72(b)(3)(xiii). NRC Operations Center has been notified via commercial phone line at time of event."
The licensee will notify the NRC Resident Inspector.
* * * UPDATE AT 1827 ON 6/15/2011 FROM FRANCIS MULLEK TO MARK ABRAMOVITZ * * *
The telephone contractor found a "cross connect missing" and it has been replaced. The Control Room Supervisor declared ENS operable at 1827 EDT.
The licensee will notify the NRC Resident Inspector.
Notified the R1DO (Joustra).
"The NRC Event Notification System phone in the Unit 2 CCR [Control Room] and the EOF [Emergency Operations Facility] at IPEC [Indian Point Energy Center] has failed. Entergy's telecommunications department and Verizon have commenced troubleshooting. This constitutes a loss of emergency notification system as required by 10CFR50.72(b)(3)(xiii). NRC Operations Center has been notified via commercial phone line at time of event."
The licensee will notify the NRC Resident Inspector.
* * * UPDATE AT 1827 ON 6/15/2011 FROM FRANCIS MULLEK TO MARK ABRAMOVITZ * * *
The telephone contractor found a "cross connect missing" and it has been replaced. The Control Room Supervisor declared ENS operable at 1827 EDT.
The licensee will notify the NRC Resident Inspector.
Notified the R1DO (Joustra).
Agreement State
Event Number: 46975
Rep Org: WISCONSIN RADIATION PROTECTION
Licensee: ST. MARY'S HOSPITAL - RHINELANDER
Region: 3
City: RHINELANDER State: WI
County:
License #: 085-1296-01
Agreement: Y
Docket:
NRC Notified By: CHERYL K. ROGERS
HQ OPS Officer: STEVE SANDIN
Licensee: ST. MARY'S HOSPITAL - RHINELANDER
Region: 3
City: RHINELANDER State: WI
County:
License #: 085-1296-01
Agreement: Y
Docket:
NRC Notified By: CHERYL K. ROGERS
HQ OPS Officer: STEVE SANDIN
Notification Date: 06/21/2011
Notification Time: 12:37 [ET]
Event Date: 06/15/2011
Event Time: 00:00 [CDT]
Last Update Date: 06/21/2011
Notification Time: 12:37 [ET]
Event Date: 06/15/2011
Event Time: 00:00 [CDT]
Last Update Date: 06/21/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
KENNETH RIEMER (R3DO)
ANGELA MCINTOSH (FSME)
KENNETH RIEMER (R3DO)
ANGELA MCINTOSH (FSME)
AGREEMENT STATE REPORT - TWO I-125 INCIDENTS INVOLVING TOTAL DOSE LESS THAN PRESCRIBED DOSE
The State of Wisconsin sent the following report via email:
"On June 15, 2011, the licensee's Radiation Safety Officer reported the identification of two medical events that were discovered, involving permanent implants of I-125 for prostate brachytherapy where the total dose delivered differs from the prescribed dose by 20% or more. During a routine inspection conducted on March 8, 2011, DHS (Department of Health Services) inspectors determined that the licensee was not reviewing prostate brachytherapy cases against the medical event criteria and identified numerous potential medical events. A Confirmatory Action Letter was sent on April 6, 2011 which required the licensee to have all of their manual brachytherapy prostate implants reviewed by an outside radiation oncologist. Upon completion of the external review of the licensee's manual brachytherapy program for prostate implants, the licensee identified the following underdoses to the prostate (using D90<80% and D90>120% as medical event criteria):
"December 12, 2005: Prescribed dose 108 Gy. Prostate D90 was 67.16%.
"July 26, 2007: Prescribed dose 144 Gy. Prostate D90 was 74.09%.
"The licensee RSO stated that they will not be notifying the patients involved. DHS will send a special inspection team following the receipt of the licensee's 15 day written report."
Wisconsin Event Report ID No.: WI10007
A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.
The State of Wisconsin sent the following report via email:
"On June 15, 2011, the licensee's Radiation Safety Officer reported the identification of two medical events that were discovered, involving permanent implants of I-125 for prostate brachytherapy where the total dose delivered differs from the prescribed dose by 20% or more. During a routine inspection conducted on March 8, 2011, DHS (Department of Health Services) inspectors determined that the licensee was not reviewing prostate brachytherapy cases against the medical event criteria and identified numerous potential medical events. A Confirmatory Action Letter was sent on April 6, 2011 which required the licensee to have all of their manual brachytherapy prostate implants reviewed by an outside radiation oncologist. Upon completion of the external review of the licensee's manual brachytherapy program for prostate implants, the licensee identified the following underdoses to the prostate (using D90<80% and D90>120% as medical event criteria):
"December 12, 2005: Prescribed dose 108 Gy. Prostate D90 was 67.16%.
"July 26, 2007: Prescribed dose 144 Gy. Prostate D90 was 74.09%.
"The licensee RSO stated that they will not be notifying the patients involved. DHS will send a special inspection team following the receipt of the licensee's 15 day written report."
Wisconsin Event Report ID No.: WI10007
A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.