Event Notification Report for June 19, 2000
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
06/18/2000 - 06/19/2000
General Information or Other
Event Number: 37094
Rep Org: MA RADIATION CONTROL PROGRAM
Licensee: AEA TECHNOLOGY
Region: 1
City: BURLINGTON State: MA
County:
License #: 12-8361
Agreement: Y
Docket:
NRC Notified By: MICHEAL WHALEN
HQ OPS Officer: FANGIE JONES
Licensee: AEA TECHNOLOGY
Region: 1
City: BURLINGTON State: MA
County:
License #: 12-8361
Agreement: Y
Docket:
NRC Notified By: MICHEAL WHALEN
HQ OPS Officer: FANGIE JONES
Notification Date: 06/19/2000
Notification Time: 14:51 [ET]
Event Date: 06/19/2000
Event Time: 11:30 [EDT]
Last Update Date: 06/19/2000
Notification Time: 14:51 [ET]
Event Date: 06/19/2000
Event Time: 11:30 [EDT]
Last Update Date: 06/19/2000
Emergency Class: NON EMERGENCY
10 CFR Section:
20.2202(b)(1) - PERS OVEREXPOSURE/TEDE >= 5 REM
10 CFR Section:
20.2202(b)(1) - PERS OVEREXPOSURE/TEDE >= 5 REM
Person (Organization):
ROBERT SUMMERS (R1)
DON COOL (NMSS)
ROBERT SUMMERS (R1)
DON COOL (NMSS)
POTENTIAL PERSONNEL OVEREXPOSURE
A technician opened a "package" on the loading dock to check the contents after an apparent miscommunication. The package contained 1650 curies of Co-60 in a shielded container. The technician received an undetermined dose to the head and shoulder areas of the body, possibly in excess of 5 rem. The dose will be determined but there is a good chance that it will be less than 5 rem. Even after removal of the outer plug there was still 1.125 inches of tungsten shielding.
The Massachusetts Radiation Control Program plans to go to the site and conduct an investigation.
A technician opened a "package" on the loading dock to check the contents after an apparent miscommunication. The package contained 1650 curies of Co-60 in a shielded container. The technician received an undetermined dose to the head and shoulder areas of the body, possibly in excess of 5 rem. The dose will be determined but there is a good chance that it will be less than 5 rem. Even after removal of the outer plug there was still 1.125 inches of tungsten shielding.
The Massachusetts Radiation Control Program plans to go to the site and conduct an investigation.
!!!!! THIS EVENT HAS BEEN RETRACTED !!!!!
!!!!! THIS EVENT HAS BEEN RETRACTED !!!!!
Power Reactor
Event Number: 37095
Facility: DAVIS BESSE
Region: 3 State: OH
Unit: [1] [] []
RX Type: [1] B&W-R-LP
NRC Notified By: CRAIG GILLIG
HQ OPS Officer: FANGIE JONES
Region: 3 State: OH
Unit: [1] [] []
RX Type: [1] B&W-R-LP
NRC Notified By: CRAIG GILLIG
HQ OPS Officer: FANGIE JONES
Notification Date: 06/19/2000
Notification Time: 16:22 [ET]
Event Date: 06/19/2000
Event Time: 15:25 [EDT]
Last Update Date: 06/22/2000
Notification Time: 16:22 [ET]
Event Date: 06/19/2000
Event Time: 15:25 [EDT]
Last Update Date: 06/22/2000
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(1)(i)(A) - PLANT S/D REQD BY TS
10 CFR Section:
50.72(b)(1)(i)(A) - PLANT S/D REQD BY TS
Person (Organization):
ROGER LANKSBURY (R3)
ROGER LANKSBURY (R3)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 100 | Power Operation | 98 | Power Operation |
PLANT SHUTDOWN REQUIRED BY TECH SPEC 3.0.3 DUE TO FAILED VALVE TESTING
The licensee was conducting Instrument and Control testing under DB-MI-03211 which failed to produce the expected response for solenoid SP6A2 on valve SP6A, Steam Generator Main Feedwater Valve. The problem is with the solenoid or associated limit switch. Due to a lack of specific Technical Specification guidance, 3.0.3 has been entered which requires the plant to initiate action to place the plant in a mode in which the specification does not apply. It is expected that the plant will be able to repair and test prior to a full plant shutdown.
The licensee notified the NRC Resident Inspector.
* * * UPDATE AT 1710 EST ON 6/19/00 BY CRAIG GILLIG TO FANGIE JONES * * *
The licensee determined the problem was with the limit switch, has exited the tech spec required shutdown, and is returning to full power from 96%.
The licensee intends to notify the NRC Resident Inspector. The R3DO (Roger Lanksbury) has been notified.
* * * UPDATE ON 6/22/00 @ 1334 BY WOLF TO GOULD * * * RETRACTION
The suspect limit switch for solenoid valve SVSP6A2 has been adjusted and satisfactorily tested via Surveillance Test DB-MI-03211. This testing confirmed that the problem was only with the limit switch. The solenoid valve and associated Steam Generator Main Feedwater Control Valve SPGA remained operable during this event. Therefore, the plant was not in the Action Statement for Technical Specification 3.0.3, and no plant shutdown was required. Therefore, the licensee desires to retract this event.
The NRC Resident Inspector has been notified of the retraction by the licensee.
The Reg 3 RDO (Lanksbury) was informed by the NRC Operations Officer.
The licensee was conducting Instrument and Control testing under DB-MI-03211 which failed to produce the expected response for solenoid SP6A2 on valve SP6A, Steam Generator Main Feedwater Valve. The problem is with the solenoid or associated limit switch. Due to a lack of specific Technical Specification guidance, 3.0.3 has been entered which requires the plant to initiate action to place the plant in a mode in which the specification does not apply. It is expected that the plant will be able to repair and test prior to a full plant shutdown.
The licensee notified the NRC Resident Inspector.
* * * UPDATE AT 1710 EST ON 6/19/00 BY CRAIG GILLIG TO FANGIE JONES * * *
The licensee determined the problem was with the limit switch, has exited the tech spec required shutdown, and is returning to full power from 96%.
The licensee intends to notify the NRC Resident Inspector. The R3DO (Roger Lanksbury) has been notified.
* * * UPDATE ON 6/22/00 @ 1334 BY WOLF TO GOULD * * * RETRACTION
The suspect limit switch for solenoid valve SVSP6A2 has been adjusted and satisfactorily tested via Surveillance Test DB-MI-03211. This testing confirmed that the problem was only with the limit switch. The solenoid valve and associated Steam Generator Main Feedwater Control Valve SPGA remained operable during this event. Therefore, the plant was not in the Action Statement for Technical Specification 3.0.3, and no plant shutdown was required. Therefore, the licensee desires to retract this event.
The NRC Resident Inspector has been notified of the retraction by the licensee.
The Reg 3 RDO (Lanksbury) was informed by the NRC Operations Officer.
General Information or Other
Event Number: 40085
Rep Org: WA DIVISION OF RADIATION PROTECTION
Licensee: FRED HUTCHINSON CANCER RESEARCH CENTER
Region: 4
City: SEATTLE State: WA
County:
License #: WN-L042-1
Agreement: Y
Docket:
NRC Notified By: ARDEN SCROGGS
HQ OPS Officer: JOHN MacKINNON
Licensee: FRED HUTCHINSON CANCER RESEARCH CENTER
Region: 4
City: SEATTLE State: WA
County:
License #: WN-L042-1
Agreement: Y
Docket:
NRC Notified By: ARDEN SCROGGS
HQ OPS Officer: JOHN MacKINNON
Notification Date: 08/18/2003
Notification Time: 18:10 [ET]
Event Date: 06/19/2000
Event Time: 12:00 [PDT]
Last Update Date: 08/18/2003
Notification Time: 18:10 [ET]
Event Date: 06/19/2000
Event Time: 12:00 [PDT]
Last Update Date: 08/18/2003
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
BLAIR SPITZBERG (R4)
JOHN HICKEY (NMSS)
BLAIR SPITZBERG (R4)
JOHN HICKEY (NMSS)
OVEREXPOSURE
"Exposure (intended/actual): consequences: Actual exposure received was Licensee: Fred Hutchinson Cancer "Research Center
"City and state: Seattle, Washington
"License number: WN-L042-1
"Type of license: Medium Broad License
"Date of event: Reported by licensee on 19 June 2000, (indicated overexposure for the wear period between 5 April to 4 "May 2000).
"Location of Event: Seattle, Washington
"ABSTRACT: (where, when, how, why; cause, contributing factors, corrective actions, consequences, DOH on-site investigation; media attention) On 19 June 2000, the licensed RSO reported that their dosimetry badge provider (Landauer Inc.) had notified them that one of the Fred Hutchinson employees had apparently received an exposure of 317,791 millirem of high energy gamma radiation. This employee performs animal studies involving irradiations using both a Linac and a Cobalt 60 irradiator (a J.L. Shepherd Model 285, Serial Numbers 625 & 626).
"The RSO immediately started an investigation of the reported overexposure. The RSO discovered that the individual's dosimetry badge had been lost during the second week of April 2000 for a period of about one week. An unknown person, via the inter-office mail system, returned it to the individual the next week. The employee was unable to recall any situation that would have lead to an exposure of any amount greater then the usual for the work performed over that time period.
"Several circumstantial events as well as actual occurrences seem to indicate that the exposure was probably only received by the dosimetry badge. These were: first, the employee indicated that the dosimetry badge had been lost during the second week of April 2000, for a period of about one week. Second, only the Cobalt 60 irradiator was in operation during that period; the Linac was out of service then. Third, since several groups share use of the irradiator, the badge conceivably was found, in the irradiator room, by one of those people and returned in the inter-office mail system. Lastly, the employee never experienced any radiation related illnesses. The reported exposure of 317,791 millirem was removed from the employee's exposure history and replaced with a 20 millirem exposure (average monthly exposure for previous 12 months).
"No DOH on-site investigation was made or media attention was noted.
"What is the notification or reporting criteria involved? 10 CFR 20.2202 (a)(1) significant . After reviewing our incident files and the Handbook on Nuclear Material Event Reporting in the Agreement States , we determined that an immediate notification should have been sent to NRC. This did not occur; consequently we are now submitting this completed report, although late.
"Activity and Isotope(s) involved: 518 terabecquerels (1400 curies), cobalt 60.
"Overexposures? (number of workers/members of the public; dose estimate; body part receiving dose; consequence) The initial notification indicated that one worker (employee) had been overexposed. The event did not involve a member of the public. The Landauer report indicated that an employee had received a whole-body exposure of 317,719 millirem of high-energy gamma radiation. No consequences will be realized since the exposure was later determined to only involve the dosimetry badge. The employee's exposure history was revised to indicate a 20 millirem exposure for that period of wear.
"Lost, Stolen or Damaged? (mfg., model, serial number) The employee's dosimetry badge was lost for a period of about one week.
"Disposition/recovery: Badges were to be used by placing them into a pouch for individuals using the irradiator devices.
"Leak test? N/A
"Vehicle: N/A
"Release of activity? None
"Activity and pharmaceutical compound intended: N/A
"Misadministered activity and/or compound received: N/A
"Device (HDR, etc.) Mfg., Model; computer program: J.L. Shepherd Model 285 irradiator.
"Exposure (intended/actual): consequences: Actual exposure received was estimated to be the usual, average amount of 20 millirem for that wear period.
"Was patient or responsible relative notified? N/A
"Was written report provided? Yes, from licensed RSO dated 21 July 2000.
"Was referring physician notified? N/A
"Consultant used? No"
Washington State Event Report # WA-00-023.
"Exposure (intended/actual): consequences: Actual exposure received was Licensee: Fred Hutchinson Cancer "Research Center
"City and state: Seattle, Washington
"License number: WN-L042-1
"Type of license: Medium Broad License
"Date of event: Reported by licensee on 19 June 2000, (indicated overexposure for the wear period between 5 April to 4 "May 2000).
"Location of Event: Seattle, Washington
"ABSTRACT: (where, when, how, why; cause, contributing factors, corrective actions, consequences, DOH on-site investigation; media attention) On 19 June 2000, the licensed RSO reported that their dosimetry badge provider (Landauer Inc.) had notified them that one of the Fred Hutchinson employees had apparently received an exposure of 317,791 millirem of high energy gamma radiation. This employee performs animal studies involving irradiations using both a Linac and a Cobalt 60 irradiator (a J.L. Shepherd Model 285, Serial Numbers 625 & 626).
"The RSO immediately started an investigation of the reported overexposure. The RSO discovered that the individual's dosimetry badge had been lost during the second week of April 2000 for a period of about one week. An unknown person, via the inter-office mail system, returned it to the individual the next week. The employee was unable to recall any situation that would have lead to an exposure of any amount greater then the usual for the work performed over that time period.
"Several circumstantial events as well as actual occurrences seem to indicate that the exposure was probably only received by the dosimetry badge. These were: first, the employee indicated that the dosimetry badge had been lost during the second week of April 2000, for a period of about one week. Second, only the Cobalt 60 irradiator was in operation during that period; the Linac was out of service then. Third, since several groups share use of the irradiator, the badge conceivably was found, in the irradiator room, by one of those people and returned in the inter-office mail system. Lastly, the employee never experienced any radiation related illnesses. The reported exposure of 317,791 millirem was removed from the employee's exposure history and replaced with a 20 millirem exposure (average monthly exposure for previous 12 months).
"No DOH on-site investigation was made or media attention was noted.
"What is the notification or reporting criteria involved? 10 CFR 20.2202 (a)(1) significant . After reviewing our incident files and the Handbook on Nuclear Material Event Reporting in the Agreement States , we determined that an immediate notification should have been sent to NRC. This did not occur; consequently we are now submitting this completed report, although late.
"Activity and Isotope(s) involved: 518 terabecquerels (1400 curies), cobalt 60.
"Overexposures? (number of workers/members of the public; dose estimate; body part receiving dose; consequence) The initial notification indicated that one worker (employee) had been overexposed. The event did not involve a member of the public. The Landauer report indicated that an employee had received a whole-body exposure of 317,719 millirem of high-energy gamma radiation. No consequences will be realized since the exposure was later determined to only involve the dosimetry badge. The employee's exposure history was revised to indicate a 20 millirem exposure for that period of wear.
"Lost, Stolen or Damaged? (mfg., model, serial number) The employee's dosimetry badge was lost for a period of about one week.
"Disposition/recovery: Badges were to be used by placing them into a pouch for individuals using the irradiator devices.
"Leak test? N/A
"Vehicle: N/A
"Release of activity? None
"Activity and pharmaceutical compound intended: N/A
"Misadministered activity and/or compound received: N/A
"Device (HDR, etc.) Mfg., Model; computer program: J.L. Shepherd Model 285 irradiator.
"Exposure (intended/actual): consequences: Actual exposure received was estimated to be the usual, average amount of 20 millirem for that wear period.
"Was patient or responsible relative notified? N/A
"Was written report provided? Yes, from licensed RSO dated 21 July 2000.
"Was referring physician notified? N/A
"Consultant used? No"
Washington State Event Report # WA-00-023.