The U.S. Nuclear Regulatory Commission is in the process of rescinding or revising guidance and policies posted on this webpage in accordance with Executive Order 14151 Ending Radical and Wasteful Government DEI Programs and Preferencing, and Executive Order 14168 Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government. In the interim, any previously issued diversity, equity, inclusion, or gender-related guidance on this webpage should be considered rescinded that is inconsistent with these Executive Orders.

Home NRC Library Document Collections Events, Reports Associated with Event Notification Reports 2019

Event Notification Report for March 04, 2019

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
3/1/2019 - 3/4/2019

** EVENT NUMBERS **

Non-Agreement State	Event Number: 53887
Rep Org: AVERA MCKENNAN HOSPITAL Licensee: AVERA MCKENNAN HOSPITAL Region: 4 City: SIOUX FALLS State: SD County: License #: 40-16571-01 Agreement: N Docket: NRC Notified By: TRACI HOLLINGSHEAD HQ OPS Officer: BETHANY CECERE	Notification Date: 02/21/2019 Notification Time: 11:28 [ET] Event Date: 02/21/2019 Event Time: 07:00 [MST] Last Update Date: 02/21/2019
Emergency Class: NON EMERGENCY 10 CFR Section: OTHER UNSPEC REQMNT	Person (Organization): RICK DEESE (R4DO) GRETCHEN RIVERA-CAPELLA (NMSS DAY) WILLIAM GOTT (IRD)

Event Text

MOBILE DIAGNOSTIC TRUCK INVOLVED IN FATAL TRANSPORTATION ACCIDENT

The Avera McKennan Hospital mobile diagnostic truck was in an accident where the truck went off the road, the cab and box detached, and the driver was killed. The truck contained various used sources and medical materials used in nuclear diagnostic medicine. The sources, although ejected from the truck, were found nearby in their respective transport boxes with the exception of the Tc-99 used syringes (sharps). Surveys and wipe tests show no contamination. The sealed sources will be leak checked. The transport box for the Co-60 source was damaged with a small hole. Radiation readings are slightly higher in the proximity of the hole. All the recovered sources are in storage at the hospital. The sharps container was empty with the sharps strewn along the snow bank alongside the road. Residual materials may be within the sharps. Cleanup of the material is underway but may be delayed until the snow melts.

The accident occurred on I-29, north of Sioux Falls, between the Baltic and Dell Rapids exits. The truck was headed north. The South Dakota Highway Patrol responded to the scene.

Notified South Dakota Health Agency, DOT Crisis Management Center, DOE Ops Center, and DHS SWO.

Non-Agreement State	Event Number: 53888
Rep Org: ABERDEEN PROVING GROUNDS Licensee: U. S. ARMY Region: 1 City: ABERDEEN State: MD County: License #: 19-10306-01 Agreement: Y Docket: NRC Notified By: AMY RAMSEY HQ OPS Officer: MARK ABRAMOVITZ	Notification Date: 02/21/2019 Notification Time: 13:27 [ET] Event Date: 02/21/2019 Event Time: 11:20 [EST] Last Update Date: 02/21/2019
Emergency Class: NON EMERGENCY 10 CFR Section: 20.2201(a)(1)(ii) - LOST/STOLEN LNM>10X	Person (Organization): ANNE DeFRANCISCO (R1DO) RICK DEESE (R4DO) NMSS_EVENTS_NOTIFICATION (EMAIL) ILTAB (EMAIL)

This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

NI-63 SOURCE LOST DURING SHIPMENT

The following was received from the licensee via e-mail:

"On 21 February 2019 the Aberdeen Proving Ground Garrison Radiation Safety Officer (RSO) notified [the Combat Capabilities Development Command Chemical Biological Center RSO] of a lost [commercial carrier shipment] containing multiple Chemical Agent Monitor (CAM) detectors. Shipment, dated November 26, 2018.

"On November 26, 2018, the Garrison RSO shipped a package containing multiple chemical detectors with radioactive sources. One CAM, serial # 11769, containing 10 mCi of Ni-63 which is owned by the Chemical Biological Center under NRC license 19-10306-01, was included in the package.

"The shipment was going to Pine Bluff, Arkansas for final waste disposal.

"The Garrison RSO stated that a search for the packaged had been conducted at two [commercial carrier] locations, one in Maryland and one at the Pine Bluff final destination location with no package being found."

This event is related to NRC Event Number 53884.

THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL

Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf

Non-Agreement State	Event Number: 53889
Rep Org: GLACIER NATIONAL PARK Licensee: NATIONAL PARK SERVICE Region: 4 City: WEST GLACIER State: MT County: License #: GENERAL LICENSE Agreement: N Docket: NRC Notified By: RITA CAUSBY HQ OPS Officer: JEFFREY WHITED	Notification Date: 02/22/2019 Notification Time: 10:17 [ET] Event Date: 08/31/2018 Event Time: 00:00 [MST] Last Update Date: 02/22/2019
Emergency Class: NON EMERGENCY 10 CFR Section: OTHER UNSPEC REQMNT	Person (Organization): RICK DEESE (R4DO) NMSS_EVENTS_NOTIFICATION (EMAIL) ILTAB (EMAIL)

This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

TRITIUM EXIT SIGNS DESTROYED IN A FIRE

On August 31, 2018, an intense fire in Glacier National Park destroyed a building and with it six (6) exit signs containing Tritium (H-3). The intensity of the fire was such that the building has been reduced to ash. The remains of the building are still on site.

After a discussion with Region IV, the licensee determined that the loss of the exit signs was reportable in accordance with 10 CFR 31.5.

The licensee notified the Department of the Interior, National Park Service, Intermountain Regional Office in Denver CO, of the event.

THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL

Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf

Agreement State	Event Number: 53890
Rep Org: NEW MEXICO RAD CONTROL PROGRAM Licensee: TECHCORR USA LCC Region: 4 City: Carlsbad State: NM County: License #: IR 478 11 Agreement: Y Docket: NRC Notified By: CARL SULLIVAN HQ OPS Officer: BRIAN P. SMITH	Notification Date: 02/22/2019 Notification Time: 13:30 [ET] Event Date: 02/21/2019 Event Time: 00:00 [MST] Last Update Date: 02/22/2019
Emergency Class: NON EMERGENCY 10 CFR Section: AGREEMENT STATE	Person (Organization): RICK DEESE (R4DO) ANDREA KOCK (NMSS) NMSS_EVENTS_NOTIFICATION (EMAIL) PATRICIA MILLIGAN (INES)

Event Text

AGREEMENT STATE REPORT - POTENTIAL RADIOGRAPHER OVEREXPOSURE

"The Chief RSO for TechCorr USA, LLC contacted the Radiation Control Bureau of the State of New Mexico after he received a report from Landauer IAC that showed an employee had received in excess of 1000 Rads.
"TechCorr is an industrial radiography company licensed in New Mexico. Based on the activity of the camera, the badge would have had to be exposed for 4 hours to get a dose reading of greater than 1000 Rads. After an interview with the employee, TechCorr has decided to send the employee to the hospital and have a blood sample drawn.
"The film badge of the crew member who worked with the individual with the high film badge reading only showed around 200 mrem dose on his badge. A more complete investigation will follow"

State Item Number: NM190001

Power Reactor	Event Number: 53903
Facility: LASALLE Region: 3 State: IL Unit: [] [2] [] RX Type: [1] GE-5,[2] GE-5 NRC Notified By: WAYNE CLAYTON HQ OPS Officer: JOANNA BRIDGE	Notification Date: 03/01/2019 Notification Time: 04:03 [ET] Event Date: 02/28/2019 Event Time: 22:17 [CST] Last Update Date: 03/01/2019
Emergency Class: NON EMERGENCY 10 CFR Section: 50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION	Person (Organization): JOHN HANNA (R3DO)

Unit

SCRAM Code

RX Crit

Initial PWR

Initial RX Mode

Current PWR

Current RX Mode

Refueling

Event Text

SPECIFIED SYSTEM ACTUATION - TRIP OF SAFETY RELATED BUS

"On February 28, 2019, at 2217 CST, LaSalle Unit 2 experienced a trip of the 241Y Safety Related Bus during surveillance testing resulting in a valid undervoltage actuation signal to the Common Emergency Diesel Generator ('O' EDG), causing it to start and load to Bus 241Y. The purpose of the surveillance testing was to demonstrate the operability of the breakers necessary to provide the second off site source to Unit 2. This event is reportable in accordance with 10 CFR 50.72(b)(3)(iv)(A), as an event that results in a valid actuation of the emergency AC electrical power system. In addition to the 241Y bus trip and 'O' EDG actuation signal, the following plant responses occurred as designed due to the momentary loss of this AC Bus: "A" RPS de-energized due to the loss of the 2A Reactor Protection System Motor-Generator Set, and the running Unit 2 Fuel Pool Cooling pump tripped. The Non-Safety Related Bus 241X de-energized resulting in a trip of the Unit 2 Station Air Compressor. All systems have been restored and troubleshooting is currently in progress. Unit 1 remained in MODE 1 during this event.

"The NRC Senior Resident Inspector has been notified."

Power Reactor	Event Number: 53906
Facility: COMANCHE PEAK Region: 4 State: TX Unit: [] [2] [] RX Type: [1] W-4-LP,[2] W-4-LP NRC Notified By: CHRISTOPHER METZ HQ OPS Officer: DONALD NORWOOD	Notification Date: 03/02/2019 Notification Time: 06:12 [ET] Event Date: 03/02/2019 Event Time: 03:17 [CST] Last Update Date: 03/02/2019
Emergency Class: NON EMERGENCY 10 CFR Section: 50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL 50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION	Person (Organization): RICK DEESE (R4DO)

Unit

SCRAM Code

RX Crit

Initial PWR

Initial RX Mode

Current PWR

Current RX Mode

A/R

100

Power Operation

Hot Standby

Event Text

REACTOR TRIP DUE TO FEEDWATER ISOLATION VALVE CLOSURE

"At 0317 CST, the Unit 2 Reactor tripped due to Feedwater Isolation Valve (FWIV) 2-04 going closed. All Auxiliary Feedwater Pumps started due to steam generator Lo-Lo levels.

"Unit 2 is being maintained in Hot Standby (Mode 3) in accordance with Integrated Plant Operating Procedure IPO-007B. The Emergency Response Guideline Procedure Network has been exited. Decay heat is being rejected to the Main Condenser via the Steam Dump Valves.

"The cause of the FWIV going closed is currently under investigation."

All control rods fully inserted and the reactor trip was uncomplicated. Unit 2 is in a normal post-trip electrical line-up. There was no impact on Unit 1 due to the Unit 2 reactor trip.

The licensee notified the NRC Resident Inspector.

Power Reactor	Event Number: 53908
Facility: NORTH ANNA Region: 2 State: VA Unit: [] [2] [] RX Type: [1] W-3-LP,[2] W-3-LP,[3] M-4-LP NRC Notified By: DAVID MOSSER HQ OPS Officer: JOANNA BRIDGE	Notification Date: 03/03/2019 Notification Time: 00:13 [ET] Event Date: 03/02/2019 Event Time: 22:37 [EST] Last Update Date: 03/03/2019
Emergency Class: NON EMERGENCY 10 CFR Section: 50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL	Person (Organization): STEVE ROSE (R2DO)

Unit

SCRAM Code

RX Crit

Initial PWR

Initial RX Mode

Current PWR

Current RX Mode

M/R

Power Operation

Hot Standby

Event Text

MANUAL REACTOR TRIP DUE TO DEGRADING MAIN CONDENSER VACUUM

"On March 2, 2019 at 2237 EST, North Anna Unit 2 reactor was manually tripped, while operating at approximately 12 percent power, due to degrading vacuum in the main condenser. The unit was in the process of a planned shutdown for refueling when condenser vacuum degraded to greater than 3.5 inches of mercury absolute. The operations crew entered the reactor trip procedure and stabilized the unit in Mode 3 at normal operating pressure and temperature.

All control rods fully inserted into the core following the reactor trip. The reactor protection system actuation is reportable per 10 CFR 50.72(b)(2)(iv)(B). There were no ESF system actuations. Decay heat is being removed by the Steam Generator Pressure Operated Relief valves. Unit 2 is in a normal shutdown electrical lineup.

"The NRC Resident Inspectors have been notified. The Louisa County Administrator will be notified."

Power Reactor	Event Number: 53909
Facility: NORTH ANNA Region: 2 State: VA Unit: [] [2] [] RX Type: [1] W-3-LP,[2] W-3-LP,[3] M-4-LP NRC Notified By: JOHN A LEAKE HQ OPS Officer: JOANNA BRIDGE	Notification Date: 03/03/2019 Notification Time: 09:54 [ET] Event Date: 03/03/2019 Event Time: 09:16 [EST] Last Update Date: 03/03/2019
Emergency Class: UNUSUAL EVENT 10 CFR Section: 50.72(a) (1) (i) - EMERGENCY DECLARED	Person (Organization): STEVE ROSE (R2DO) JEFFERY GRANT (IRD) CATHY HANEY (R2RA) MICHELE EVANS (DNRR) BRIAN McDERMOTT (DNRR)

Unit

SCRAM Code

RX Crit

Initial PWR

Initial RX Mode

Current PWR

Current RX Mode

Hot Standby

Event Text

NOTICE OF UNUSUAL EVENT DUE TO UNCONFIRMED FIRE ALARM

At 0916 EST on March 3, 2019, North Anna Unit 2 declared a Notice of Unusual Event under Emergency Action Level HU 2.1 (fire in/or restricting access to any table H-1 area not extinguished within 15 minutes of control room notification or verification of a control room alarm). At 0906 the control room received a heat sensor alarm for the Unit 2, Reactor Coolant Pump motor cube. The fire brigade was dispatched to the scene where they found no indication of fire, no smoke and no fire damage. There were no actuations associated with the alarm and no redundant indications of fire. There was no effect on plant equipment and no indications of RCS leaks. The site determined that the alarm was invalid and terminated the NOUE. Unit 2 is in a stable condition and in a normal electrical lineup. Offsite support was not requested.

The NRC Resident Inspector, State, and local authorities have been notified by the licensee.

Notified R2RA (Haney), DNRR (Evans), IRD MOC (Grant), R4RDO (Rose), DHS SWO, FEMA Operations Center, DHS NICC, FEMA NWC (email), DHS Nuclear SSA (email), and FEMA NRCC SASC (email).

Page Last Reviewed/Updated Wednesday, March 24, 2021