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| Work Task:
Clean Relay Contact
Occurrence:
Reactor Trip
Sequence of Events:
Barriers Analysis:
MWR requests
Electricians given
Electricians
Electricians
Tag hung on
de-energizing
P689 - only
MWR to work, which
go to P690 and
never trained
two panels so
P690 is still
references a Maint.
begin procedure.
to always
relays can be
energized.
Procedure, but
Procedure has no
check power
cleaned. Opera-
not told of change
supply prior to
step to verify
tions will only
in scope by
dead power
working on
allow one panel
foreman.
supply before
electrical
equipment.
at a time to be
starting. They
open first relay
tagged out.
and plant trips.
Electrical foreman
told and agrees.
Barrier
Barrier
Barrier
Barrier
Barrier
Holds
Holds
Fails
Fails
Fails
Figure F-1. Examples of Barrier Analysis
F-3
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