Discussion cont'd - s1037cn10016

DOE-STD-1037-93

This example illustrates how a unique process can affect an operator's activities. The

research was a unique process to the chilled water system operator. Although the operator

did not require detailed knowledge of the research, integrated knowledge of the system

interactions was needed. Effective communication with the research project personnel

would have enabled the operator to anticipate the load increase and ensure that sufficient

reserve cooling capacity was on line.

A periodic chemistry sample from a fluid system is used to evaluate the condition of the

system components and determine their fitness for continued operation. Just before the

sample was taken, the system operator started a pump that had been in a standby status.

The change in flow characteristics caused contamination to be picked up in the sample. The

indicated level of contamination normally signals equipment damage, which requires

resampling the system and possible shutdown of equipment.

This example illustrates how a unique process can be affected by an operator's activity. To

the operator, chemistry sampling is a unique process, even though it is routinely performed.

To prevent adverse effects on the sample, the operator requires an integrated knowledge

of the process interactions, i.e., how the sampling is affected by pump startup, and needs

to inform chemistry support personnel of operating activities that can adversely affect

sampling. This would permit coordination of operations and chemistry activities, and would

have avoided the need for resampling.

Technicians working with radioactive materials needed to move the materials through an

operational area of the facility. Following their procedures, they took all appropriate

precautions to prevent the spread of contamination or personnel exposure during the

movement; however, they failed to coordinate their movement with the operations

supervisor. The materials set off an operational radiation alarm, causing the operations

organization to respond as if an emergency had occurred.

The movement of radioactive material may have had nothing to do with the facility

operation or mission. However, the movement was capable of affecting operations and was