Analysis Of Human Error In Commissioning Of Nuclear Power Plant

Commissioning is an indispensable important stage in the transition from construction and installation to operation during the construction of a nuclear power plant.The commissioning phase has the characteristics of tight schedules,a large number of cross-operations,many team collaboration activities,and many unknown risks.In order to be able to establish effective reduction and preventive measures for human factor commissioning errors in nuclear power plants,reduce the occurrence of human factor commissioning errors in nuclear power plants,and ensure the safe and smooth commissioning of nuclear power plants.In-depth analysis and research mainly completed the following work.(1)Based on WANO's root cause and cause factor classification framework,and root cause analysis method,using barrier analysis technology,a total of 155 debuggers' incident barriers and their root causes were reported in a nuclear power construction company in China from 2009 to 2018.The statistical analysis and statistics show that: work practices,procedures,systems and documents,personnel factors,training authorization,supervision methods,and language communication are themain barriers to failure;the procedures are not used,the procedures are incomplete,the skills are insufficient,and job training and positions Insufficient experience,inadequate monitoring of the process,and inadequate communication between teams and teams are the main root causes.(2)Through Spearman's correlation analysis and cluster analysis of statistical failure barriers,the correlation and structural characteristics of the failure barriers were obtained.The correlation of failure barriers related to personnel behavior mainly includes: rules,regulations,documents and Language communication,personnel's own factors and training authorization,supervision methods and personnel's own factors,rules and regulations and environmental conditions,work organization and environmental conditions,work arrangements and human-machine interfaces,the correlation between personnel's own factors and human-machine interfaces is more significant.The relevance of management-related failure barriers are mainly: management policies and management supervision and evaluation,significant correlation of organization safety culture;communication and coordination and organization safety culture,management supervision and evaluation and organization safety culture,decision-making process and root change management The correlation is significant.When formulating preventive management measures,the mutual influence of failure barriers should befully considered.(3)Due to the time lag of the incident report,in order to understand the characteristics of the current commissioning human error more widely,refer to the analysis results of the commissioning human error report,combined with the relatively mature and systematic operational human error analysis theory method,through on-site surveys and expert interviews,etc.,Compiled a questionnaire for factors influencing the commissioners of nuclear power plants due to mistakes,and further analyzed the differences in the positions of commissioners due to mistakes and the main influencing factors.It was found that the role of the test leader(TS)responsible for leading and decision-making and cooperation and execution The role of the assistant person in charge of the experiment(ATS)is consistent with the ranking of the individual factors in the subclass;the program rank of the assistant in charge of the experiment is higher than the person in charge of the situation;/ Design ranking is ahead of the person in charge of the experiment.These differences should be fully considered in training and preventive management measures.(4)Based on the above research results,targeted preventive management measures for commissioning human errors are proposed.It mainly includes: perfecting the organization management mechanism;fully considering the differences in positions and increasing targetedtraining;further standardizing personnel behavior and supervision methods;further enhancing the knowledge and skills of the staff.The work in this paper has important guiding significance to reduce human errors during the commissioning phase of nuclear power plants,ensure the quality of commissioning,and shorten the commissioning period.