[DNFSB
LETTERHEAD]
April 24, 2006
The Honorable James A. Rispoli
Assistant Secretary for
Environmental Management
U.S. Department of Energy
1000 Independence Avenue, SW
Washington, DC 20585-0113
Dear Mr. Rispoli:
The staff of the Defense Nuclear
Facilities Safety Board (Board) reviewed the implementation of activity-level
work planning and control by Fluor Hanford, Inc. (Fluor). Fluor has developed a formal and disciplined
program for the planning and control of activity-level work in its assigned
projects. This program is fundamentally
sound; however, some issues remain with regard to its implementation. Work management directives appeared to comply
with local requirements, and workers played an active role in the development
of work packages. Areas for improvement
include analysis and integration of hazards, especially radiological hazards;
identification of controls; additional training for key personnel; and feedback
and improvement mechanisms.
In addition, the Board notes
that the National Nuclear Security Administration, with the assistance of
several Department of Energy site contractors, including representatives from Environmental
Management sites, has recently developed a comprehensive document setting forth
attributes, best practices, and guidance for the incorporation of Integrated
Safety Management and quality assurance into work planning. The Board encourages the Office of
Environmental Management to consider adopting this document and strive to
strengthen each of the work planning and control programs at the sites under
its purview.
The enclosed report prepared by
the Board’s staff provides observations resulting from a recent review of Fluor’s
work planning and control, and is provided for your use as you continue to upgrade
work planning and control at the Hanford Site.
Sincerely,
A. J. Eggenberger
Chairman
c: The Honorable Linton Brooks
Mr.
Keith A. Kline
Mr.
Mark B. Whitaker, Jr.
Enclosure
DEFENSE
NUCLEAR FACILITIES SAFETY BOARD
Staff
Issue Report
April
4, 2006
MEMORANDUM FOR: J. K. Fortenberry, Technical Director
COPIES: Board Members
FROM: D. Burnfield
SUBJECT: Review of Activity Level Work
Planning and Control by Fluor Hanford, Inc.
This report documents a review
of work planning and control processes in projects conducted by Fluor Hanford,
Inc. (Fluor). This review was conducted
by members of the staff of the Defense Nuclear Facilities Safety Board (Board)
D. Burnfield and L. Zull, along with outside expert D. Volgenau. Subsequent discussions, including a telephone
conference among the Board’s staff, the Department of Energy (DOE), and Fluor
during February 2006, supplemented the information gathered during this review.
Background. Work
on the Plutonium Finishing Plant and the K-Basin Closure project, as well as
that on other projects under the Central Plateau Project, is controlled by
DOE’s Richland Operations Office (DOE-RL). These projects involve long-term deactivation
and decommissioning activities. During
calendar year 2005, Fluor made significant revisions to its work planning and
control directives and documentation requirements. Commitments made in response to the Board’s
Recommendation 2004-1, Oversight
of Complex,
High-Hazard Nuclear Operations, appear to have been a main
stimulus for these revisions. One
purpose of these revisions was to improve processes and mandate the use of
consistent work planning and control procedures by each of the projects
assigned to Fluor. However, some
flexibility in the implementation of the revisions was permitted to account for
the unique features of particular projects. Fluor uses a computer-based automated job
hazards analysis (AJHA) tool to assist in the planning of work. Recently, this tool was upgraded, purportedly
to make the tool more useful and efficient. At the time of the staff‘s visit, the required
training for the use of the new tool was being formulated. Unlike other sites that have adapted this
tool, Fluor requires that its use be based on a team approach, thus benefiting
from the expertise of identified subject matter experts (SMEs). Pertinent hazard controls are required to be
transferred from the AJHA tool to work instructions.
The staff’s review revealed that
Fluor’s procedures do require formal and disciplined processes for the planning
and control of work in the contractor’s assigned projects. A review of actual work packages and
discussion with those who prepared them revealed that work management
directives appear to comply with local requirements, although greater rigor
could have been exercised in performing the hazard analyses and defining
controls, especially radiological controls. Workers played an active role in developing
work packages and in providing feedback. A number
of areas for improvement were noted, but in most cases Fluor was aware of these
areas and was taking actions to improve the system for work planning and control.
Observations
and Comments. Specific observations and
comments resulting from the staff’s review are presented below, organized
according to the basic functions of Integrated Safety Management.
Define the Scope of Work―The
staff observed that formal and disciplined processes were being used to plan
and control work. Project work control
was governed by a work management procedure (HNF-PRO-12115) and a work planning
guide (HNF-GD-12116).
The radiological controls organization
had been fully integrated procedurally into the work planning process. Use of the procedure was mandatory, while use
of the guide was encouraged. Discussions
revealed that both were commonly used during work planning. The procedure required that each organization
formally designate individuals who would be responsible for performing key work
management functions (validation, work release, and work acceptance). Fluor had identified a weakness in the
indoctrination and training in the planning process for key individuals,
including work planners and fieldwork supervisors. This weakness is significant since the success
of the work planning and control process is heavily dependent on the skills of
these personnel. A
review of training
plans and records confirmed this weakness.
The level of work planning
required was identified through the use of a formal screening and validation
process that included evaluating the urgency of the requested work task and its
characteristics. Basically, the Fluor
directives provided for three categories of work: (1) minor work (e.g., skill-of-craft), which
met certain screening criteria; (2) work that required no additional planning
(e.g., routine maintenance covered by another procedure); and (3) work requiring
planned work instructions. Determining
the scope of the work and its proper category typically could involve a
preliminary walkdown of the work site by planners, supervisors, SMEs, and
workers. The product of this screening
process was validated by a “responsible” person, and the work was then planned
to the degree identified during the screening. The staff’s review of project work packages
indicated that this process was being used and that work was being appropriately
screened into the correct categories. The third of the above work category types required
the most extensive planning.
Each project was required to
establish priorities for work accomplishment, taking into consideration
site-wide resource limitations and project needs. Guidance provided by Fluor directives appeared
to be adequate, and project work appeared to be properly prioritized.
Analyze the Hazards―Typically for new work, a work planner constructed a draft work procedure
and completed a preliminary hazards analysis using the AJHA
tool after
examining the results of the work screening process, reviewing similar work
packages, and consulting with appropriate SMEs and workers. The Enhanced Work Planning (EWP) process,
involving a multidisciplined team of workers,
supervisors, and SMEs, was then used to identify and analyze the hazards
associated with the work. The AJHA
tool was used to
facilitate these hazard analysis tasks. If the work was deemed to involve radiological
risk, a radiological work planner reviewed the draft package. Controls for significant radiological hazards
were integrated into the work package; however, many of the less significant
radiological controls were contained only in the radiological work permit. Typically, full identification of the hazards
and appropriate controls for complex work would require an iterative process.
Once work had been screened and
determined to be minor, the process did not always clearly articulate adequate
criteria for considering potential hazards associated with the environment in
which the work was to be conducted.
The staff’s review of completed
work packages for both the Plutonium Finishing Plant and the K-Basin Closure
project and observation of an AJHA/EWP planning meeting indicated that the
process had been effective in identifying and analyzing hazards associated with
the planned work. Discussion during the
review of a work package for the K-Basin Closure project revealed that some
opportunities for mitigating hazards to workers through engineered preventive
measures, such as reducing radiation exposure, had been missed. A more
integrated approach to radiological work planning would be appropriate.
Develop
and Implement
Controls―Work controls for the identified hazards
resulted from the AJHA/EWP planning meetings and from analysis of other hazards
through the permit preparation processes associated with the planned work. Controls were then incorporated at the appropriate
point in the work instructions, retained in the permit documentation as
appropriate, or determined to be within the skills of the workers. When radiological controls were required, the
local As Low As Reasonably Achievable (ALARA) Center
was available to provide assistance. The
staff’s review of completed work packages and discussions revealed that this process
had been carried out successfully. Yet
while radiological controls had been integrated into the work instructions, the
process could be enhanced by developing these controls during the AJHA/EWP
meeting(s), rather than independently using the Radiological Work Permit, and through
a more rigorous process of design and engineering to eliminate, reduce, or
mitigate the hazards.
Perform Work―Fluor
had a formal process for the review and approval of work packages. Generally, on the day prior to commencement of
work, the package was checked for adequacy, and readiness for accomplishing the
work was confirmed. The release authority―the
shift manager or equivalent―was responsible for confirming the
field conditions required for the work to start. A pre-job briefing was conducted, facilitated
by the field work supervisor; SMEs attended, as appropriate, to assist in the
brief and to answer questions. The work
team then confirmed the conditions in the field by conducting a walkdown. Work was supervised by the field work
supervisor, who was responsible for monitoring work activities and conditions
in the work area. Workers understood
their right and responsibility to stop work should conditions warrant doing so.
A formal system existed for changing the
work instructions when required field conditions. The work instructions reviewed by the staff
contained a statement that the instructions were “...intended to be followed in
sequence” yet “...at the discretion of the field work supervisor certain steps
may be performed out-of-sequence.” Among
the procedures reviewed by the staff, no work steps had been designated to have
this flexibility, and the statement appeared to be a contradiction. When the staff questioned this, Fluor
management indicated that such flexibility was not required for the work being
completed.
Provide
Feedback and Continuous Improvement―Fluor’s
work management directives contained provisions for post-job reviews, and in
particular, established criteria for reviewing work performance following nonroutine radiological work. In practice, it appeared that any lessons
learned from the previous day’s work were generally discussed during the
following day’s pre-job briefing. For
work that covered an extended period, it appeared that little effort had been
made to capture formally lessons learned as the work progressed. Following work completion, project support
personnel were assigned responsibility for capturing formal lessons learned. This appeared to be a weakness since these
staff had not been involved in either the planning or the work. Fluor personnel acknowledged the need for
improvement in promptly and formally capturing lessons learned during the
conduct of work.
DOE Oversight―Oversight of Fluor by DOE-RL appeared to have been generally effective
and to be improving. DOE-RL has implemented
an oversight program that includes among other things:
·
A project-oriented
organizational structure mirroring the major Hanford work projects.
·
The
ability of federal project directors to establish multidisciplined
teams to assess project progress or problems.
·
The
use of well-qualified Facilities Representatives.
·
The
establishment of a cooperative but arms-length relationship with site
contractors.
These actions appeared to have
improved the ability of DOE-RL to carry out its oversight responsibilities more
effectively. Of particular pertinence to
this review, it was noted that the project Facilities Representatives had
conducted a number of surveillances during the past year focused on the Fluor’s
work planning and control processes. Many of these surveillances appear to have
been driven by commitments in the Implementation Plan for the Board’s Recommendation
2004-1, Oversight of Complex,
High-Hazard Nuclear Operations.