Management of Change in Nuclear

Houston Forum 2017

Douglas Ferguson Lowther-Rolton

Doug was an investigator in the 2013 Arkansas Nuclear One event and regularly performs technical audits on engineering systems. The 2013 event was analyzed through one such technical audit and ended with an evaluation of lifting and hoisting operations and capabilities. The result was a change in rated lifting equipment. This event resulted in one fatality that is due in part to deviation from a plan. Despite the strength of the nuclear industry in procedural adherence, the change was not thought to be one that initiated an MOC process. This led to personnel under the impression that their position was within a protected area, but ended in the line of fire when the stator fell during change out operations.