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5.0.3 AC Programmatic Deficiency
The CREDITED PROGRAMMATIC ELEMENTS in each AC are the standards by
which the adequacy of the AC is assessed. The programmatic ACs may be
implemented by specific Site Integrated SMP elements or through a building-specific
program.
An AC programmatic deficiency occurs when:
a. Facility management can not demonstrate that an adequate administrative and
physical infrastructure exists to implement each programmatic AC;
b. Facility management can not demonstrate that the infrastructure has been
reasonably implemented to meet the programmatic ACs; or
c. Facility management can not demonstrate that appropriate measures have been
taken to address recurring individual failures to meet the programmatic ACs.
An AC programmatic deficiency shall require the following actions:
a. Notify DOE-RFFO of the programmatic deficiency in accordance with
Occurrence Reporting requirements;
b. Conduct a root cause analysis to identify the corrective actions to ensure future
compliance with the AC requirement and prevent recurrence;
c. Inform DOE-RFFO of root cause analysis and corrective actions in accordance
with Occurrence Reporting requirements; and
d. Implement corrective actions.
5.0.4 AC VIOLATION
An AC VIOLATION occurs when:
Revision
September 1930
a. Planned corrective actions for a programmatic deficiency are not fully
implemented;
b. The same programmatic deficiency occurs within one year of the initial-systemic
safety concern;
c. An AC limit and its action statement are not met; or
d. Failure to perform an AC specified SURVEILLANCE REQUIREMENT within
the required frequency.
A-78 Building 991 Complex FSAR
Appendix .4