NSTX Team Meeting June 25, 2010 College W&M Colorado Sch Mines Columbia U Comp-X General Atomics INEL Johns Hopkins U LANL LLNL Lodestar MIT Nova Photonics New York U Old Dominion U ORNL PPPL PSI Princeton U Purdue U SNL Think Tank, Inc. UC Davis UC Irvine UCLA UCSD U Colorado U Maryland U Rochester U Washington U Wisconsin Culham Sci Ctr U St. Andrews York U Chubu U Fukui U Hiroshima U Hyogo U Kyoto U Kyushu U Kyushu Tokai U NIFS Niigata U U Tokyo JAEA Hebrew U Ioffe Inst RRC Kurchatov Inst TRINITI KBSI KAIST POSTECH ASIPP ENEA, Frascati CEA, Cadarache IPP, Jülich IPP, Garching ASCR, Czech Rep U Quebec NSTX Supported by

NSTX NSTX Team Meeting June 30, Time: 1:30 ~ 3:00, June 25, 2010 Place: LSB 318, PPPL General / Program Items (5 minutes) Safety (30 minutes) Engineering Operations Update (15 minutes) Research Operations Update (15 minutes) Run Coordination (10 minutes) New CS/2nd NBI Project Update (15 minutes) NSTX Team Meeting Agenda

NSTX NSTX Team Meeting June 30, Dust Detector Experiment Incident An abnormal event occurred on the Dust Detector Experiment in D-Wing Room D243 this afternoon. This event, which involved a graduate student who was operating the experiment, resulted in over-pressurizing a glass window in a vacuum chamber which shattered outwards. Fortunately, no one was injured in this event, but there appear to be flaws in the design, operating procedures, and training associated with this experiment, and no Job hazard Analysis (JHA) was evident. Accordingly, and following PPPL Policy P-012, I am directing you to stop work on the operation of this Dust Detector Experiment until: o A report is written outlining the causes of this event and the actions that will be taken to prevent future such occurrences and ensure safe operations; o The necessary actions (design, installation, documentation, training, etc.) are satisfactorily completed; o ES&H representatives meet with all cognizant personnel (including line management) and the operator(s) to ensure readiness to resume operations. If these items are found to be satisfactory, I will issue a written authorization at that time to resume operation of this experiment.

NSTX NSTX Team Meeting June 30, Path Forward A Review Committee (Brent Stratton - chair, Lane Roqumore, Mike Gonzales, and Mike Williams - Ex Officio) was formed to investigate the incident with a report by July 15, The committee is chartered to find the root cause of this particular incident as well as identify the "extent of condition" (i.e., how pervasive is this type of activity and/or are there similar issues that need to be considered more broadly throughout the Laboratory). Look forward to the Review Committee findings/recommendations. Make sure the area responsible managers are in the loop. Make sure to arrange a substitute mentor during the absence of the primary mentor. Asked the NSTX managers to look into possible deficiencies in other areas. Communicate to NSTX researchers and students the importance of safety at the laboratory (and will be reinforced).

NSTX NSTX Team Meeting June 30, Engineering Operations Division Small Experiment/Testing Safety: A Work Planning Form can be tailored to match the scope of a project, and set up agreement on reviews/procedures. A Job Hazard Analysis is required for all PPPL activities with potential hazards: - Prompts to establish hazard controls such as engineered (window covers, pressure reliefs, monitors), administrative (procedures), or PPE - Establishes training requirements for detailed tasks - Communicates test plans to the RLM - Analyzes as-built hazards in the field (worst case scenarios)

NSTX NSTX Team Meeting June 30, Engineering Operations Division Small Experiment/Testing Safety (con’t): When bringing in a new employee or student, first step should be to establish general training requirements. Provide oversight. Be clear about your expectations. We need to set the standard for working safely. A new employee or student will only follow our example.

NSTX NSTX Team Meeting June 30, NSTX Host Many Visiting Students

NSTX NSTX Team Meeting June 30, How do we know that all the equipment (including experimental devices & test stands) in our group (Project, Section, Division, or Department) is safe to operate? What is the worst thing that can happen if something goes wrong” and how do we make sure no one will get hurt if it does? What processes do we use to make sure that new equipment we build or acquire is properly designed, built and operated safely? How do we ensure that people we assign to operate equipment are trained and motivated to do so in a safe manner? Do we/should we use subject matter experts from within or outside our group to help us build and operate equipment safely? What can the Laboratory do to make sure this kind of accident never happens again?