L-21-028, Annual Fitness for Duty Report for 2020

Annual Fitness for Duty Report for 2020

ML21061A004
Person / Time
Site:	Pilgrim
Issue date:	03/01/2021
From:	Bouchard A Holtec Decommissioning International, Holtec Pilgrim
To:	Document Control Desk, Office of Nuclear Reactor Regulation, Office of Nuclear Security and Incident Response
References
HDI-PIL-21-028
Download: ML21061A004 (10)

Text

Digitally signed by Andrea Sterdis DN: cn=Andrea Sterdis, c=US, o=Holtec Decommissioning International, ou=HDI, email=a.sterdis@holtec.com Date: 2021.03.01 16:15:29 -05'00' Andrea Sterdis ATTACHMENT 9.4 NRC SUBMITTAL REVIEW Letter#: HDI-PIL-21-028

Subject:

Pilgrim Annual FFD report to NRC Response Due: February 26, 2021 Date Issued for Review: February 24, 2021 Correspondence Preparer / Phone #: Amy Bouchard / (508)830-8330 Section I POSITION / NAME Preparer / Amy Bouchard Reviewer/ John Leary HDI - Security Manager/

Brian McWilliams-Sr. Mgr Regulatory Compliance/ Dave Noyes PNPS HD!- Site VP/ John Moylan

, HoltecVP; Regulatory Affairs / Andrea Sterdis Letter Concurrence and A reement to Perform Actions Action concurrence, certification, etc.

Preparer Reviewer Approver Approver Approver Approver COMMENTS Signature (sign, interoffice memo, e-mail, or telecom)

• NOTE: Individuals signing above confirm their review and concurrence with this outgoing letter and the completeness and accuracy of the information contained within in their area of responsibility and technical knowledge pursuant to 10 CFR 50.9, Completeness and accuracy of information.

ATTACHMENT 9.4 NRC SUBMITTAL REVIEW Review for: HDI-PIL-21-028 S f II ec,on C orrespon d ence Screening Does this letter contain commitments? If "yes," identify the commitments with due Yes dates in the submittal and in Section Ill and initiate a PCRS LR-LAR to track No

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implementation and/or completion of the commitment. When fleet letters contain commitments, a PCRS LR-LAR should be initiated with a CA assigned to each applicable site to enter the commitments into the site's commitment management system.

Does this letter contain any information or analyses of new safety issues performed at Yes NRC request or to satisfy a regulatory requirement? If "yes," reflect requirement to No

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update the UFSAR in Section Ill.

Does this letter require any document changes (e.g., procedures, DBDs, UFSAR, TS Yes Bases, etc.), if approved? If "yes," indicate in Section Ill an action for the responsible No

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department to determine the affected documents. (The Correspondence Preparer may indicate the specific documents requiring revision, if known or may initiate an action for review.)

Does this letter contain information certified accurate? If "yes, identify the information Yes and document certification in an attachment: (Attachment 9.5 must be used.)

No

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Section Ill Actions and Commitments Required Actions

• Note: Actions needed-upon approval should be captured in the.

• Due Date

• Responsible Dept.

appropriate action tracking system None s ect,on IV Final Document s* 1gno or u m1tta fff S b.

• Correspondence Preparer Amy Bouchard (See page 1 for signoff)

Final Submittal Review (optional)

Responsible Department Head Brian McWilliams (See page 1 for signoff)

EN-Ll-106 REV 19

~.;tief'MJirl!F-f<\\"-;_;FFD Program Performance Data Reporting System

~ *

. -1... _.:'. a::.:.,*.;2

~-F~~m-1391, *Annual Reporting Form for Drug and Alcohol Tests United Slate, Nucle,r RegufatOI)' Commusion.

• Prvtect/11jj Pedp/c and tllc'E1i1*l;oiilhei,1...,..:,_

(EIE General Submission Portal) 0 y

Estimated burden per response lo comply with this collection request is 108 hours0.00125 days <br />0.03 hours <br />1.785714e-4 weeks <br />4.1094e-5 months <br />. This form is a voluntary means of reportilg lhe information required under to CFR 26.417(b)(2) and 26.717. The infDl'rnation is requred by t1RC to obtain on an ainual basis site specific filnt1ss-for-duty (FFO) program pelfonnance data on drug and alcohol programs from licensees and other entities. Send comments regartflllg burden estimate lo the FOIA, lnformalion Services Branch (T6-A10M}, U.S.,._,\\Jdear Regulatmy Commission, Washington DC 20555-0001, or by o-m.tl lo lnfocollects.Rcsouce@NRC.oov and lo the Desk Officer, Offico of Information and Regulatory Aff.irs, NEOB-1020, (319)..0146), Office of Management aKI Budge!, Washinglon DC 20503. If a means used to impose inrorma~on co!leciioo does not display a ClRTcnlly vafid 0MB control number, lho NRC m'r1j not conduct or sponsor, and a person is not required lo respond to, the information collection.

1) All f/e/ds required unless marked 'op/Iona/'

2) Use of Adobe Reader 8 or tater Is required 3} Mouse over fields for additional Information Facility I

Pilgrim [50-293]

Tests Conducted In the Calendar Year I

0 Submission Update Period of Report I

2020 I

Total Number of Tests Conducted Reason For Testing Licensee Employees ContractorsNendors Total Number of Positive, Adulterated, Substituted, and Refusal to Test Results Pre-Access Random For Cause ol Post-Event Follow-up Total (Calculaled)

FFD Program Random Testing Population and Rate*

Average number of,

. /\\verage number of ficensee employees

• conliaclors/vendors 1

22~1 *. -. I.

111 1 Laboratory Testing Does your-program use a

• 1 I

Licensee Tesling Facility? _No I

(Yes/ No).

'-----~-'

140 73 0

0 10 223 Total.size of lhe random tesling pool throughout the period.(Calculated)

J 331 1 HHS-Certified Labo-ratory (Pri-;,;a,1;)

,,-Q_u_e_s_l

-.-ia-g.-no_s_ti_cs_,_l_n_c_----~, HHS-Certified Laboratory (Backup)

Lenexa, KS ol Annual random tesling percentage achieved for the testing pool Quest Diagnostics, Inc.

Norristown, PA 7_5.2 ~

ldenlify your Biind Performance Test Sample supplier(s) I EISohly Laboratories, Incorporated (ELI)

~O~xf~o~rd=M~S~------------------------~

Substances Tested Did your program only lest for NRG-required substances Ives I

AND al the NRG-specified minimum cutoff levels? (Yes I No).__ -------'*

Special Analyses Testing Results Total Number of "Dilute*

1 1

Specimen Tes! Resulls (Optional)

~---~

Does your program conduct LOD testing Ives I

pennilled in 26.163(a)(2)? (Yes/ No)

~------~

Total Number of"Dilule" Specimens I 13 1 (Special Analyses Testing Conducled) ~---~-

Substance Use NRC Initial Cutoff Confirmatory Limit of Detection Comment (Optional I Cutoffs?

Cutoff (LOD) Testing?

Alcohol Ives jNot Applicable Cocaine Ives Ives Marijuana Ives Ives Amphelamines Ives Ives Opiates Ives jves PCP Ives Ives Annual Report Fann (version 1.9.0 - January 2020)

-Page 1 of2-NRC Fonn891

Substances Tested - con6nued Summary of Management Actions - 26.717(b)(BJ Summarize actions implemented lo improve FFD program performance. As applicable, reference in lhe topic description audit reports, 30-day reports, and/or corrective action reports. If reporting information on more than three topics, select "Others* for Topic 3 to report any additional topics.

Topic 1

!Program and System Management Add an additional Topic Person(s) Responsible for Information Provided Person 1 (required):

!Amy I

lsouchard Topic 1 Description NRC Security Deco*mmissioning Inspection 05000293/2020401 conducted August 2020 reviewed all aspects of lhe*Access Authorization and Fitness for Duty program al Pilgrim Slalion. There were no findings or areas f<>_r improv~men_t identified for any p_ortion of AA/FFD during the course of !he audit.

I IAA/FFD Supervisor I

A.Bouchard@hollec.com First Name Last Name Position Tille Company Email Address Person 2 (optional):

ii II I

First Name Last Name

• Position f,ue Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the "Validate & Lock" bu lion has been selected and all errors (i.e., those highlighted in red) have been corrected. The *validate & Lock" bullon will change lo "Locked" arter the data validation process has been successfully completed and the form is ready for submission.

1-Form Locked On:jFeb 24, 2021 al 9:43:33 AM I I Save to Local PC 11 Print this Report I Annual Report Form (version 1.9.0 - January 2020)

-Page 2 of2-NRC Form 891

~U.S.NR.G,,, FFD Program Performance Data Reporting System NRC Form 890, Single Positive Test Form Um1c.-J St.:m;1 Nudu.r 1't~ulllul) Ccmm11\\1(1n Prottctiug A*ojl/1! mul 1/Je £mlromne11t

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(EIE General Submission Portal}

1i All fl old* reqiilriii e>:?J,lpt thou mritd 'optional' APPROVED BY 0MB: CLEARANCE NO. 3150-014&

EXPIRES: 04/3012021

'J Entries In aome fialds auto-popular. fnfo~tlon In oth~ fi*ld~

Estimated burden per response lo eomply with this collection requcs1 is 30 minutes. This

3) Mou:111, ovu forin field* to vl*w additional Information form is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2)

4) Un of Adobe RHder 8 or l*t*r Is rttqulnd Md 26.717. Tho information is required by NRC lo obtain on an annual basis silo specific filnC'$$-rOf-duty (FFO) program perfomwnco data on drug and alcohol programs from D Submission D ~~~e!~ssion licertSces and olhcr entities. Send comments regarding burden osfimatc lo the FOIA.

Update lnformction Set"Vices Branch (T6-A1 OM), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Inroco1Iects Rcsourc;c@NRC goy and to tho Desk Officer, Un/oue Reference ID tlicensee Supolied)

Office of lnfomJalion and Regulatory Affairs. NEOB-1020, (3150--0146), Office of IPNP-2020-01 I

Management and Budget, Washinglon DC 20503. Ir a means used lo Impose Information collection does not display a currently vatid 0MB control number, the NRC may not con duel 0tsponsor, and a person is not required lo respond to, the information coUeclion.

Facility

!Pilgrim [50-293]

I Date of Collect/on I 01/06/2020 (mm/dd/yyyy)

I Reason for TeSl/ng - 26.717(b){5)

Folk>w-up Testing Reason (oplionalJ I

Follow-up I I Prior 10 CFR Part 26 positive result I

Employment Type* 26.717(b)(3)

Outage Worker (optlonaQ?

!conlractorNendor I jNo I

LaborCategory-26.717{b)(3)

I Facility Suppon I

Is this a 24-hour reportable event under 26.719(b)? ~

Was this collect/on re~used?

• 26.717(b)(7) & 26.75 ~

Test RefUlts_

• 26?17(bJ(4)

Test Type(s) for Resull(s) Reponed - 26_.717(bl(2)

Drug Specimen Tested j0ru90nly I

(urine I

Test Validity jvalid I

Was this c'?.lla~tlon."bs:~~fJd?: 26_. ?1:IH>)(7)_ & 2p.75 ~.

HOw many su~~t~.n~c~ 1~-~rf: ~,:ifi_rmc~ rAJ!iiii\\'e for this indivi.dual? I 1

I Substance - 26.717(b)(2) & (b)(6)

UseNRC.

lnilial Confirmatory umuor I Cutoffs?

• CutoU Culoff Detection IMarijuMa

,.. I I~

I Subversion Attempt* Did this collection involve a subversion attempt?* 26.717(b)(7) and 26.75{b) I No I

Management Actions* 26.717(bl(8) II. 26.75 Reason for the Action

!second drug or alcohol positive I

Sanction Applied (NRC Minimum or Licensee Administrated) luconsee Administrated I

Specific Sanction Applied

!Permanent Denial I

Person(s) Responsible for lnformaUon Provided Person 1 (required):

1~

lle~asd I

IAA/FFO Supervisor I

A.Bouchard@hottec.eom First Name Last Name PositiQnTiUe Company Email Address Person 2 (optional):

I first Name II Last Name II P0s1t10n TiUe I

Company Email Address Flml Step (R*t:plred)

• NRC wll consldl'f this form authentic in accordance with 10 CFR 26. t 1 only when the *validate & lock" button is dicked and all eaor.. (highlighted in red) have been coo eel ed. The *validate & Lock" bul1on will change to "Locked" after lhe data vaJidation process has been successfully completed imficat:ng the form is ready for,ubmisslon.

I-Farm Locked On:IFeb24, 2021 at 7:12:31 AM I I

Save to Local PC I j* Print this Report I Single Positive Test Form (version 1.9.0 -January 2020)

NRC Form 890

ci1f u.s.NRCi,.,

.. f'FD Program Perfunn~nce Da~ Reporting System Umt<JSmesNuclmRq;uL,ro.,*Q,mmn>>on

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NRC Form 890, Single Positive Test Form Protettilll! P,*op/e aJJd the £m:lrn11111e111

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(EIE General Submission Portal)

1) AJl'floldar*qulred oxcopt rhoao mark*d 'optional' APPROVED BY 0MB: CLEARANCE NO. 3160-0146 EXPIRES: 04/30/2021

2) Entrlea /ti aomo fi*lch auto-populato Information In othor 6*1d~

Estimated burden per response 10 comply with lhis collcclion request Is 30 minutes. This

3) Mou*o ovuform* field~ to vlow 8dditional Information form is a voluntary means of reporting tho information required under 10 CFR 26.-117(b)(2)

4) Uoo of Adobe R11ador a or l11tt1r I* rllf{Ulrod and 26.717. The lnfonnation is required by NRC to obtain on an annual basis site specitl.c fitness-for-duty (FFD) program performance data on drug and alcohol programs from D Submission D ~~~e!~ssion licensees and olher entities. Send comments regarding burden estimate lo lhe FOIA.

Update Information Services Branch (T6-A10M). U.S. Nuctear Regulatory Commission. Washington DC 20555-0001, or by e-mail lo lo(ocollects Besource@NRC 90' and to the Desk Officer, Unlaue Reference JD (Licensee Suooliedl Office of Information and Regulalory Affairs, NEOB-1020, (3150-0146), Office ol jPNP-2020-02 I

Management and Budget. Washfngton DC 20503. If a means used to Impose information collection does nol display a CU1TenUy valid 0MB control number. the NRC may nol conduct or sponsor, and a person is not required to respond to, the information coHection.

. Facility

!Pilgrim [50-293]

I Date of Collect/on I 0510412020 I

{mm/dd/yyyy)

Reason for Testing - 26.717{b)(5J Please elaborate (optional)

!Random I l'nd~~~l re~~~ ~~~~.,?.'1sile for random FFO testing citing COVID*19 concerns after seeing multiple out of stale license plates J Employment Type* 26.717(bJ(3)

Outage Worker (optlonaQ?

jcontractorNendor I

!No I

Labor category-26.717(b)(3)

Please elaborate on the Labor Category selected

!olher I

IEversource swilchyard employee I

Is this* 24-hour reportable event under 26.719(b)7 ~

Was this collect/on refused?- 26.717(bJ(7} & 26.75 ~

~**:*,1* *: : *'

Subversion Attempt -

Did this collection involve a subversion attempt?* 26. 717(b}(7) and 26.75(b) J Yes:

• I 0 Did not appear for testing D Specimen charaderistics (e.g., color, odor, precipitant)

Please elaborate on the choice{sl selected:

D Shy-bladder (no medical condition)

D Invalid test result (initial specimen collected)* 26.185(f)

Refused to come onsite for random FFO tesl. Claimed fear of COVJQ.19 aner seein!J multiple oul of slate license pla!es 181 Refused to provide inltial specimen D Rerused to follow directions on vehicles in the parking lot.

D Refused to provide second specimen D Donor admitted to subversion attempt D Specimen temperature (out of range)

Olher D Specimen paraphernalia identified Management Actions - 26.717(b)(8) & 26.75 Reason for the Action

!subversion attempt I

Sanction Applied (NRC Minimum or Licensee Administrated)

INRC Minimum I

Specific Sanction Applied (Pennanent Oenfal I

Person(s} Responsible for Information Provided Person 1 (requited):

IAmy I

leouch~d I

IAAJFFD Supervisor I

A.Bouch.ird@hollcc.com First Name Last Name Posillon Title Company Email Address Person 2 (optional):

I II II I

First Name Last Name Position TiUe Company Email Ad'dress Final Sttp (R~qulrod).. NRC v.;u consider this form autt,entic In accotdancev.;th 10 CFR 26.11 only when the "Varidate & Loclr:button is clicked and all errors (highlighted In red) have been corrected. The *validate & Lock* button will change lo 'locked"' arter tho data validation process has been successfuDy completed indicating the form is ready for submission.

Jdiitiiii Form Locked On:IFeb 24. 2021 at 7:34:02 AM I I Save to Local PC 11 Print this Report

• I Single Positive Test Form (version 1.9.0-January 2020)

NRCFonn890

'0Jy us:iiilj;;y;~,cJ5~ Program Pelformance Data Report;ng System v~~

.....,1<:o1.,,;~,.;,.-~.:... ron J[, : *' 'NRC Form 890, Single Positive Test Form Protecting Peopfcand the ~11r/ro~11!':n

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(EIE General Submission Por1al)

1) All fi*fd* roqulfdd excopt thoH marbd 'optfonal' APPROVED BY 0MB: CLEARANCE NO. 3150-4146 EXPIRES: 04130/2021 2J ~triu In some ri*ld* *auto-populate fnform:ation In othorfiefd*

Estimaled burden per response lo comply with this c:olleetiori request Is 30 minutes. This

3) A-bun oVorlorm field* to vJow 8dditjonaJ Jnfomu,rion fOJm is a voluntary means of reporting the information required under 10 CFR 26.4t7(b)(2)

4) U** of Adobo Road er 8 or l~ter f* required and 26.717. The information is required by NRC to obi.in on an amual basts sile ~pecific fitness-for--dury {FFD) program pcrformence data on drug and alcohol programs from D Submission D ~~~e,!,~ssion licensees and other entitles. Send comments regardng burden eslimalo lo the FOIA, Update Information Services Branc:h (T6-A10M), U.S. Nudear Rcgulalory Commission, Washington OC 20555-0001, or by e-mail Jo Jnfoc@ects Rcsoy:ce@NRC.gov and to the Desk Officer, Unfaue Reference ID fUconsoo Succlledl Olfic:c of lnformntion and Regulntory Atfairs, NEOB-1020, (3150-0146). Ottiee of I PNP-2020-03 I

Man:Jgemenl and Budgel. Wsshington DC 20503. If a me:Jns used to lmp05e information cOllection does not display a airrenlly valid 0MB control number, the NRC may not conduct 01 sponsor, and a person 15 not required to respond to, the infOfmaUon collection.

Faclllty

!Pilgrim [50-293]

I D*t* of Collect/on I 0810312020 I (mm/dd/yyyy)

Reason for Testing-26,717(b)(5)

Please elaborate (optional)

IRandom I

IFir.;t con6nned positive for drug, I

Employment Type-26,717(b)(3)

Outage Worker (optlona.1)7 Iconlrac1orNendor I INo I

Labor Category-26.717(b)(3)

IHPIRP I

Is this a 24-hourreportable event under 26.719/b)? ~

Was this collect/on rofused? -26.717(b)(7) & 26.75 ~

Test Results* 26,717(b)(4)

Test Type(s) ror Resull(s) Reported - 26.717(b)(2)

Drug Specimen Tested

!Drug Only I 1urine I

Test Validity lva5d I

Was this col/octlon ob~ervet/7 -26.717(b)(7) & 26,75 r*. No J*,.

How many svbslances were confirmed positivr. for trnS iucl:viduoi;' [

• 1 I

Substance-?.6.717(b)[2) & {b)(6)

U,c NRC Initial Confinnatory Limitof l.

Cutoffs?

Cu~off Cutoff Dftection I

Marijuana

• 7 I~

I Subvenlon Attempt. Did this collection involve a subversion auempl?

• 26.717(b)(7) and 26.75(b) j No I

Management Actions -26.717(b)(8) & 26.75 Reason (or the Action (First drug or afcohol positive I

Sanction Applied (NRC Minimum or Licensee Administrated) lucensee Administraled I

Specific Sanction Appied 13-Year Denial I

Person(s) Responsible for Information Provided Person 1 (required):

IAmy I

leoucha,d IIAAIFFO SupO<Visor I

A.Bouchnrd@holtec.com First Name last Name Position Title Company Email Address Person 2 (optionol):

I II First Name Last Name II Pos1tton Title I

Company Email Address Final St*p (Roqul,.d) -NRC \\1110 consider thls form authentk: In acccrdance with 10 CFR 26.11 only when tho -Volidato & Lock* bu non Is clicked and all errors (llighllghted In red) have been c:orrect&d. Tha "Valida lo & Lod:.* button wi"I chal'l!18 lo L.ocke~ after 1h11: data validation proc.os:1 hns beer1 suecacsfuUy completed Indicating Uie form b ready for submission.

Form Locked On:!feb 24, 2021 at 7:50:46 AM I I Save lo Local PC 11 Prinl lhis Report I Single Positive Test Fonn (version 1.9.0-January 2020)

NRC Form 890

'~fU.'.SlN~-;;n:~ Program Performance Data Reporting System Unl1cdSmc<N:iJ.,,;,i,.t..i.,,;"a,ii;.,

j;-, ~ '.., NRG Fc:irm 890, Single Positive Test Form

• Pto(fdinf:Peoj,lea~d 11!! £1fr/ron

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(EIE General Submission Portal)

• 1j Alf litJlds:reqiilrocl oXc'opt thoa. marked 'optiON:aJ' APPROVED BY 0MB: CLEARANCE NO.'3150-0146 EXPIRES: 04130/2021

2) Entries In somo fields auto-populate lnform.atfon In oth~r fields Estimated burden per response to comply with this collection request is 30 minutes. This

3) Mouu ov.-, form fields to view addltional lnfo~tion form is a voluntary means or reporting lhe information required under 10 CFR 26.417(b)(2)

4) UH Of Adobt Road or B or later l* roquirW and 26.717. Tho lnfOl'malionis required by NRC lo obtain on an annual basis sile specific fitncss-ror-duty (FFO) program performance data on drug and alcohol programs from D Submission D~~:~ssion licensee::. ;:md olhcr entities. Send comments Iegarding burden eslimalc to the FO/A, Update Information Services Branch (T6--A 10M), U.S. Nuclear Regulatory Commission, Washinglon DC 20555-0001, or by e-mail lo lnfocollects.Resource@NRC gov and to the Desk Officer, Un/aue Reference ID IUcensee Suoolledl Office or lnfmnation and Regulatory Affairs, NEOB-1020, (31~146), Office of I

PNP-2020-04 I

Management and Budget, Wastington DC 20503. IC a means used to Impose Information collection does not display a currenttv valid 0MB conlrol number, the NRC may not conduct or sponsor, and a person is not required to respond to, the infonnation collection.

Fac/1/ty

'Pilgrim (50-293)

I Date of Collect/on I 0810412020 (mm/dd/yyyy)

I Reason for Test/ng-26,717(b)(5)

Pre-Access Testing Reason (optional)

I Pre-Access I I Please Setecl I

Employment Type-26,717(b)(3)

OutBge Worher (optional)?

IContractorNendor I 'No I

Labor Category* 26.717(b){3)

Please elaborate on the labor Category selected Jother I

jGEcootrac!Of I

Is this a 24-hour reportable event under 26.719/b)? ~

Was this collect/on refused7-26.111(b)(7) & 26,75 ~

Test Results -26.717(b)(4)

Test Type(s) for Result(s) Reported - 26.717(b)(2)

Drug Specimen Tested jorugOnly I furine I

Test Validity

!valid I

Was this collect/on observed? - 26.717(b)r/) & 26,75 ~

How many substances were confirmed PQSilive ro, ~his individual? I *

• I*

• 1 Substance-26.717(b)(2j & (b)(6)

UseNRC Initial Confirmatory

• Limitor. I Cutoffs?

Cutoff Cutoff Oeteclion I

Marijuana I

,~

I Subversion Attempt* Did lhis collection Involve a subversion allempl?-26.717(b)(7) and 26.75(b) I No I

Management Actions - 26.717(b)(8) & 26.75 Reason for the Action I

First drug or alcohol positive I

Sanction Applied (NRC Minimum or licensee Administrated)

!Licensee Administrated I

Specific Sanction Applied 13-Year Denial I

Person(s) Responsible for lnfonnatlon Provided Person 1 (requited):

IAmy I laooehard IIANFFO Supe,visor I A.Bouchard@hottec.com First Name Last Name Position Title Company Email Address Person 2 (optional}:

I II I

First Name Last Name Posrt1on TiUe Company Email Address Final Step (RequlroaJ - NRC will consider this form authentic In aa:cnfanco with 10 CFR 26.11 only when the "Va~date & Lock* button is clicked and au em>JS (highlighted In red) have been corrected, The -Validate & Lock"' button will change to *Lockecr after the data vaUdatlon process has been successfully completed indicating the form is ready for submission.

I-Form Locked On:IFeb 24, 2021 at 7:58:32 AM I I Save lo Local PC 11 Print this Report I Single Positive Test Form (version 1.9.0- January 2020)

NRG Form890

~ riS.Ni.,~fF,~ P'."gram Performance Dal~ Report;ng System l'nitedS..i<<l>ucl,,,R,,iuhu,,y(,,,i,;:i,,,.-.:,

NRC F,orm 890, Single Pos1t1ve Test Form Proteding hop!ea!,d 11,e Em*/ro11mi nt ;' _

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(EIE General Subm,ss,on Portal)

1) 'All liofds ntqU!t~ eXcepf fhoae tt:*rked "optional' APPROVED BY OMS; CLEARANCE NO, 3150-0146 EXPIRES: 04130/2021

2) Entries In :some fields auto.popul*te /nformadon In othor fletch Eslima1ed' butden per. response lo comply wilh this collection request is 30 minutes. This

3) MouH ovor form fields to view additional Information rotm is n voluntary means of reporting the information required under 10 CFR 26.417(b)(2}

4) Un of Adob* Read*r 8 or later la required ood 26.717. The information is required by NRC to obt;:iin on an annual basis site specific litncs~ror-duty (FFD} program performance data on drug ond alcohol programs from 0 Submission D ~~~~~ssion licensees and other entities. Send comments regarding burden ostimalo to the FOIA, Update Information Services. Branch {T~A10M), U.S. Nuctcar Regulatory Commission, Washington DC 205SS.0001, or by e-mail to lnfocollects.Resource@NRC.gov and to the Oesk: Officer, Unioue Reference ID fUccnsee Sunolledl Qf(,c:e of Information and Regulalory Affairs, NEOB--1020. (3150-0146), Office of jPNP-2020-05 I

Management and Budget, Washington OC 20503. If a means U!ed lo impose infonnalion collection docs noldispfay a currcndy vilfid 0MB control number, the NRC may not conduct

°' sponsor, and a person is not required to respond to, tho information collection.

Fae/Illy

!Pilgrim [50-293]

I Dato of Col/o<:t/on I 09110/2020 I (mmlddlyyyy)

Reason for Testing* 26,717(b)[5)

Please elaborate (optional)

!Random I I I

Emp/oymant Typo* 26,717(b)(3)

Outage Worker (optlon11Q?

I licensee Employee I IND I

Labor Category* 26,717(b)(3)

Please elaborate on the assigned area or rosponsibilirf for the supervisor I

Supervisor I

Joesign Engineering SupefVisor I

Please era borate on the 24-hour reportable event Is this a 24-hour reportable event under 26.719(b)? ~ INRC notir>ed 9/10/2020 I

Was this collect/on refused?* 26.717(b)(7.l & 26,75 ~

Test Results* 26,717(b)(4)

Test Type(s) for Resull(s) Reported* 26.717(b)(2) jAtcohol Only I

Subs\\Dnco ~ 26J17(bi(2) & (b)(6)

.,Alcohol

,. I A!COho! SpCcinit?n Tl?sted IBreath I

Villa! 26,103 BAC level was exceeded?

J 0.03 and in wo~ slatus at least 1 hr I Subversion Attempt-Did this collection involve a subversion attempt?. 26.717(b)(7) and 26.75(b) I No I

Management Actions - 26,717(b)(B) & 26,75 Reason for the Action I

Fsrst drug or alcohol positive I

Sanction Applied (NRC Minimum or Licensee Administrated) jucensce Administrated I

Specific Sanction Applied

!Permanent Denial I

Person(s) Responsible for lnfonnatlon Provided Person 1 (required):

IAmy lleooch~d I IAJVFFO Supetvi$Clt I

A.Bouch.lrd@h0Uec.c1;1m First Name Last Name Position Tille Company Email Address Per.;;on 2 (optiooal):

I II II I

First Name Last Name Position Tiile Company Email Address Final Stop (Roqulrod) -NRCwill consk!er thts form eulhentic in accon:fanco with 10 CFR 26.11 only when U,e 'Validate & Lock." buUon Is dicked and all errors (highGghled in red) have been corrected. Tho-Valida lo & Loe.It* button wiU change to *Locked. elter the data validation proceu has been sueeessfully compfeled indicating the form ls ready for submlss!on.

I-Fonm locked On:jFeb 24, 2021 al 8:05:0SAM I I Save to Local PC 11 Print this Report I Single Positive Test Form (version 1.9.0 -January 2020}

NRCFonm890

• 1jA/1 ti Ottis re'{U!red *xcoj,_t thon mtirlotd *optional*

2J 'EntrlH In,omo fitfd~ tiUto-popufaro lnfoi'marion In orhe,r fit Ids

3) Moun ov;,r fom, f1cld~ to view 11ddltional Information

4) Uao of Adobo Rttaddr 8 or /ator ls roqu{red Submission Update Unloue Reference ID IUcensoo Suocllad)

. jPNP-2020-06 I

Facility Pilgrim (50-293)

I Reason for Test/ng-26.717(b)(5)

Follow-up TesUng Reason (optional)

APPROVED BY 0MB: CLEARANCE NO. 3150.0146 EXPIRES: 04/3012021 Estimated burden per response to comply 'Hith this collection request-ls 30 minutes. This form is a voluntary means of reporting the Information required under 10 CFR 26.417(b){2) and 26.717. The inrOl'malion is required by NRC lo obtain on an annual basis silo specific fitness-for-duty (FFO) program performance data on drug and alcohol programs from licensees and olhcr entities. Send comments regarding burden estimate lo the FOIA.

Information Services Branch (f6-A10M), U.S. Nuclear Regulalo,y Commission, Washington DC 20555-0001, or by e-ma:I to lnrocolleets.ResOUfct@NRC.gov and to lhe Desk Officer, Office of lnfonnation and Rcgulalory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget. Washington DC 20503. If a means used to impose inrormation collection does not display a currcnUy valid 0MB control number. the NRC may not conduct or sponsor, and a person is not required to respond to, the information coUcelion.

Date of Collection j 1012812020 I (mm/dd/yyyy)

I Follow-up j

!Potentially disqualifying FFD information Employment Type-26.717(b)(3)

IContractorNendor Labor Category-26.717(b)(3)

'Facility Support Outage Worker (optional)?

!No j

fs this a 24-hour reportable event under 26.719(b)? ~

Was this collection refused? -26.717(b)(7) & 26.75 ~

Test Results -26.717(b)(4)

Test Type(s) for Resull(s) Reported-26.717(b)(2)

!Alcohol Only Substance -2G.717(b){2j & (b)(6)

Alcohol Specimen TcstCd jsrealh

\\/Vhat 26.103 BAC level was exceeded?

jo.02 and in work status at least 2 hrs J

Subversion Attempt* Did this collection involve a subversion attempt? -26.717(b)(7) and 26:75{b).._I __

N_o __

-"I Management Actions - 26.717(b)(B) & 26.75 Reason for the Action First drug or alcohol positive I

Sanction Applied (NRC Minimum or Licensee Administrated)

I Licensee Administrated Specific Sanction Applied f 1-Year Denial Person(s) Responsible for Information Provided Person 1 {required}:

LIA_m_Y __ ~~~-----'I1 Le_ou_ch_ar_d _==-~-----JI IAA/FFO Supervisor I

A.Bouchard@holtcc.com First Name Last Name L---~P-o-si-tio-n-r-;u-.----' ____

C_o_m_p_a-ny-Em-ai-1 A-d-d-,e-ss ___

Person 2 (optional):

~I ~-~l~I ~-~l~I -~~I ____,

First Name Last Name Pos1t1on Tille Company Email Address Final St~p (Roqulrod) - NRC will consider this roon authentic in accordance with 10 CFR 26.11 only when tho -Validate & tock* button ts dicked and all errors (highlighted In red) have been eorredod. Tho "'Validate & ~

button will change to *Locketf' after the data validation process has been successfully completed indicating the foan Is readyforsubmlssk>n.

j-Form Locked On:IFeb 24. 2021 at 8:21:45 AM I Single Positive Test Form (version 1.9.0- January 2020)

I Save to Local PC 11 Print this Report j NRCForrn890