ML100620790

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Fitness for Duty Program Performance Data Report for 2009
ML100620790
Person / Time
Site: Nine Mile Point  Constellation icon.png
Issue date: 02/24/2010
From: Verno A
Constellation Energy Group
To:
Document Control Desk, Office of Nuclear Reactor Regulation
References
Download: ML100620790 (24)
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Text

P.O. Box 63 Lycoming, New York 13093 CENG a joint venture of A&Constellation C Enemi bg-eDF NINE MILE POINT NUCLEAR STATION February 24, 2010 U.S. Nuclear Regulatory Commission Washington, DC 20555-0001 ATTENTION: Document Control Desk

SUBJECT:

Nine Mile Point Nuclear Station Unit Nos. 1 & 2; Docket Nos. 50-220 and 50-4 10 Fitness for Duty Propram Performance Data Renort for 2009 In accordance with the requirements set forth in 10 CFR 26.717(e), 10 CFR 26.203 (e)(1) and 10 CFR 26.203 (e)(2), Nine Mile Point Nuclear Station, LLC has compiled and is submitting the enclosed annual Fitness for Duty Program Performance Data Report covering the period January 1, 2009 through December 31, 2009.

Should you have any questions regarding the information in this submittal, please contact Terry Syrell, Director Licensing at (315) 349-5219.

Very truly yours, Anthony Verno Director Security AV/RJC

Enclosure:

NRC FFD Program Performance Data Reporting System cc: NRC Regional Administrator, Region I NRC Project Manager NRC Senior Resident Inspector c(

T CA

ENCLOSURE NRC FFD PROGRAM PERFORMANCE DATA REPORTING SYSTEM Nine Mile Point Nuclear Station, LLC February 24, 2010

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1) All fields are required except those marked 'optionalP Optional Reference 2) Entries In some form fields may result In Information Optional ReferenceNumberforLicenseeUse SingleForm20091RA being auto-populatedInto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mm/dd/yyyy) 0/I2009 Nine Mile Point Reason for Testing - 26.717(b)(5) l~andom Employment Type - 26.717(b)(3)

ContractorNendor I Labor Category- 26.717(b)(3)

Maintenance (Craft)_

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?iFo Test Results - 26.717(b)(4)

Test Validity Not Applicable Test Type(s) for Result(s) Reported Alcohol Testing

Alcohol Only I 19reath Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (as applicable) AdditionalSubstance (asapplicable) jAlcohol 1Please Select 71 IPlease Select Use NRC Cutoff (Yes / No)lI* Use NRC Cutoff (Yes / No) l l Use NRC Cutoff (Yes / No)[e Is this a 24-Hour Reportable Event (Yes /1No)?- 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

If this result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors 0] 11 Refusal to Cooperate Other 11 E0 Management Actions - 26.717(b)(8)

Disciplinary Action I1- Year DenialJ Reason(s) for the Action (select all that apply):

[I MRO Confirmation

  • First drug or alcohol positive 0 Resignation/Withdrawal El Subversion [0 Subsequent positive test result from testing El Misuse 0 Violation of 5-hour abstinence rule [] Other:

0 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entries needing correction willbe highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document Fý4ýve to Loýýai--PC Port to NkC Print this Report]

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1) All fields are required except those marked 'optional"
2) Entries in some form fields may result in information Optional Reference Number for Licensee Use ISingle Form 2009 2 JL FU Sub being auto-populatedinto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mmlddlyyyy)

Nine Mile Point Reason for Testing - 26.717(b)(5)

Followup Employment Type - 26.7 17(b)(3)

Contractor/Vendlor I Labor Category - 26.717(b)(3)

Maintenance (Craft)

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)? NoN Test Results - 26.717(b)(4)

Test Validity Test Type(s) for Result(s) Reported Drug Testing jUrine1 jDrug Only Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (asapplicable) AdditionalSubstance (asapplicable)

IMarijuana PleaneselectI 1Please Select I Use NRC Cutoff (Yes I/ No) Use NRC Cutoff (Yes / No) ( Use NRC Cutoff (Yes / No)Yes 1 Is this a 24-Hour Reportable Event (Yes /1No)? - 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

Ifthis result relates to a subversion attempt, select one or more of the following choices as applicable.

Ifnot a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors Please elaborate on the choicels) selected:

0 0 First sample was out of acceptable temoeralture ranue. Seound sarmole was conllected For Cause, under direct observation andwas positive.

Refusal to Cooperate Other 0 03 Management Actions - 26.717(b)(8)

Disciplinary Action Permanent Denial Reason(s) for the Action (select all that apply):

" MRO Confirmation [3 First drug or alcohol positive 0 Resignation/Withdrawal 0 Subversion 0 Second drug or alcohol positive [3 Subsequent positive test result from testing

[3 Misuse 0 Violation of 5-hour abstinence rele 0 Other:

0 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entries needing correction will be highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting *Clear Signature".

Click to Digitally Sign This. Document Resiportto.N C SIingPoo TjetSeFnrd single Positie Ted 50,0 vamio 1.1.26

Utrtci~ýU SI0 R0 0 epefli bivriie NRC FFD Program Performance Data Reporting System Single Positive Test Form Online Help 1)All fields are requiredexcept those marked 'optionaP

2) Entries In some form fields may result in Information Optional Reference Number for Licensee Use ISingle Form 2009 3 ST 3rd D being auto-populated Into other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mm/dd/yyyy) 03022009Z Nine Mile Point Reason for Testing - 26.717(b)(5)

Pre-Access I Employment Type - 26.717(b)(3) aContraorNendor Labor Category- 26.717(b)(3)

Maintenance (Craft)

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity IValid Test Type(s) for Result(s) Reported Drug Testing 1Drug Only jurine Was this collection observed (Yes/No)?- 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (as applicable) AdditionalSubstance (as applicable)

Ilariuana 'eae Select lPlease Select Use NRC Cutoff (Yes / No)* Use NRC Cutoff (Yes / No)* Use NRC Cutoff (Yes / No)e Is this a 24-Hour Reportable Event (Yes/ No)?- 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

If this result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors 11 El Refusal to Cooperate Other 11 01 ManagementActions - 26.717(b)(8)

Disciplinary Action iPermanent Denial Reason(s) for the Action (select all that apply):

O MRO Confirmation 0 First drug or alcohol positive 0 Resignation/Withdrewal o Subversion El Second drug or alcohol positive 0 Subsequent positive test result from testing O Misuse [I Violation of 5-hour abstinence rule § Other: Please elaborate

[I Sale, Use or Possession in PA 3r oiie rgts I This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entries needing correction willbe highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document

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R* SX 0-NRC FFD Program Performance Data Reporting System Single Positive Test ForrinOlneHl Note

1) Alufields are required except those marked 'optional'.
2) Entries in some form fields may result In information Optional Reference Number for Licensee Use ISingle Form 20094CM Ref being auto-populatedinto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mm/dd/yyyy) j/0/2009 Nine Mile Point Reason for Testing - 260717(b)(5)

Pre-Access l Employment Type - 26.717(b)(3) contractorNendor I Labor Category- 26.717(b)(3)

IMaintenance (Craft) I Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

I1 Test Validity Test Type(s) for Result(s) Reported Was this collection observed (Yes/No)? - 26.717(b)(7) &26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (as applicable) Additional Substance (asapplicable)

II I I 1 --

Use NRC Cutoff (Yes / No)IZ] Use NRC Cutoff (Yes / No)IZ] Use NRC Cutoff (Yes I No)-

Is this a 24-Hour Reportable Event (Yes /1No)? - 26.719(b)

Subversion Attempts - 26.717(b)(7) and 26.75(b)

If this result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors Please elaborate on the choice(s) selected:

01First Samole out of acceptable temoerature ranso. reouested another under direct Refusal to Cooperate Other

[] 03 observation andthe donor refused.

Management Actions - 26.717(b)(8)

Disciplinary Action Permanent Denials Reason(s) for the Action (select all that apply):

0 MRO Confirmation E] First drug or alcohol positive 0 Resignation[Withdrawal I& Subversion 0 Second drug or alcohol positive [0 Subsequent positive test result from testing El Misuse 0 Violation of 5-hour abstinence rule [] Other:

El Sale, Use or Possession in PA "

This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check willbe performed when the user digitally signs the form. Any entries needing correction will be highlighted in red and the form cannot be signed until allerrors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the.

signature box and selecting "Clear Signature".

Click to Digitally Sign Thit Document Save tP Senod ReportttorNRCtoi 11.2

NRC FFD Program Performance Data Reporting System Single Positive Test Form Help O'-,nline

1) All fields are required except those marked 'optional'.
2) Entries In some form fields may resultin Information being auto-populatedinto other form fields.

Optional Reference Number for Licensee Use ISingle Form 2009 5 KS Ref

3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mmlddlyyyy) 03042009 Nine Mile Point Reason for Testing - 26.717(b)(5)

Er-Access ]

Employment Type - 26.717(b)(3)

Contractor/Vendor Labor Category- 26.717(b)(3)

Maintenance (Craft)

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)? FYe77 Test Results - 26.717(b)(4)

F1 Test Validity Test Type(s) for Result(s) Reported Il Was this collection observed (Yes /No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) Additional Substance (asapplicable) Additional Substance (asapplicable)

Use NRC Cutoff (Yes / No)[j Use NRC Cutoff (Yes / No) IZ Use NRC Cutoff (Yes I No)[I Is this a 24-Hour Reportable Event (Yes /No)? - 26.719(b)

Subversion Attempts - 26.717(b)(7) and 26.75(b)

Ifthis result relates to a subversion attempt, select one or more of the following choices as applicable.

Ifnot a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors Please elaborate on the choice(s) selected:

0 0

[] Completed alcohol test. When informed that the sample was required under direct Refusal to Cooperate Other observation the donor refused to cooperate.

0 0[I ManagementActions - 26.717(b)(8)

Disciplinary Action Permanent Denial Reason(s) for the Action (select all that apply):

[I MRO Confirmation 0 First drug or alcohol positive 0 Resignation/Withdrewal M Subversion 0 Second drug or alcohol positive 0 Subsequent positive test result from testing O Misuse [ Violation of 5-hour abstinence rule E] Other:

0 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be penformed when the user digitally signs the form. Any entries needing correction will be highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document I

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  • 0
  • NRC FFD Program Performance Data Reporting System Single Positive Test Form ~ne Help
1) All fields are required except those marked "optional'.
2) Entries In some form fields may result In Information Optional Reference Number for Licensee Use ISingle Form 2009 6 BG Q Sub I being auto-populatedInto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mmndd/yyyy)[03/0/2009

[Nine Mile Point 7 Reason for Testing - 26.717(b)(5)

Pe-Access Employment Type - 26.717(b)(3) lContractorNendor Labor Category- 26.717(b)(3)

Maintenance (Craft)

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity lvalid Test Type(s) for Result(s) Reported Drug Testing Drug Only Urine Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) Additional Substance (asapplicable) Additional Substance (as applicable)

IMarijuana 1Please select IPlease Select Use NRC Cutoff (Yes / NO) Use NRC Cutoff (Yes / No )' Use NRC Cutoff (Yes / No) Yes Is this a 24-Hour Reportable Event (Yes / No)?- 26.719(b)

Subversion Attempts - 26.717(b)(7) and 26.75(b)

Ifthis result relates to a subversion attempt, select one or more of the following choices as applicable.

Ifnot a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors Please elaborate on the choice(s) selected:

0 01 First sample provide out of acceptable temunerature runoe, second samosle collected under Idirect observation.

Refusal to Cooperate Other 0 01 Management Actions - 26.717(b)(8)

Disciplinary Action Permanent Denial Reason(s) for the Action (select all that apply):

E] MRO Confirmation 0 First drug or alcohol positive 0 Resignation/Withdrawal 10 Subversion 0 Second drug or alcohol positive 0 Subsequent positive test result from testing 0 Misuse 0 Violation of 5-hour abstinence rale 0 Other:

0 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entries needing correction willbe highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document

[ptveoLaC 1Send Report to NRC1 1ýPrint this Report SinglePoslre T-t ro vmrsio1.1.26

NRC FFD Program Performance Dataý Reporting System Single Positive Test Form OnlineHelp Note:

1) All fields are requiredexcept those marked 'optional'.
2) Entries In some form fields may result in Information Optional Reference Number for Licensee Use 1Single Form 2009 7 GL Q Sub being auto-populatedinto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility INine Mile Point Date of Collection (mm/dd/yyyy) IlI0/2009Z Reason for Testing - 26.717(b)(5)

Pre-Access Employment Type - 26.717(b)(3)

FCOntractorNendOr Labor Category - 26.717(b)(3)

[Maintenance (Craft)

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity Test Type(s) for Result(s) Reported Drug Testing IUrine

[Drug Only Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (as applicable) Additional Substance (as applicable)

[Marijuana I Please Select Please Select I Use NRC Cutoff (Yes I NO)*"T I* Use NRC Cutoff (Yes / No)'F*e7il Use NRC Cutoff (Yes / No) Yes Is this a 24-Hour Reportable Event (Yes/ No)? - 26.719(b) [No Subversion Attempts - 26.717(b)(7) and 26.75(b)

Ifthis result relates to a subversion attempt, select one or more of the following choices as applicable.

Ifnot a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors Please elaborate on the choice(s) selected:

S01 rFirst sample was provide out of acceptable Itemeereture ranne, second sumnie obtained I Refusal to Cooperate Other 0 E0 Under direct observation.

Management Actions - 26.717(b)(8)

Disciplinary Action Femanent Denial Reason(s) for the Action (select all that apply):

O MRO Confirmation 0] First drug or alcohol positive . 0 Resignation/Withdrawal H Subversion 0 Second drug or alcohol positive 0 Subsequent positive test result from testing O Misuse 0 Violation of 5-hour abstinence rule [] Other:

0 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entdes needing correction willbe highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document I o wocal CIReportlo1 Send il1, OrAsto PftvN Tou F-e rorsh ti.2%

PUSARC 0lctoi Inomto Exchange NRC FFD Program Performance Dat a Reporting System Single Positive Test Fo rr noOnH 1)All fields are requiredexcept those marked 'optional'

2) Entries in some form fields may result In Information Optional Reference Number for Licensee Use ISingle Form 2009 8 JB D I being auto-populatedInto otherform fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Data of Collection (mm/dd/yyyy)

INine Mile Point Reason for Testing - 26.717(b)(5)

IPre-Access Employment Type - 26.717(b)(3)

IContractorNendor Labor Category- 26.717(b)(3)

Maintenance (Craft)

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity Test Type(s) for Result(s) Reported Drug Testing jUrine Drug Only Was this collection observed (Yes INo)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (as applicable) Additional Substance (as applicable) lCocaine I Please Select Please Select Use NRC Cutoff (Yes / No)I Use NRC Cutoff (Yes I No)I'" " Use NRC Cutoff (Yes / No)'Yes Is this a 24-Hour Reportable Event (Yes /No)?- 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

If this result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors r0 0 Refusal to Cooperate Other El 0l ManagementActions - 26.717(b)(8)

Disciplinary Action 1 -Year Denial Reason(s) for the Action (select all that apply):

El MRO Confirmation 0 First drug or alcohol positive 0 Resignation/Withdrawal 0 Subversion 0 Subsequent positive test result from testing O Misuse 0 Violation of 5-hour abstinence ule o Other:

0 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check willbe performed when the user digitally signs the form. Any entries needing correction will be highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document

[-SavetoL.*/-PC I*Send Report toNRC- Rp Single Posive Test Fom verson 1.1.26

3l-tcii cd ri b 1);-

-- N-l- I Slg 6 NRC FFD Program Performance Data Reporting System Single Positive Test Form i Online Help Note..

1) All fields are required except those marked 'optional'.
2) Entries in some form fields may result in information Optional Reference Number for Licensee Use ISingle Form 2009 9 JC D being auto-populatedinto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mm/dd/yyyy)0222009 Nine Mile Point Reason for Testing - 26.717(b)(5)

Pre-Access Employment Type- 26.717(b)(3) iContractorNendor Labor Category- 26.717(b)(3)

Maintenance (Craft)

Refusal- 26.717(b)(7) & 26.75 Was this collection refused (Yes I No)?

Test Results - 26.717(b)(4)

Test Validity Test Type(s) for Result(s) Reported Drug Testing Drug Only lUrine Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.1 N]

Substance - 26.717(1b)(2) & (b)(4) AdditionalSubstance (as applicable) Additional Substance (asapplicable)

Marijuana I Please Select ]Please Select Use NRC Cutoff (Yes / No)II* Use NRC Cutoff (Yes / No)rY'iI Use NRC Cutoff (Yes / No)Y Is this a 24-Hour Reportable Event (Yes /1No)?- 26.719(b)

Subversion Attempts - 26.717(b)(7) and 26.75(b)

Ifthis result relates to a subversion attempt, select one or more of the following choices as applicable.

Ifnot a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors 0 0 Refusal to Cooperate Other ManagementActions - 26.717(b)(8)

Disciplinary Action 1- Year Denial Reason(s) for the Action (select all that apply):

EO MRO Confirmation 0 First drug or alcohol positive 0 Resignation/Withdrawal O] Subversion 0 Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule E] Other:

[ Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entries needing correction willbe highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document to l Send Report tN. I tthis Report*

Single Pwieve Test Foe vemion1.1.26

NRC FFD Program Performance Data Reporting System Single Positive Test Form Onlin elp-p Note:

1) All fields are required except those marked 'optional'.
2) Entries in some form fields may resultIn information Optional Reference Number for Licensee Use ISingle Form 2009 10JF D being auto-populatedInto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works property.

Select Facility Date of Collection (mrnddly)0 INine Mile Point Reason for Testing- 26.717(b)(5)

Pre-Access ]

Employment Type, 26.717(b)(3)

ContractorNendor I Labor Category- 26.717(b)(3)

Maintenance (Craft)

Refusal- 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity Test Type(s) for Result(s) Reported Dreg Testing lUrine Drug Only Was this collection observed (yes No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (as applicable) Additional Substance (asapplicable)

Marijuana ilease select I JPlease Select Use NRC Cutoff (Yes / No) I'Y _7 Use NRC Cutoff (Yes / No)'-III Use NRC Cutoff (Yes / No)-Yes Is this a 24-Hour Reportable Event (Yes / No)? - 26.719(b)

Subversion Attempts - 26.717(b)(7) and 26.75(b)

If this result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors 0 n Refusal to Cooperate Other o] 0 Management Actions - 26.717(b)(8)

Disciplinary Action 1-Year Denial Reason(s) for the Action (select all that apply):

o] MRO Confirmation 0 First dreg or alcohol positive E] Resignation/Withdrawal o Subversion [I Subsequent positive test result from testing If Misuse 0 Violation of 5-hour abstinence rule [] Other:

[] Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check willbe performed when the user digitally signs the form. Any entdes needing correction willbe highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document II I Save o'aPC l [ Report Nis Ptont R epo.

Single Pmw TwltF version 1r..26

3-tchgIepeallteEivpiie S S

  • 0
  • 6 NRC FFD Program Performance Data Reporting System Single Positive Test Form ~ne Help Note.

1)All fields are required except those marked 'optional'

2) Entries In some form fields may result In information Optional Reference Number for Licensee Use Single Form 2009 11 CL D being auto-populatedInto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mmldd/yyyy) 03/1/2009 Nine Mile Point Reason for Testing - 26.717(b)(5)

Pre-Access Employment Type - 26.717(b)(3)

Contractor/Vendor Labor Category- 26.717(b)(3)

Maintenance (Craft) I Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity lValid Test Type(s) for Result(s) Reported Drug Testing IDrug Only 7 Was this collection observed (Yes/ No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (as applicable) Additional Substance (as applicable) lCocaine I ~lpease Select IPlease Select Use NRC Cutoff (Yes / No)* Use NRC Cutoff (Yes I No) ] Use NRC Cutoff (Yes / No) Ye Is this a 24-Hour Reportable Event (Yes /1No)?- 26.719(b) No Subversion Attempts - 26.7 17(b)(7) and 26.75(b)

If this result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence

  • Observed Actions/Behaviors Refusal to Cooperate Other o 11 Management Actions - 26.717(b)(8)

Disciplinary Action 1- Year Denial Reason(s) for the Action (select all that apply):

E] MRO Confirmation 0 First drug or alcohol positive 0 Resignation/Withdrawal 0 Subversion 0 Subsequent positive test result from testing 0 Misuse 0 Violation of 5-hour abstinence rule El Other.

[ Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entries needing correction will be highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the isignature box and selecting "Clear Signature".

Cikto Digitally Sign This Document I

-Sv toLo P 1 ISend Reprtto RC I PrntthisReport SinglePolttve Test For- ve-ion 1.1.26

I lwtchg eope471" /1 ~zhoipel LPU N R 1 I. R*,- ........ 0~i-NRC FFD Program Performance Data Reporting System Single Positive Test Form Online Help Note:

1)All fields are requiredexcept those marked 'optional'.

2) Entries In some form fields may result In Information Optional Reference Number for Licensee Use ISingle Form 2009 12 RM A being auto-populatedInto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mm/dd/yywlI)037/2009 Nine Mile Point Reason for Testing - 26.717(b)(5)

Pre-Accessll Employment Type - 26.717(b)(3)

IContractor/vendor I Labor Category - 26.717(b)(3)

IMaintenance (Craft)

Refusal - 26.717(b)(7) & 26,75 Was this collection refused (Yes / No)? N.

Test Results - 26.717(b)(4)

Test Validity Not Applicable Test Type(s) for Result(s) Reported Alcohol Testing Alcohol OnlyBreath Was this collection observed (Yes /No)? - 267J17(b)(7) & 26.1 N.

Substance - 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (asapplicable)

Alcohol Please Select Please Select Use NRC Cutoff (Yes/ No) Z Use NRC Cutoff (Yes / No) Z Use NRC Cutoff (Yes / No)Y Is this a 24-Hour Reportable Event (Yes/No)? - 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

If this result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors 171 0 Refusal to Cooperate Other 0 0 Management Actions - 26.717(b)(8)

Disciplinary Action I -Year Denial Reason(s) for the Action (select all that apply):

[] MRO Confirmation I@ First drug or alcohol positive [0 Resignation/Withdrawal o Subversion [0 Subsequent positive test result frmmtesting

[ Misuse E] Violation of 5-hour abstinence rule E] Other:

[3 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be l performed when the user digitally signs the form. Any entries needing correction will be highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Cikto Digitally Sign This Document I paet ojC JSendl Repcit to NRC I I PM isRap 8SnitrPostv Test Fon- version 1.1+26

U. S. N R C NRC FFD Program Performance Data Reporting System Single Positive Test Form 1)All fields are required except those marked 'optional" Optional Reference 2) Entries in some form fields may result in information OptionalReference NumberforLicenseeUse Single Form 200913 FP D being auto-populatedinto other form fields.

3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Nine Mile Point Date of Collection (mrnddl/yyyi)I2 200 I Reason for Testing - 26.717(b)(5)

Pre-Access Employment Type - 26.717(b)(3)

ContractorNendor I Labor Category- 26.717(b)(3)

Maintenance (Craft)

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)? No Test Results - 26.717(b)(4)

Test Validity lValid Test Type(s) for Result(s) Reported FDrug Only

[0rine Drug Testing Was this collection observed (Yes I No)? - 26.717(b)(7) & 26.1 Substance - 26.717(tb)(2) & (b)(4) AdditionalSubstance (as applicable) AdditionalSubstance (as applicable)

IMarijuana Pease Select Please Select Use NRC Cutoff (Yes / No) m Use NRC Cutoff (Yes / No)I'- Use NRC Cutoff (Yes / No) Ye Is this a 24-Hour Reportable Event (Yes /No)?- 26.719(b)

Subversion Attempts - 26.717(b)(7) and 26.75(b)

It this result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors o1 0 Refusal to Cooperate Other o] 03 ManagementActions - 26.717(b)(8)

Disciplinary Action I1- Year Denial Reason(s) for the Action (select all that apply):

I] MRO Confirmation 1@ First drug or alcohol positive 0 Resignation/Withdrawal O Subversion [] Subsequent positive test result from testing 1 Misuse 0 Violation of 5-hour abstinence rule 0] Other:

0 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any enties needing correction will be highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document

[ e tom PoC SelnReo rttthios Ne Single PsNitive Tent Fn version 1.1.26

0rttti 0lol tin th E* 0opinp NRC FFD Program Performance Data Reporting System Single Positive Test Form OnIne l

1) All fields arerequired except those marked 'optional'
2) Entries in some form fields may resultin information Optional Reference Number for Licensee Use 1Single Form 2009 14 JR D being auto-populatedInto otherform fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mm/dd/yyyy)0 9/2009 Nine Mile Point Reason for Testing - 26.7t17(b)(5) 1Pre-Access]

Employment Type - 26.717(b)(3)

Contractor/Vendor I Labor Category- 26.717(b)(3)

Maintenance (Craft)

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)? o Test Results - 26.717(b)(4)

Test Validity lValid Test Type(s) for Result(s) Reported Drug Testing jUrineI Drug Only Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (asapplicable)

Marijuana ] Please Select - Please Select I Use NRC Cutoff (Yes / No)[ Use NRC Cutoff (Yes / No)l' Use NRC Cutoff (Yes / No)s Is this a 24-Hour Reportable Event (Yes / No)?- 26.719(b)

Subversion Attempts - 26.717(b)(7) and 26.75(b)

Ifthis result relates to a subversion attempt, select one or mom of the following choices as applicable.

Ifnot a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors 0 11 Refusal to Cooperate Other 11 01 ManagementActions - 26.717(b)(8)

Disciplinary Action 1-Year Denial Reason(s) for the Action (select all that apply):

O MRO Confirmation Eg First drug or alcohol positive [] Resignation/Withdrawal o Subversion 0 Subsequent positive test result from testing O Misuse E] Violation of 5-hour abstinence rule [] Other:

[] Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entdes needing correction will be highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking ]the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document I I savto°P d'SendReport

°to NRCl I nipo SWoePorute Tes Fo versson1.1.26

U.S- N R C *6 NRC FFD Program Performance Data Reporting System Single Positive Test Form Online Help

1) All fields are required except those marked 'optional'.
2) Entries in some form fields may result In Information Optional Reference Number for Licensee Use ISingle Form 2009 15 MS 0 being auto-populatedInto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works property.

Select Facility Nine Mile Point I Date of Collection (mm/ddyyyy) /2009 Reason for Testing - 26.717(b)(5) lPre-Access }

Employment Type - 26.717(b)(3)

ContractorNendor I Labor Category - 26.717(b)(3)

Maintenance (Craft)

Refusal- 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity lValid Test Type(s) for Result(s) Reported Drug Testing Drug Only Fur, ne Was this collection observed (Yes /No)?- 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (as applicable) Additional Substance (as applicable)

Marijuana ] Please Select ] lPlease Select Use NRC Cutoff (Yes / No) Use NRC Cutoff (Yes / No)l Use NRC Cutoff (Yes / No) Ye Is this a 24-Hour Reportable Event (Yes/No)? - 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

Ifthis result relates to a subversion attempt, select one or more of the following choices as applicable.

Ifnot a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors

[] 01 Refusal to Cooperate Other M 0 ManagementActions - 26,717(b)(6)

Disciplinary Action 1- Year Denial Reason(s) for the Action (select all that apply):

[I MRO Confirmation [ First drug or alcohol positive [3 Resignation/Withdrawal

[I Subversion [I Subsequent positive test result from testing

[3 Misuse 0 Violation of 5-hour abstinence rule 0 Other:

0 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC, Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entries needing correction will be highlighted in red and the form cannot be signed until all eror have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document I

~avetoLocalPCI SendReport tNRC] r enthisReportI S e Posve eW F.r.m -eon1.1.28

  • S f-ol eii th
  • S.~e~i NRC FFD Program Performance Data Reporting System Single Positive Test Form, Online Help I) All fields are requiredexcept those marked 'optlonal.
2) Entries In some form fields may result In Information Optional Reference Number for Licensee Use ISingle Form 2009 16 JS A being auto-populated into other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility Date of Collection (mm/ddyyyy)w/7/009 Nine Mile Point Reason for Testing - 26.717(b)(5)

Pre-Access Employment Type - 26.717(b)(3)

ContractorNendor Labor Category- 26.717(b)(3)

Maintenance (Craft)

Refusal- 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity Not Applicable Test Type(s) for Result(s) Reported Alcohol Testing Alcohol Onlyreath Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2)'& (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) iplease Select IPlease Select Use NRC Cutoff (Yes / No) Use NRC Cutoff (Yes / No)I*] Use NRC Cutoff (Yes / No)Y Is this a 24-Hour Reportable Event (Yes /1No)? - 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

Ifthis result relates to a subversion attempt, select one or more of the following choices as applicable.

Ifnot a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors 0 [0 Refusal to Cooperate Other 11 0 Management Actions - 26.717(b)(8)

Disciplinary Action 1-Year Denial Reason(s) for the Action (select all that apply):

[I MRO Confirmation 19 First drug or alcohol positive 0 Resignation/Withdrawal 0 Subversion [ Subsequent positive test result from testing 0 Misuse 0 Violation of 5-hour abstinence rule 0 Other:

E] Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the User digitally signs the form. Any entries needing correction will be highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed. changes only can be made to the form by first removing your signature by right-cl icking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document I

[*Save~to LcalP-C I [end Report t6 NRC PrthintRePod, singlePosive Test Formversion 1.1.26

i 4V

-I-tern 0y/

  • 0* I*ep3 NRC FFD Program Performance Data Reporting System Single Positive Test Form Online Help
1) All fields arerequired except those marked 'optional'
2) Entries In some form fields may resultIn Information Optional Reference Number for Licensee Use ISingle Form 200917 JS D being auto-populatedinto other form fields.
3) Use Adobe Reader9.3 to ensure this form works properly.

Select Facility Date of Collection (mmndd/yyyy) [0/2009 Nine Mile Point Reason for Testing - 26.717(b)(5)

Pre-Access Employment Type - 26.717(b)(3) lContractorNendor Labor Category - 26.717(b)(3)

Maintenance (Craft)

Refusal- 26.717(b)(7) & 26.75 Was this collection refused (Yes I No)?

Test Results - 26.717(b)(4)

Test Validity lValid 7 7 Test Type(s) for Result(s) Reported Drug Testing Drug Only lUrine Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) Additional Substance (asapplicable) Additional Substance (asapplicable)

Marijuana piea Se lect

, 1Please Select Use NRC Cutoff (Yes / No) Use NRC Cutoff (Yes / No)IY.' 3 Use NRC Cutoff (Yesa No)Y Is this a 24-Hour Reportable Event (Yes /No)?- 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

Ifthis result relates to a subversion attempt, select one or more of the following choices as applicable.

Ifnot a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors 0 0 Refusal to Cooperate Other 01 01 Management Actions - 26.717(b)(8)

Disciplinary Action i -Year Denial Reason(s) for the Action (select all that apply):

E] MRO Confirmation 0 First drug or alcohol positive 0 Resignation/Withdrawal r] Subversion 0 Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule [0 Other:

0 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entries needing correction willbe highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document

-rav-itL*-c FC_ IsendRep°ort fo-NRC I nIttiReIýrt SinglePoitive Test For- versIon1.1.20

i , 1, 0 ,,

1't-otectini '.,ople ayid the 1-"M)h-oitnvPit U,,1-1 S-- N,.Ll,-., RgA .....

Eiec'tronic Information Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form IH l Nofte.

1) All fields are requiredexcept those marked optional'
2) Entries In some form fields may resultIn Information Optional Reference Number for Licensee Use Single Form 2009 18 CS D being auto-populatedInto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility ate of Collection (mmndd/yyyy)01/2009 Nine Mile Point Reason for Testing - 26.717(b)(5)

Pre-Access Employment Type - 26.717(b)(3) iContractor/vendor Labor Category - 26.717(b)(3)

Maintenance (Craft)

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity Test Type(s) for Result(s) Reported jDrug Only 10rine Drug Testing Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (asapplicable) Additional Substance (as applicable)

IMarijuana I IPlease Select I jPlease Select Use NRC Cutoff (Yes / No)* Use NRC Cutoff (Yes / No)' Use NRC Cutoff (Yes / No) es Is this a 24-Hour Reportable Event (Yes /1No)?- 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

If this result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed ActionslBehaviors O1 01 Refusal to Cooperate Other o3 0 ManagementActions - 26.717(b)(8)

Disciplinary Action I1" Year Denial Reason(s) for the Action (select all that apply):

O MRO Confirmation M First drug or alcohol positive [I Resignation/Withdrawal o Subversion [I Subsequent positive test result frm testing E0 Misuse 0 Violation of 5-hour abstinence rule 0 Other:

0 Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entries needing correction will be highlighted in red and the form cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document I Save to Locl PC ISend Report to NRC f tWisReport Singil P-itfe Tist Foee v-ion 1.1.26

4 1. 0 Sopi Awern idt, S S -

  • S.C NRC FFD Program Performance Data Reporting System Single Positive Test Form
1) All fields are required except those marked 'optional'.
2) Entries In some form fields may result In Information Optional Reference Number for Licensee Use [Single Form 2009 19 FSD being auto-populatedinto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works properly.

Select Facility INine Mile Point Date of Collection (mm/ddlyyyy)00/2009 I Reason for Testing - 26.717(b)(5)

Pre-Access l Employment Type - 26.717(b)(3)

IContractorNendcor Labor Category - 26.717(b)(3)

Maintenance (Craft)

Refusal- 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity IValid Test Type(s) for Result(s) Reported FDrug Only -

[Urine]

Drug Testing Was this collection observed (Yes /No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (as applicable) Additional Substance (as applicable)

ICocaine IIPlease Select IPlease Select Use NRC Cutoff (Yes / No)* Use NRC Cutoff (Yes / No) Yes ] Use NRC Cutoff (Yes / No)Ye Is this a 24-Hour Reportable Event (Yes /1No)?- 26.719(b)

SubversionAttempts - 26.717(b)(7) and 26.75(b)

If this result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors 11 El Refusal to Cooperate Other 03 0 ManagementActions - 26.717(b)(8)

Disciplinary Action i -Year Denial Reason(s) for the Action (select all that apply):

O MRO Confirmation [] First drug or alcohol positive 0 Resignation/Withdrawal 0 Subversion 0 Subsequent positive test result from testing 0 Misuse 0 Violation of 5-hour abstinence rule 0 Other:

[] Sale, Use or Possession in PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be performed when the user digitally signs the form. Any entries needing correction will be highlighted in red and the form cannot be signed until all errors have been resolved, After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking,the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document Save SI-end Report °oNR PntthisReport SirglePositv Twt Frum vrsvn 1.t1i

I '.1k tte-tb -I - -

l NR0'-ý~ S1f~l g eii 0h-Eibwiiel NRC FFD Program Performance Data Reporting System Single Positive Test Form Online Help

1) All fields arerequired except those marked 'optional'
2) Entries In some form fields may resultIn Information Optional Reference Number for Licensee Use ISingle Form 2009 20 WY D being auto-populatedInto other form fields.
3) Use Adobe Reader 9.3 to ensure this form works property.

Select Facility Date of Collection (mmldd/yyyy)0 /2009 Nine Mile Point Reason for Testing - 26.717(b)(5)

Pre-Access Employment Type - 26.717(b)(3)

ContractorNendor Labor Category - 26.717(b)(3)

Maintenance (Craft)

Refusal- 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?

Test Results - 26.717(b)(4)

Test Validity lValid]

Test Type(s) for Result(s) Reported Drug Testing Drug Only 1 lUrine Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4) AdditionalSubstance (asapplicable) Additional Substance (asapplicable)

Marijuana IPlease Select [Please Select Use NRC Cutoff (Yes I No) I Use NRC Cutoff (Yes I No)l'* Use NRC Cutoff (Yes / No)rYes Is this a 24-Hour Reportable Event (Yes / No)? - 26.719(b)

Subversion Attempts - 26.717(b)(7) and 26.75(b)

Ifthis result relates to a subversion attempt, select one or more of the following choices as applicable.

If not a subversion attempt, do not select any of the four boxes.

Physical Evidence Observed Actions/Behaviors 0] E0 Refusal to Cooperate Other 01 []

Management Actions - 26.717(b)(8)

Disciplinary Action 1- Year Denial Reason(s) for the Action (select all that apply):

O MRO Confirmation [ First drug or alcohol positive O Resignation/Withdrawal O Subversion o Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule O Other:

0 Sale, Use or Possession id PA This report must be digitally signed before it can be sent to NRC. Click on the empty box below to sign this report. A data validation check will be I performed when the user digitally signs the form. Any entries needing correction will be highlighted in red and the furm cannot be signed until all errors have been resolved. After the report has been digitally signed, changes only can be made to the form by first removing your signature by right-clicking the signature box and selecting "Clear Signature".

Click to Digitally Sign This Document

-saveto ColP. ] Seond Reporto NC I t Single pOOJtv5 Twt F, veron 1.1182

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