ML12066A094

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Annual Reporting Form for Drug and Alcohol Tests, for Period Ending 2011
ML12066A094
Person / Time
Site: Pilgrim
Issue date: 12/31/2011
From: Denise Wilson
Entergy Nuclear Operations
To:
Office of Nuclear Reactor Regulation, Document Control Desk
References
PNP-2011-001, PNP-2011-002, PNP-2011-003, PNP-2011-004, PNP-2011-005, PNP-2011-006, PNP-2011-007, PNP-2011-008, PNP-2011-009, PNP-2011-010, PNP-2011-011, PNP-2011-012, PNP-2011-013, PNP-2011-014, PNP-2011-015, PNP-2011-016, PNP-2011-017
Download: ML12066A094 (20)
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{{#Wiki_filter:. \\ USNR C Pro(,', (11Ig Proplr <1l1d ti,,* /-.""I*i",,"/IIOI( - \\It I A I I ( ~ Electronic Inform.ClJion Exchange NRC FFD Program Performance Data Reporting System Annual Reporting Form for Drug and Alcohol Tests for the EIE General Submission Portal Please explain the change(s) to the form NPIe: 1'\\71 Submission Did not submit original report using correct format. Notice sent back

1) All fields required except those marked *optional'.

IC>J Update from NRC requesting re-submittal

2) Use Adobe Reader 8 or later for this form 10 work properly.
3) Hold your mouse over a form field to view additional information.

Select Facilily Ipilgrim [50-293] Tests Conducted in the Calendar Year Period of Report 2011 Total Number of Tests Conducted Total Number of Positive, Adulterated, Reason For Testing Licensee Employees ContractorsNendors SUbstituted, and Refusal to Test Results Pre-Access I 591 I 6941 I 141 Random I 4201 87 1 I 21 For Cause I 31 01 I 11 Post-Event I 41 11 I 01 Fonowup I 171 161 I 01 Total (Calculated) I 5031 7981 I 171 FFD Program Random Testing Population and Rate Average number of Average number of licensee employees contractors/vendors I 6971 I 261 1 Total size of the random testing pool throughout the period (Calculated) I 9581 Annual random testing percentage achieved for the testing pool Laboratory Testing Does your program use a I Licensee Testing Facility? No (Yes / No) Identify your HHS-Certified Laboratory(ies) IQuest Diagnostics: PA L----.===================================== Identify your Blind Performance Test Sample supplier(s) ILE_1So_h_IY_L_a_bs_._ln_c_.. _o_Xfo_rd_'_M_S_3_86_5_5 Substances Tested Did your program only test for NRC-required substances Iv illiQ at the NRC-specified minimum cutoff levels? (Yes / No). es Does your program conduct LOD testing Ives permitted in 26.163(a)(2)? (Yes / No) ..J Substance Use Only NRC Cutoff Levels? (Yes / No) Alcohol Ives Cocaine Ives Marijuana Ives Amphetamines Ives Opiates Ives PCP Ives Initial Cutoff Confirmatory Cutoff LOO Testing? (Yes/ No) INot Applicable Ives Ives Ives !ves Ives Comment (Optional) Annual Report Form (version 1.3.0* Nov 8, 2011)

  • Page 1 of 2-

Substances Tested* continued Summary of Management Actions - 26.717(b)(8) Summarize actions implemented to improve FFD program performance. As applicable. reference in the topic description audit reports. 30-day reports. and/or corrective action reports. If reporting information on more than three topics. select "Others" for Topic 3to report any additional topics. Topic 1 Iprogram and System Management o Add an additional Topic Topic 1 Description Fitness for Duty/Access Authorization (including PADS) audit conducted between July 11 and August 31.2011. Quality Assurance Audit Report QA-01-2011-HQN-1 Rev. 1 The audit concluded that these programs at each of the Entergy Sites continue to be effectively implemented and meet the requirements of 10CFR Parts 26. 73.58 and 73.57 Person(s) Responsible for Information Provided Person 1 (required): I....D_ia_nn_e__=,.,.,=:-:- IIV'Alson First Name Person 2 (optional): Last Name IISecurity Coordinator Position Tille dwilso3@entergy.com Company Email Address I'------",,=:-;=::c::-----'....---.,-;;;:TM=;------"'-----O;:;=:::Tr.:;:::------' ---~==-r=::;;-;c:T:'r:=---1 First Name Company Email Address Fina/ Step (Required) - NRC will consider this form authentic in accordance with 26.11 only when the "Validate & Lock" bullon has been selected and all errors (i.e.. those highlighted in red) have been corrected. The "Validate & Lock" bullon will change to "Locked" after the data vatidation process has been successfully completed and the form is ready for submission. Annual Report Form (version 1.3.0 - Nov 8.2011)

I LJC N I{ (--.... l~:'" f111.( I'ropu.",,1 rI.t' I-III,,,,,,,,,,.,/1 .~-,. --A , ~ Electronic Informft~c;r~XChange O Submission Update - check this box only if this is an update to a prevK>us submission. in which case you must use the same Unlque Reference Number. Unique Reference Number (Ucensee Supplied) I,-P_N_P_2_0_1_1_-{}_0_1 ---J Select Facility Ipilgrim [50-293] NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal rtQIJ~:

1) All rteld5 are required except those marked *optional'.
2) Entries in some form fields may result in information being auto-populated into other fuml fields.
3) Use Adobe Reader 8 OT later for this lomJ to work properly.

Dale of Collection (mmJddJyyyy)103114/2011 Reason for 'esdng-26.717(bX5) IPre-Access Employment Type - 26.717(b)(3) IContractorNendor Labor Category-26.717(bX3) lather Refusal* 26.717(b)(7) & 26.75 Was this collection refused (Yes I No)? Test Results - 26.717(b)(4) Test Validity Ivalid Test Type(s) for Resull(s) Reported IDrug Only Pre-Access Testing Reason (optional) !Initial Authorization Please elaborate ISTATION CLEANER Drug Testing IUrine Was this collecdon observed (Ves/No)?- 26.717(bX7) & 26.1 INo Substance - 26.717(b)(2) & (bX4) IMarijuana Use NRC Culoff (Yes I No)..IY'-'e:.:s'-_---' Additional Substance (as applicable) Iplease Select Use NRC Culoff (Yes I NO)L:IY"e"'s__--' Additional Substance (as applicable) IPlease Select Use NRC Culoff (Yes I No)IL:Y"e"'s__--' Is tl>is a 24-Hour Reporting Evenl (Ves/No)? - 26.719(b) LIN_O 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 o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8) Individual Sanction 13-Year Denial Reason(s) for the Action (select all that apply): (gJ MRO Confirmallon (gJ Firsl drug or alcohol positive o Subversion o Misuse 0 Violation of 5-hour abstinence rule o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 {required}: D ResignationlWithdrawal o Subsequent positive test result from testing o Other: ID_I_AN_N_E_-.====- IIWILSON First Name Person 2 (optional): Last Name IISECURITY COORDINATOR I dwilso3@enle'9y*com

"P'"'o""si7'tio=-=n~T..I".lle:----..J Email Address I----.F"'irs=tNua:::m=e=----"----.L--;a:::s>11Nua:::m=e=----II'----.p.-:o-:'si;;rtio:::n:--TT;i7Ttle=----' -----"E"'m=-=a'"il"A""d"""dr=e""::ss=------!

Final Step (RequirfJd)

  • NRC will consider this form an official submission only when the "Validate & lock" button has been selected and all errors (Le., those highlighted in red) have been corrected. The "Validate & Lock" button wfll change to "Locked" after the data validation process has been successfully completed and the form is ready for SUbmission.

Form Locked On:IMar 18, 2011 at 10:57:11 AMI i save to~~I Prinl Single Positive Test Form version 1.2_24

\\ l J (,.2 N 0 C ""'.'""".( P,op/~.,,,d,J,~ 1-.1111""- ."J. I ~ ,1,.:. I ~ Electronic Inform"t~a~Xchange D Submission Update - check this box only if this is an update to a previous submission, in which case you must use the same Unique Reference Number. Unique Reference Number (Licensee Supplied) I_P_N_P_.2_0_1_1_-o_0_2 ~ Select Facilily IPilgrim [50-293] NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note:

1) All fields are required except those marked 'optionar
2) Entries in some form fields may result in inf6rmiltion being auto*popufattNi into other farm fields.
3) Use Adobe Reader 8 or later for this form to work properly.

Dale of Collection (mmlddlYYYY)!03/1 4/2011 Reason fo, Testing - 26.717(b)(5) IPre-Access Employment Type - 26.717(b)(3) ILicensee Employee Labo, Category - 26.717(b)(3) IHP/RP Pre-Access Testing Reason (optional) IReinstatement (Between 31 and 365 days) Refusal* 26.717(b)(7) & 26.75 c-I Was this collection refused (Yes I No)? ~ Test Results - 26.717(b)(4) Test Validily Ivalid Test Type(s) for Result(s) Reported IDrUg and Alcohol Alcohol Testing !Breath Drug Tesllng lurine Was thIs collection observed (Yes I No)? - 26.717(b)(7) & 26.1 IN_O__-, Substance - 26.717(b)(2) & (b)(4) Additional Substance (as applicable) ICocaine IPlease Select Additional Substance (as applicable) IPlease Select Use NRC Cutoff (Yes I No)"lvc.:e"s__--' Use NRC Cutoff (Yes I NO)Llv:.:e"'s'-_--' Use NRC Cutoff (Yes I NO)L!v:.:e"'s'-_--' Is IMs a 24-Hou, ReportIng Event (YeslNo)?

  • 26.719(b)

IL.N_O 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 o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b}(8) Individual Sanction 114-Day Denial Reason(s) for Ihe Action (select all that apply): f8l MRO Confirmation l'8I First drug or alcohol positive 0 ResignatlonNVithdrawal o Subversion 0 Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule 0 Other: o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required); IL.D_IAN_N_E_-r=== IIWILSON IISECURITYCOORDINATOR I dw;lso3@entergy.com First Name

Ll,-;;;s"t<IName::---- '------,P,.o"'s"'iti.,-on"""'Ti"'tie.,-------'

Email Address Person 2 (optional); I,--~::::--II--------;-:=r.=-----,II--=~- FIrst Name Last Name Position Title Email Address Final Step (Required)

  • NRC will consider this form an official submission only when the "Validate & Lock~ button has been selected and all errors (I.e., those highlighted in red) have been corrected. The "Validate & Lock" button will change to "Locked" atter the data validation process has been successfully completed and the form is ready for submission.

Form Locked On:IApr 22. 2011 aI9:48:36 AM r--;;l..oc::... PC I, P!lnl I Single Positive res! Form~J

~, lJ.S.N ll.C l'JlJf,.t;IIX l'ropl,.",,/,I" 1,.1"""'"' ( ~ Elect~onic Inform~ion Exchange Unique Reference Number (Licensee Supplied) Ic..P_N_P_-_20_11_-oD __3 NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal N9~:

1) All fields are required except those marked *optional'.
2) Entries in some form fields may result in information being auto*popufated into other (orm fields.
3) Use Adobe Reader 8 or later fOt this form to work properly.

Date of Collection (mmlddfyyyy)103116/2011 Ipilgrim [50-293] O Submission Update - check this box only if this is an update to a previous submission, in which case you must use the same Unique Reference Number. Select Facility Resson lor Testing - 26.717(b)(5) Ipre-Access Pre-Access Testing Reason (optional) !Initial Authorization Employment Type - 26.717(b)(3) IContractorNendor Labor Category - 26.717(b)(3) lother Please elaborate IWAREHOUSE. STOCK KEEPER Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes I No)? EJ Test Resufts - 26.717(b)(4) Test Validity Ivalid Test Type(s) for Result(s) Reported IDrug and Alcohol Alcohol Testing IBreath Drug Testing IUrine Was this collection observed (Yes I No)? - 26.717(b)(7) & 26.1 ILN_O__--' Substance - 26.717(b)(2) & (b)(4) IMarijuana Additional Substance las applicable) IPlease Select Additional Substance las applicable) IPlease Select Use NRC Cutoff (Yes f No)"ly:..:e:.:s__----' Use NRC Cutoff (Yes f NO)!'-'Y-"e"s__--' Use NRC Cutoff (Yes J NO)!'-'Y-"e"s__--' Is this a UHour Reporting Event IYes/No)? - 26.719(b) Ic..N_o Subversion Attempts - 26.717(b)(7) and 26.75(b) If this result retates 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 o 0 Refusal to Cooperate Other o 0 Management Actions* 26.717(b)(8) Individual Sanction 13-Year Denial Reason(s) for the Action (select all that apply): 181 MRO Confirmation 181 First drug or alcohol positive o Subversion o Misuse 0 Violation of ~hour abstinence rule o Sale, Use or Possession in PA o ResignationiWithdrawal o SUbsequent positive test result from testing o Other: Person(s) Responsible for Information Provided Person 1 (required): 'c..D_IAN_N_E_-..=== IILWl_L_S_O_N_-.===:-__---CIISECURITY COORDINATOR First Name Last Name Position Title Person 2 (optional): dwilso3@entergy.com Email Address <---I~~II,---~=-----,II,---~=-- First Name Last Name Position Title Email Address Final Step (Required)

  • NRC will consider this form an official submission only when the ~Va[jdate & Lock" button has been selected and all errors (I.e., those highlighted in red) have been corrected. The ~Validate& Lock" button will change to "Locked" after the data vatidation process has been successfully completed and the form is ready for submission.

Form Locked On: lAp' 22. 2011 at9:5439 AM

  • 1 l 1.S.N [{C

~;"'<I"/,~ Pt'Oplr'11I.1 '''''''''''/1,',1 , ~ Electronic Inforrri~~~~xchange O Submission Update - check this box only if this is an update to a prev"'us submission, in which case you must use the same Unique Reference Number. UniqU~ Reference Number (Licensee Supplied) I_P_N_P_.2_0_1_1_.00_4 Select Facility IPilgrim [50*2931 NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal NJllit:

1) AU fields are required except those marked 'optlonal',
2) Entries in some form fields may result;n information being auto*populated into other fam) fields.

3J Use Adobe Reader 8 or later for this form to work properly. Dale of Collection (mmiddlywy)103/28/2011 Reason for Testing' 26.717(b)(5) IPre.Access Employmenr Type* 26.717(b)(3) IContractorNendor Labor Category* 26.717(b)(3) IMaintenance (Craft) Pre-Access Testing Reason (optional) !Initial Authorization Refusal* 26.717(b)(7) & 26.75 r::::::--I Was Ihis collection refused (Yes I No)? ~ Tesl Results* 26.717(bX4) Test Validity Ivalid Test Type(s) for Result(s) Reported IDrUg and Alcohol Alcohol Testing IBreath Drug Testing lurine Was this collection observed (Yes INa)?* 26.717(b)(7) & 26.1 INo Substance* 26.717(b)(2) & (b)(4) ICocaine Use NRC Cutoff (Yes I No)'-'IY~e~s__--' Additional Substance (as applicable) IMarijUana Use NRC Cutoff (Yes I NO)LIY:..:e"'s'-_---' Additional Substance (as applicable) Iplease Select Use NRC Cutoff (Yes I NO)LIY:..:e"'s'-_---' Is tllis. 24-Hour Reporting Eve", (Yes/No)?* 26.719(b) LIN_O__---' 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 o 0 Refusal to Cooperate Other o 0 Management Actions* 26.717(bX8) Individual Sanction 13' Year Denial Reason(s) for the Action (select all thai apply): ti':I MRO Confirmation ti':I First drug or alcohol positive o Subversion o Misuse 0 Violation of 5-hour abstinence rule o Sale. Use or Possession in PA Person(s) Responsible for Information Provided PefSOn 1 {required}: o ResignationlWithdrawal o Subsequent positive test result from testing o Other. IOIANNE IIWILSON IISECURITY COORDINATOR IdwHso3@entergycom '----"FT::lrs"'IO:NT.:a=m:::e-----' '----TLa"'s"t"N"'a;;m::;e---- ----,.P.-:o:::si"'tio:::n"'T"it"'le::------'

"""'E~m-a...,il:cA;-d:cd,-re-ss------I Person 2 (optional):

'----"2FT::irs:::tO:NT::a:=m:::e::----II...----.La;::s::tITNr;:a:::m:=e------J11---......,P;::O::;si"iItio:::n;-Tflirr.tle::-----' -----'E"m"'a"iI"A"d"'d"'re:::s:::s----- Fina! Step ('ReqUired) ~ NRC will consider this form an official submission only when the "Validate & Lock" button has been selected and all errors (I.e., those highlighted in red) have been corrected. The Validate & Lock" button will change to ~Locked" after the data validation process has been successfully completed and the form is ready for submission. Form Locked On:IApr 22. 2011 aI9:58:56 AM Single Positive Test FOfm 'f6l"8ioo t.2.24

.6 ") 11.S.N ){C /'1<1(,. /;.,x ",*"pl...,.,,! rI*, 111/ ;".",./,.,( I ( ~ Electronic InformaJioo Exchange O Submission Update

  • check this box only if this is an update to a previous submission. in which case you must use the same Unique Reference Number.

Unique Reference Number (Ucensee Supplied) I_P_N_P_-2_0_1_1_-0_0_5 Select Facility Ipilgrim [50-293) NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal !'!.9.M:

1) AU fields are required E'JtcPpt those marked 'optional'.
2) Entries in some form fields may result in information being 8tJto~populatedinto other form fields.

3} Use Adobe Reader 8 or later for this form to 'NOrA properly. Date of Collection (mmJddlyyyy) 103/31 /2011 Reason for Testing - 26.717(b)(5) IPre-Access Pre-Access Testing Reason (optional) !Initial Authorization Employment Type - 26.717(b)(3) IcontractorNendor Labor Category* 26.717(b)(3) IMaintenance (Craft) Refusal-26.717(b)(7) & 26.75 r.:::--I Was this collection refused (Yes I No)? ~ Test Results - 26.717(b)(4) Test Validity IVaiid Test Type(s) for Result(s) Reported Alcohol Testing Drug Testing IDrug and Alcohol IBreath IUrine W.slhls collection observed (Yes/ No)? - 26.717(b)(7) & 26.1 LIN_o__--' Substance - 26.717(b)(2) & (b)(4) IAlcohol Additional Substance (as applicable) IPlease Select Additional Substance (as applicable) IPlease Select Use NRC CutOff (Yes I No)..,IV"'e"'s__--' Use NRC Cutoff (Yes I No}..,IV"e"'s__--' Use NRC Cutoff (Yes I No)..,IV"e"'s__---' Is this. 24-Hour Reporting Event (Yes/No)? - 26.719(b) I_N_o 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 o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8} Individual Sanction 11-Year Denial Reason(s) for the Action (select all that apply): I8J MRO Confirmation I8J First drug or alcohol positive o Subversion o Misuse 0 Violation of 5-hour abstinence rule o Sale, Use or Possession in PA o ResignationlWithdrawal o Subsequent positive test result from testing o Othec Person(s) Responsible for Information Provided Person 1 (required): Email Address '----'F:===-=-----' -----rLa=:s"t"Nr::a=m:::e----II----"p;;;O;;;Si:i1:tio;;;n;-'Trlit;;:le,---- I..D_JAN_N_E_-c=== IIVlltLSON IISECURITY COORDINATOR Idwilso3@entergy.com

'La=:s"t"Nr::a=m:::e-----' -----,.P"o"'si"'tio:::n"'T"il;;:le,------J

*E~m:::-a"il;-,A;-,dd=re:-:s.,.s-----I

D Submission Update ~ check this box only if this is an update to a previous submission, in which case you must use the same Unique Reference Number. Unique Reference Number (Licensee Supplied) I_PN_P_-2_0_'_1_-0_0_6 Setect Facility Ipilgrim [50-293J NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal ~: 1j All fie-Ids are required except those marked *optiona".

2) Enuies in some form fields may result in informatror1 being aUlo~poplJJatedinto other fom) fields.
3) Use Adobe Reader 8 or later fOf this form to work.

properly. Date of Collection {mmJddlyyyy)103/31/20" Reason for Testing-26.717(bX5) Ipre-Access Pre-Access Testing Reason (optional) Iinitial Authorization Employment Type - 26.717(b)(3) IComractorNendor Labor Category - 26.717(b)(3) IMaintenance (Craft) Refusal* 26.717(b)(7) & 26.75 r.::::---l Was this collection refused (Yes I No)? ~ Test Results - 26.717(b)(4) Test Validity Ivalid Test Type(s) for Result(s) Reported IDrUg and Alcohol Alcohol Testing !sreath Drug Testing lurine Was this colfectlon observed (Yes I No)?- 26.717(b)(7) & 26.1 ILN_O__--' Substance-26.717(bX2) & (bX4) ICocaine AdditJonal Substance (as applicable) IMarijUana AddWonal Substance (as applicable) IPlease Select Use NRC Cutoff (Yes I NO)!LY"e;;:s__--' Use NRC Cutoff (Yes f NO)LiY"e"'s'-_--' Use NRC Cutoff (Yes I NO)L!Ycoe"'s'-_--' Is tl!is a 24-Hour Reporting Event (Yes/Noi? - 26.719(b) LIN_O Subversion Attempts* 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the fof/owing choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8} Individual Sanction 13-Year Denial Reason(s) for the Action (select all that apply): 181 MRO Confinnation 181 First drug or alcohol positive o Subversion o Misuse 0 Violation of 5-hour abstinence rule o Sale, Use or Possession in PA o Resignation,Withdrawal o Subsequent positive test result from testing o Other: Person(s) Responsible for Information Provided Person t (reqUired): ID_'_AN_N_E_-.===:- IIW'LSON IISECURITY COOROINATOR Idwilso3@ente'lly.com First Name '----rCa"'s"t"N"'a::::m::::e---- '-----,P,..o-si"'Uo,..n:-T"'i""lIe----

;E'"'m=a"'i1'Ac:dc:d=rec:sC"s-----

Person 2 (optional): I~===----,IIL-~=---II---=~--, _---;==:~_I First Name Last Name Position Title Email Address [SM~~I Pllnl ~"]I SlnglB Positive Test version 12.24 Fonn Locked on:IAp' 22,2011 at 11:11:22 AM I Final Step (Required) M NRC will consider this form an official submission only when the ~Validate & Lock~ butlon has been selected and all errors (Le.. those highlighted in red) have been corrected. The "Validate & Lock" button will change to "locked" after the data validation process has been successfully completed and the form is ready for submission.

l lJ S N I..:>> r-.. /'"",. ':OJX /'r"/'/t,,,,,I,l*, / '" J",,,,,,,;I' ~' \\. \\...... ( ~ Elect~onic Information Exchange . ~ Unique Reference Number (Ucensee Supplied) L-O Submission Update w check this box o~ly if this is an update to a previous submission, in which case you must use the same Umque Reference Number, Pre-Access Testing Reason (optional) llnitial Authorization NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note,'

1) AU fields are-requirod except those marked 'optionaL Entries in some form fields may result in information be,ing aulo-,pOI,uh.te,rj ;,)to other form fields, 3} Use Adobe Retider 8 or later for this form to worK properly.

Date of Collection (mmiddlyyyy) 104/04/2011 Reason for Testing-26.717(b)(5) IPre-Access Empfoyment Type* 26.717(b)(3) IcontractorNendor Labor Category* 26.717(b)(3) IMaintenance (Craft) Refusal* 26.717(b)(7) & 26.75 Was this collection refused (Yes I No)? Test Results - 26.717(b)(4) Test Validity lvalid Test Type(s) for Result(s) Reported Drug Testing lurine Substance* 26.717(b)(2) & (b)(4) IMarijUana Additional Substance (as applicable) IPlease Select Additional Substance (as applicable) IPlease Select Use NRC Cutoff (Yes I No)",IY.::e",s__--, Use NRC Cutoff (Yes I No)"'IY.::e:.;::s__--' Use NRC Cutoff (Yes I No)I..Y"e:.::s__--' Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) IN_o__-, 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 o 0 Refusal to Cooperate Other o 0 Reason(s) for the Action (select all that apply): I8l MRO Confirmation 181 First drug or alcohol positive o Subversion o Misuse 0 Violation of &-hour abstinence rule o Sale. Use or Possession in PA o ResignationlWithdrawal o Subsequent positive test result from testing o Other: Email Address Email Address dwilso3@entergy.com Position Title IISECURITY COORDINATOR Last Name Form locked First Name Final Step (Required) ~ NRC wilt consider this form an official submission only when the "Validate & Lock" button has been selected and all errors (i,e" those highlighted in red) have been corrected. The "Validate & lock'" button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission, I...O_IAN_N_E_-.==== --'IIV'ALSON First Name Person 2 (optional): Person(s) Responsible for Information Provided Person 1 (required):

.. ! u.s.N I{C ~'",,"""'P"'''''f''''''''''' ( ~ Electronic Inform tiot"*:.~xchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Unique Reference Number (Licensee Supplied) Ip_N_P,_2_0_1_1_-00_8 O Submission Update - check this box only if this is an update to a previous submission. in which case you must use the same UnIque Reference Number. Select Facility Ipilgrim [50,293] Note:

1) All fields are required except those marked 'opti<maf'.
2) Entries in some form fields may result In information being auto~poplJJatedillto otlH;!r form flalds,
3) Use Adobe Reader 8 or later for this form to work properly.

Date ot Collection (mmiddlyyyy)104/05/2011 Reason for Testing' 26.717(b)(5) Ipre-Access Employment Type - 26.717(b)(3) IContractorNendor Labor Category - 26.717(b)(3) IMaintenance (Craft) Pre-Aceess Testing Reason (optional) Iinitial Authorization Refusal* 26.717(b)(7) & 26.75 r.:::::--I Was thIS collection refused (Yes I No)? ~ Test Results - 26.717(bK4) Test Validity Ivalid Test Type(s) for Result(s) Reported IDrug and Alcohol Alcohol Testing IBreath Drug Testing IUrine Was this collection observed (Yes I No)? - 26.717(b)(7) & 26.1 ILN_O__-J Substance, 26.717(b)(2) & (b)(4) IMarijuana Use NRC Cutoff (Yes I No)"lvc:e",s__-J AddItional Substance (as applicable) Iplease Select Use NRC Cutoff (Yes I NO)Llv"'e"s'-_--' Additional Substance (as applicable) IPlease Select Use NRC Cutoff (Yes I No)"lvc:e"s__-J Is t!>is a 24-Hour Reporting Event (Yes/No)?* 26.719(b) LIN_O Subversion Attempts* 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the fo/lowing choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(B) Individual Sanction 13' Year Denial Reason(s) for the Action (select all that apply): r8l MRO Confirmation 181 First drug or alcohol positive o Subversion o Misuse 0 Violation of 5-hour abstinence rule o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): o ResignationlWithdrawal o Subsequent positive test result from testing o Other: ILD_IA_N_N_E_--,,=== IIWILSON IISECURITY COORDINATOR I dwllso3@entergy.com First Name '----rCa"'s"t'"Nr;;a;;;mr;;e---- ----"P""os"'i"'l/on=T"'it"'le,----

;E"'m=a"'II'A"d"'d=rec:s:cs-----

Person 2 (optional): 1----F1"1i7.rs:01"'N::-am=e-----'IIL---..-La::S:Tt"N;:;:a7.m::-e----"----"p;:;:O::1Siottlo::n"T"'it"'te:----' -----'E"'m::a'"il'A"d"'d=re::-s"'s----- Final Step (Required) ~ NRC will consider this form an official submission only when the "Validate & Lock" button has been selected and all errors (l.e., those highlighted in red) have been corrected. The Validate & Lock" button will change to "Locked" after the data validation process has been successfUlly completed and the form is ready for submission. Form Locked On:IApr 22, 2011 at 11:09:04 AM I ~J Single Positi'l6 Test Formversioo 1.224

__ '\\lit, u.S.NRC /'1<1/" flllX /'r0l"".lIl</ r/., 1 nr" "'"1/'11/ I ( "-.J Electronic Inform~$iQn Exchange Unique Reference Number (Ucensee Supplied) '--------------' O Submission Update ~ check this box only if this is an update to a previous submission, in which case you must use the same Unique Reference Number. Select NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal !'1rJte,'

1) Ali fields are required except those marked 'optional'.

Entries in some form fields information being.ulo-/Jo"ul"te,; 11"0 other fields.

3) Use Adobe Reader 8 or later tor this form to ',frork properly.

Date of Collection (mmiddlyyyy) 104/07/2011 Reason for Testlng-26.717(b)(5) IPre-Access Pre-Access Testing Reason (optional) IReinstatement (Between 31 and 365 days) Employment Type - 26.717(b)(3) IContractorNendor Relusal-26.717(b)(7) & 26.75 r:::::---I Was this collection refused (Yes I No)? ~ rest Results - 26.717(b)(4) Drug Testing lurine Alcohol Testing IBreath Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.1 '-----' Test Type(s) for Result(s) Reported IDrug and Alcohol Substance - 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) Use NRC Cutoff (Yes I NO)LIY",e",s,-_-...J Use NRC Cutoff (Yes I NO)LIY:..:e:.:s'-_--' Use NRC Cutoff (Yes I No)IYes L:..::.:'-------' Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) LIN_o__--' 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 o 0 Refusal to Cooperate Other o 0 Reason(s) for the Action (select all that apply): 181 MRO Confirmation I2l First drug or alcohol positive o Subversion o Misuse 0 Violation of 5-hour abstinence rule o Sale, Use or Possession in PA o ResignationlWithdrawal o Subsequent positive test result from testing o Other: Person(s) Responsible for Information Provided Person 1 (required): I_D_IAN_N_E_-",=== IIVV1LSON IISECURITY COORDINATOR First Name '----rL"'as"t'N'-'a""m"'ec-----' Position Title Person 2 (optional)' dwilso3@entergy.com Email Address First Name Email Address Final Step (Required) ~ NRC will consider this form an official submission only when the "Validate & Lock" button has been selected and atl errors (I.e" those. JI highlighted in.red) have been corrected. The 'Validate & Lock" button will change to "Locked" after the data validation process has been successfully completed and the form IS ready for submission, Form Locked Is.,..lIIl.oCl11 PC II PrInIIhIa RiIpoIt I Single- "'-Te-st 'orm '1......,iT:l14

) lJ S N I{(-'" J~U'IJlI"I'..opl"'I".IIJ,r"II/."""".*.,.1 .~ .A ~ o£ i ~ Electronic Inforni tio~ Exchange O Submission Update - check this box only if this is an update to a previous submission, in whidl case you must use the same Unique Reference Number. Unique Reference Number (Licensee Supplied) ILP_N_P_,_20_'_'_,_O_,_O Select Facility Ipilgrim [So-293} NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal HpJ!!: 1} All fields are required e-xcept those marked *optlona1'.

2) Entries in some form fields may result in information being auto--populated into other fomf fields.
3) Use Adobe Reader 8 or later for this form to work properly.

Date of Collection (mmlddJyyyy)I04/07120' 1 Reason for Testing* 26.717(b)(5) Ipre,Access Employment Type, 26.717(bX3) IContractorNendor Labor Category, 26.717(b)(3) IMaintenance (Craft) Pre-Access Testing Reason (optional) Iinitial Authorization Refusal* 26.717(bX7) & 26.75 c::--l Was this collection refused (Yes I No)? ~ Test Results* 26.717(b)(4) Test Validity Ivalid Test Type(s) for Result(s) Reported ...A1_co_h_ol_T_e_S_ting...:.... IDrug and Alcohol IBreath '-------;:::::==:;-----' Was this collection obselVed (Yes! No)? - 26.717(b)(7) & 26.1 LIN_O Drug Testing IUrine Substance* 26.717(bX2) & (b)(4) IMarijUana Use NRC Cutoff (Yes I No)..,IY",e",s,-_--, Additional Substance (as applicable) Iplease Select Use NRC Cutoff (Yes I No)..,IY",e",s__--, Additional Substance (as applicable) IPlease Select Use NRC Cutoff (Yes I NO)!..,Y"'e"'s__--' Is thIs a 24-Hour ReportIng Event (Yes/No)? - 26.719(b) LIN_O__--, 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 o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8) Individual Sanction 13' Yeat Denial Reason(s) for the Action (select all thai apply): F8I MRO Confirmation 18I First drug or alcohol positive o Subversion o Misuse 0 Violation of 5-hour abstinence rule o Sale. Use or Possession in PA PeTson(s) Responsible for Information Provided Person 1 (required): o ResignatioruWithdrawal o Subsequent positive test result from testing o Other. IOIANNE IIWILSON IISECURITY COORDINATOR Idwilso3@enlergy.com

.F"'ir.,.,s7"tN=am-e----' ~---r[a"'s:i't"N""am=e----'----"P"'o.,.si"'tio""n""T""i-:;-tle:----

Email Address Person 2 (optional): 1-------.F"'i::rs7"tN=am=e----'II-------.Lr-:ac:S7"tN..a:::m::::e=----IIL----,p'i':Oc::S;.;fti:::on::-'i'Ti"-tie:-------' -----"E"'m"'a'"i1'A"'d"d::rec::ss:------1 Final Step (ReqUired)

  • NRC will consider this form an official submission only when the "Validate & Lock" button has been selected and all errors (Le., those I

highlighted in red) have been corrected. The "Validate & Lock~ button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission. L-!-lorAI PCI~~ I SIngle Positive T6St Foon version 1.2-24

'_. I u.s.N I~C I',ufr, r:"X I'r"plr./1/,1 rI., I '.r 1'1' "f I ( ~ Electronic Information Exchange ~ O Submission Update - check this box only if this is an update to a previous submission, in which case you must use the same Unique Reference Number, Unique Reference Number (Licensee Supplied) ILP_N_P_-_20_'_'_-O_,_, Select Facility !Pilgrim [50-293] NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal NQt~:

1) All fields are required eKcept those marked 'opt/onar
2) Entries in some form fields may result in information being auto~popuJatedinto other form fields.
3) Use Adobe Reader 8 or fater for this form 10 work properly.

Date of Collection (mmiddlyyyy) 104/07/20" Reason for Testing - 26.717(b)(5) Ipre-Access Employment Type - 26.717(b)(3) IContractorNendor Labor Category - 26.717(b)(3) IMaintenance (Craft) Pre-Access Testing Reason (optional) Iinitial Authorization Refusal - 26.717(b)(7) & 26.75 r=--I Was this collection refused (Yes I No)? ~ Test Results - 26.717(b)(4) TestValidily IValid Test Type(s) for Result(s) Reported rA_Ic_O_ho_I_T_e_Sti_*ng-=- IDrug and Alcohol ILB_re_a_t_h Was this collection observed (Yes I No)? - 26.717(b)(7) & 26.1 I_N_O__--' Substance - 26.717(b)(2) & (b)(4) Additional Substance (as applicable) IMarijUana Use NRC Cutoff (Yes I NO)o..;IV:..:e:.:s__--' IPlease Select Use NRC Cutoff (Yes I No)I...,V..::e"'s__--' Drug Testing JUrine Additional Substance (as applicable) IPlease Select Use NRC Cutoff (Yes I No)I...,V..::e"'s__--' Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) I...N_o__--' 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. It not a subversion attempt. do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8) Individual Sanction 13-Year Denial Reason(s) for the Action (select all thai apply): 131 MRO Confirmation 131 First drug or alcohol positive o Subversion o Misuse 0 Violation of 5-hour abstinence rule o Sale. Use or Possession in PA o ResignationlWithdrawaJ o Subsequent positive test result from testing o Other: Person(s) Responsible for Information Provided Person 1 (required): IDimNE II_W_l_S_O_N_.,.,=== -'IISECURlTY COORDINATOR First Name Last Name Position Title Person 2 (optional): I dwilso3@entergy.com Email Address 1-----..r~_II---;-;=-_II----,.;;,~- First Name Last Name Position Title Email Address Final Step (Required) - NRC will consider this form an official submission only when the "Validate & Lock~ button has been selected and all efrors (Le., those highlighted in red) have been corrected. The "Validate & Lock" button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission. Form Locked On:lAPr 22, 2011 at 11 :06:39 AM I

1 lJ S N [{C I'rot"'lIIgPt'oplt'<llIdt/.rf."'*/I""",rrlf .~ _. . d I , ~ Electronic Inforin...m~<I~xchange Pre~AceessT85ting Reason O Submission Update check this box only if this is an update to a previous submission. in which case you must use the same Unique Reference Number. NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note: Unique Reference Number (Licensee Supplied) t) All fields are required except those marked 'optional', Entries in some form 1'lall1s ITIa'v ",)Sulf li1 ir,fol'm',tion beingau'o-l,ormli,t,,,1irltootl:'etfcrm fields. 3} Use Adobe Reader 8 Of later for this fonn to work. properly. Date of Collection (mmldd/YYYY)!04/07/2011 Employment Type - 26,717(b)(3) IContractorNendor Labor Category - 26.717(b)(3) IMaintenance (Craft) Refusal* 26.717(b)(7) & 26.75 ~ Was this collection refused (Yes I No)? ~ Test Results 26.717(b)(4) Alcohol Testing IBreath Was this collection observed (Yes! No)? - 26.717(b)(7) & 26.1 '------' Test Type(s) for Result(s) Reported IDrug and Alcohol Substance - 26.717(b)(2) & (b)(4) IAlcohol Additional Substance (as appffcable) IPlease Select Additional Substance (as applicable) Use NRC Cutoff (Yes I No)Ic.:Y-,e",s__-, Use NRC """oftIY,,. I. '-""""'-__.J Use NRC Cutoff (Yes I No)Ic.:Y.=e""s__-, Is tills a 24-Hour Reporting Even' (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 o 0 Refusal to Cooperate Other o 0 Management Actions 26.717(b)(8) Reasan(s) for the Action (select all that apply): &EJ MRO Confirmation I8l First drug or alcohol positive o Subversion o Misuse 0 Violation of 5-hour abstinence rule o Sale, Use or Possession in PA o ResignationtWithdrawal o Subsequent positive test result from testing o Other: Person(s} Responsible for !nformation Provided Person 1 (required): Email Address Email Address dwilso3@entergy.com Fin'al :Step O<.'lu!I'ed)- NRC wi!! consider this form an official submission only when the "Validate & Lock" button has been selected and all errors hig,hlighled irHed) have been corrected. The "Validate & Lock" button will change to "locked" after the data validation process has been RIl"Ce,,,I.Jliv amithe !clrm is ready for submission"

\\& I U.S.NRC I'"",. ""X l'r"pl.,,,,,I,j,, "I! '''1, "' I ( '-...l Electronic Information Exchange .0 Submission Update

  • check this box only if this is an update to a previous submission, in which case you must use the same Unique Reference Number.

Unique Reference Number (Licensee Supplied) IL.P_N_P_-_20_11_-D_l_3 Select Facility Ipilgrim [50-293J NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note:

1) All fields are required except those marked 'optional'.
2) Entries in some form fields may result in information being a(Jto~popufatedinto other form fields.

3} Use Adobe Reeder 8 or later for this form to work properly. Dale of Collection (mmidd/yyyy) 104/11/2011 Reason for Testing - 26.717(b)(5) Ipre-Access Employment Type* 26.717(b)(3) IcontractorNendor Labor Category-26.717(b)(3) IMaintenance (Craft) Pre-Access Testing Reason (optional) Iinitial Authorization Refusal-26.717(b)(7) & 26.75 r.:::--I Was this collection refused (Yes I No)? ~ Test Results - 26.717(b)(4) Test Validity Ivalid Test Type(s) for Resu~(s) Reported rAJc_O_ho_I_T_e_Sti_*ng..:... IDrug and Alcohol IBreath '----;::::===::;-----' Was this collection observed (Yes! No)?

  • 26.717(b)(7) & 26.1 I:..N_o Substance - 26.717(b)(2) & (b)(4)

Additional SubsUtnce (as applicable) IMorphine IP_I:..e:..as:..e:..S:..e:..le_c_t Drug Testing lurine Additional Substance (as applicable) IPlease Select Use NRC Cutoff (Yes I No)"IY..::e:,::s,-_.....J Use NRC Cutoff (Yes I No)...,IY..::e"'s__--' Use NRC Cutoff (Yes I NO)!...,Y..::e"'s__--' Is this a 24*Hour Reporting Event (Yes/No)? - 26.719(b) IN_o__....J 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 o 0 Refusal to Cooperate Other o 0 Management Actions* 26.717(b)(8) Individual Sanction 13-Year Denial Reason(s) for Ihe Action (select all that apply): !8i MRO Confirmation gj First drug or alcohol positive o Subversion o Misuse 0 Violation of 5--hour abstinence rule o Sale. Use or Possession in PA o ResignationlWlthdrawal o Subsequent positive test result from testing o Other: Person(s) Responsible for Information Provided Pel"ion 1 (required): IDW<NE II_Wl_L_S_O_N_....,,=== --'IISECURITY COOROINATOR First Name Last Name Position Title PeBon 2 (optional): I dwilso3@entergy,com Email Address I----F"'i::rs:;-t..N-:::am=e----II----iCLa:::s:;-t..N-:::am=e---....JII-----np-:::OS;;;jtir.io"'n"'T"it"-lec---- Email Address Final Step (Required)* NRC will consider this form an official submission only when the ~Validate & Lock~ button has been selected and all errors (Le., those highlighted in red) halle been corrected. The "Validate & Lock" button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission, Form Locked On:!APr 22, 2Dll alll:04:09 AM I Single Positive Tes! Form vers]on 1.224

  • 'I lJ S N I{C

:., fllI,f, Prop/I,,"'/,h,," '11''1110 .. I .~_. .A I ~ Electronic Inforrr,~ti6~Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal ('jPJfJ: Unique Reference Number (Licensee Supplied)

1) AU fj~lds are required e-xcept those marked Entries in some form fields Submission Update check this box only if this Is an update to a previous submission, in which case you must use the same Unique Reference Number.

Select Use Adobe Reader 8 Of Jater for this form fo work properly. Date of Collection (mmiddlyyyy)I04/11/2011 Reason for Employment Type - 26,717(b)(3) IContractorNendor Labor Category - 26J17(b)(3) IMaintenance (Craft) Refusal* 26.717(b)(7) & 26.75 Was this collection refused (Yes I No)? Test Results - 26.717(b)(4) Test Type(s) for Result(s) Reported IDrug and Alcohol Drug Testing lurine Substance - 26.717(b)(2) & (b)(4) IMarijuana Additional Substance (as applicable.) Iplease Select Additional Substance (as applicable) IPlease Select Use NRC Cutoff (Yes / NO)lIY"e"'s'--__ Use NRC Cutoff (Yes I NO)LIY"'e"'sc......_----' Use NRC Cutoff(Yes/ Is tllis a 24-llo"r ReportIng Event iYes/No)? - 26.719(b) INO Subversion Altempls 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 o 0 Refusal to Cooperate Other o 0 Manageme'" Actions 26.717(b)(6) Reason(s) for the Action (select all that apply): !2l MRO Confirmation !8l First drug or alcohol positive 0 ResignationlWithdrawal o Subversion 0 Subsequent positive test result from testing D Misuse 0 Violation of 5~hour abstinence rule 0 Other: o Sale, Use or Possession in PA Person(s} Responsible far Information Provided Person 1 (required): IISECURITY COORDINATOR L.---7'i:===-----J '------r-La"'s""t"N"'a=m:::e---- Position Title dwilso3@entergy.com Email Address Email Address lDLDcaI PCJL~ ~] 1-:224

~ I lJ.S.N ){ ~ I'rut" t"'g 17,,/,1C'."u/,I"~ I." """.", J:t I ( "'-...l Electronic Information Exchange ~, O Submission Update - check this box only if this is an update to a previous submission, in which case you must use the same Unique Reference Number. Unique Reference Number (Ucensee Supplied) I'-P_N_P_-2_0_1_1_-D_l_5 Select Fadlity IPilgrim [50-293J NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal 1Y2.m:

1) All fields ere required except those marked 'optional'.
2) Entries in some form fields may resu/r in information being auto-populated into other form fields,
3) Use Adobe Reader 8 or loter for this form to work
properly, Date of Collection (mmlddiyyyy) 105/27/2011 Resson for Testing - 26.717(b)(5)

IFor Cause Employment Type - 26.717(b)(3) ILicensee Employee Labor Category - 26.717{b){3) ISecurity For Cause Testing Reason (optional) IObserved Behavior Please elaborate (optional) Individual did not 100k right". Comptained of being iQ Refusa/-26.717(b)(7) &26.75 ~ Was this collection refused (Yes I No)? ~ Test Resuffs* 26.717(b){4) Test Validity IValid Test Type(s) for Result(s) Reported IDrug and Alcohol Alcohol Testing IBreath Drug Testing lurine Was this collection observed (Yes / No)? - 26.717(b)(7) 8. 26.1 '-IN_O__--' Substance - 26.717{b)(2) 8. (b)(4) IAlcohol Use NRC Cutoff (Yes I No) "'!v"e"'s__--' Additlonsl Substance (as applicable) IPlease Select Use NRC Cutoff (Yes I NO)"'!V"e"'s__--' Additional Substance (as applicable) ,Please Select Use NRC Cutoff (Yes i NO)'V"es__--' fs this a 24-Hour Reporting Event {Yes/No}? - 26.719(b) IN_o__--' Subversion Attempts - 26.717{b){7) and 26.75{b) If this result relates to a subversion attempt, select one or more of the foJlowing choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8) Individual Sanction 114-Day Denial Reason{s) for the Action (select all that apply): o MRO Confirmation li!1 First drug or alcohol positive o Subversion o Misuse 0 Violation of s..hour abstinence rule o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): o Resignationl\\Nithdrawal o Subsequent positive test result from testing o Other. Irnanne Ilwd,on IISecurity Coordinato' I dwdso3@enter9y*com

;F"'i::rs"t"N=am=e-----J '----TLa"'s"'t"N;:;a;;m;;;e-----' '----,P"-o::s"'iti=on"'Ti"'tle=-----'

...,E=-m-a~il,.,A,.,d"d,.,re-s-s-----1 Pef$(}n 2 (optional):

1---",==-------"11-----;-;==-------"1I--==-_ First Name Last Name Position Title Email Address Final Step (Required) ~ NRC will consider this form an official submission only when the "Validate & Lock~ button has been selected and all errors (i.e., those highlighted in red) have been corrected. The ~Validate & Lock n button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission. Form Locked On: IJun 23. 2011 at 3: 10:20 PM

-.\\ISP I u.s.N Il.C 1'1lI1"I:I'X Ih."I*.11,,1,1*,1 'I'I'.,*n",u' I ( "'-...J Electronic Inform~iqn Exchange O Submission Update

  • check this box only if this is an update to a previous submission, in which case you must use the same Unique Reference Number.

Unique Reference Number (Ueensee Supplied) IPNP-201 H116 Select Facility !Pilgrim [50-293J NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal l!Lo.te:

1) All fields are required eKcept those mar~ed 'optiona/'.
2) Entries in same form fields may result in information being auto-populated into other form fields.
3) Use Adobe Reader 8 or later for this form to work properly.

Date of Collection (mmiddlyyyy)106/14/2011 Reason for Testing - 26,717(b)(5) IRandom Employment Type. 26.717(b)(3) ILicensee Employee Labor Category - 26.717(b)(3) INon-Licensed Operator Refusal* 26.717(b)(7) & 26.75 ~ Was this cellection refused (Yes J No)? ~ Test Results* 26.717(b)(4) TestVatidily Ivalid Test Type(s) for Result(s) Reported IDrUg and Alcohol Alcohol Testing IBreath Drug Testing IUrine Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.1 I_N_o Substance* 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) IAlcohol Use NRC Cutoff (Yes I No)... IY:..:e:.:s__--' IPlease Select Use NRC Cutoff (Yes I No) l-'IY"e",s__-, IPlease Select Use NRC Cutoff (Yes I No) I...,Y-,:e",s__-J Is this a 24*Hour Reporting Event (YeslNo)?* 26.719(b) IN_O__--' 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 o 0 Refusal to Cooperate Other o 0 Management Actions* 26.717(b)(8) Indi....idual Sanction 114-Day Denial Reason(s) for the Action (select all that apply): o MRO Confinnation I8l First drug or alcehol positive o Subversion o Misuse 0 Violation of ~hour abstinence rule o Sale. Use or Possession in PA o ResignationI'Mthdrawal o SUbsequent positive test result from testing o Other: Person(s) Responsible for Information Provided Person 1 (requIred): I'----Diann*~~llvwson First Name Pel1>on 2 (optional): Last Name IISeou';ly Coordinato. Position Title I dwilso3@entergy.com Email Address 1----;F"'i;:rsTI"N:::am:::e=----.JII----Lo:a::sTt"N:::am:::e=----..JII---....-,;p::-OS:citi"-.o::nC"TCOit"-leC---- EmaIl Address Final Step (Required) - NRC will consider this form an official submission only When the ~Validate & Lock" button has been selected and all errors (i.e., those highlighted in red) have been corrected. The ~Validate & Lock n button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission. Fonn Locked On:IJun 24,2011 at 11:11:28 AMI

Unique Reference Number (Licensee Supplied) L.- D Submission Update ¥ check this box only if this is an update to a previous submission, in which case you must use the same Unique Reference NumbeL _"i) U.S.N ll.C 11" 1/11;< !'t*"pl,*.11,,1 rI*, 11111,,,"'11.111 I ( '-........J Electronic Inform,~tiQ,t:1 Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal NJ:lte~'

1) All fields $re required exce-pt those marked 'optional',

Entries in some form fields information being.wto-I'OF,ul/,te,' i,'Jooth,erlorm fields. S) Adobe Render 8 or !ater for this form to work

properly, Date of Collection (mlnld,dlyyy;') ~'!!..l2:~':":'_J Refusal-26.717(b)(7) & 26.75

~ Was this collection refused (Yes I No)? ~ rest Results - 26.717(b)(4) Test Validity Ivalid Test Type(s) for Result(s) Reported IDrug and Alcohol Alcohol Testing IBreath Drug Testing IUrine Was this collection observed (Yes I No)? - 26.717(b)(7) & 26.1 LIN_o__--' Substance* 26.717(b)(2) & (b)(4) Use NRC Cutoff (Yes I No)IL;Y~e",s__--, Additional Substance (as applicable) Use NRC Cutoff (Yes I NO)L;IY~e",s__--, Additional Substance (as applicable) IPlease Select Use NRC Cutoff (Yes I NO)L;IY~e",s__--, Is this a 24-Hour Reporting Event (YeS/No)? - 26.719(b) IN_O 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 o 0 Refusal to Cooperate Other o 0 Management Actions* 26.717(b)(8) Individual Reason(s) for the Action (select all that apply): o MRO Confirmation 121 First drug or alcohol positive o Subversion o Misuse 0 Violation of 5-hour abstinence rule o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): o ResignationlWithdrawal o Subsequent positive test result from testing o Other: dwilso3@enter9y*com Email Address Email Address

Fatigue Rule Waivers Issued for 2011 Facility: Pilgrim Nuclear Power Station Period of Report: 1/112011 -12/31/2011 Facility Outage During Report Period: Yes .._.. QIjE:MISTRYl£!BEJ3RI<3AOE is -~ ,,'j,,' Outage Online Outaae Online Outaae Online 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 Online Outaoe Online Outaae 0 0 0 0 2 0 0 0 2o o Online Online 2.5 MOO Iwk; 12 hr shift 3 MOO Iwk; 12 hr shift 3 MOO / 15 day period 4 MOO / 15 day period 10h between work periods I 0 2 MOO Iwk; 12 hr shift 2 MOO Iwk; 10h shift 1 MOO Iwk; 8h shift Minimum Days 00'- Ol,.!tage:. 1 MOO / 7 days (rolling) 3~h. in. anY Da 9-da Qff ys_ 0 r . I 01 I I I, J I I I L-Q.. iF- !. I. I ..Mimmlln VI f\\tnt= NUMBER OF WAIVERS PER INDIVIDUAL EMPLOYEE cC) NUMBER OF WAIVERS OPERATIONS MAINTENANCE SECURITY HP/RAOPRO CHEMISTRY FIRE BRIGADE (B) 1 4 46 5 2 0 0 2 0 12 0 0 0 0 3 0 5 0 0 0 0 4 0 0 0 0 0 0 5 0 0 0 0 0 0 6 0 0 0 0 0 0 ' I*" -'./:. "4 Highest number of waivers for 1 3 1 1 0 0 an individual employee}}

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