ML12087A165
| ML12087A165 | |
| Person / Time | |
|---|---|
| Site: | Calvert Cliffs  |
| Issue date: | 03/26/2012 |
| From: | Bartnik D Calvert Cliffs, Constellation Energy Nuclear Group, EDF Group |
| To: | Document Control Desk, Office of Nuclear Material Safety and Safeguards, Office of Nuclear Reactor Regulation |
| References | |
| Download: ML12087A165 (46) | |
Text
Calvert Cliffs Nuclear Power Plant 1650 Calvert Cliffs Parkway Lusby, Maryland 20657 CENG.
a joint venture of 0nry tJ"-' eDF CALVERT CLIFFS NUCLEAR POWER PLANT March 26, 2012 U. S. Nuclear Regulatory Commission Washington, DC 20555 ATTENTION:
SUBJECT:
Document Control Desk Calvert Cliffs Nuclear Power Plant; Unit Nos. 1 & 2; Docket Nos. 50-317 & 50-318 Independent Spent Fuel Storage Installation; Docket No. 72-8 Fitness for Duty, Program Performance Data for 2009, 2010, and 2011 Hard copies of the Annual Fitness for Duty Program Performance Data (Attachment 1) are submitted for the period of 2009 through 2011 in accordance with 10 CFR 26.717(a). This data had been previously submitted electronically via the Electronic Information Exchange.
Should you have questions regarding this matter, please contact Mr. Douglas E. Lauver at (410) 495-5219.
Very truly yours, Donald J. Bartnik Director - Security DJB/CAN/bjd
Attachment:
(1)
Fitness for Duty Program Performance Data for 2009, 2010, and 2011 cc:
(Without Attachment)
D. V. Pickett, NRC W. M. Dean, NRC Resident Inspector, NRC S. Gray, DNR
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ATTACHMENT (1)
FITNESS FOR DUTY PROGRAM PERFORMANCE DATA FOR 2009, 2010, AND 2011 Calvert Cliffs Nuclear Power Plant, LLC March 26, 2012
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Select Facility Calvert Cliffs Reason for Testing-26.717(b)(5)
IRandom Employment Type - 26.717(b)(3)
Licensee Employee Labor Category - 26.717(b)(3)
Engineering Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity Not Applicable I
Test Type(s) for Result(s) Reported Alcohol Testing Alcohol Only
[Breath Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4)
Additional Substance (as applicable) oAlcohol IPlease Select iReporting System m
Note:
- 1) All fields are required except those marked 'optional'.
- 2) Entries In some form fields may result in information being auto-populated into other form fields.
- 3) Use Adobe Reader 9.3 to ensure this form works properly.
Date of Collection (mm/ddtyyyy) 0 Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes / No)[]
Use NRC Cutoff (Yes / No)
Z ]
Use NRC Cutoff (Yes / No)i-'
]
Is this a 24-Hour Reportable Event (Yes/ No)?- 26.719(b)
No 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.
It not a subversion attempt, do not select any of the four boxes.
Physical Evidence Observed Actions/Behaviors
[1 03 Refusal to Cooperate 11 Other El Management Actions - 26.717(b)(8)
Disciplinary Action 114-Day Denial 77ý Reason(s) for the Action (select all that apply):
[] MRO Confirmation 0
First drug or alcohol positive E] Resignation/tAithdrawal C] Subversion C] Subsequent positive test result from testing o
Misuse CQ Violation of 5-hour abstinence rule 0
Other:
Cj 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".
Michele A.
Click to Digitally Sign This Document Mannino ISingleend epo to NRC' I Print thspr Singie Poevivo Teal Fo-r-m v,
1.1.26
NKIU I-FD Program Pertormance uata IKeporting tSystem Single Positive Test Form 1
Optional Reference Number for Licensee Use 12009-2B No-tv:
- 1) All fields are required except those marked 'optional.
- 2) Entries in some form fields may result in information being auto-populated into other form fields.
- 3) Use Adobe Reader 9.3 to ensure this form works properly.
Date of Collection (mm/ddtyyyy) 1/30/2009 I Select Facility lCalvert Cliffs Reason for Testing - 26.717(b)(5)
Pre-Access Employment Type-26.717(b)(3)
FContractorNendor Labor Category - 26.717(b)(3) 10ther]
Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Please elaborate (optional)
Crane Operator Test Results - 26.717(b)(4)
Test Validity lValid Test Type(s) for Result(s) Reported Drug Only Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.1 [~o Substance - 26.717(b)(2) & (b)(4)
Additional Substance (as applicable)
Marijuana jPlease Select Drug Testing jurine Additional Substance (as applicable)
[Please Select Use NRC Cutoff (Yes / No) Yes Use NRC Cutoff (Yes / No)[
Use NRC Cutoff (Yes / No)[Y-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 0
0 Refusal to Cooperate Other 0
0 Management Actions - 26,717(b)(8)
Disciplinary Action 1 -Year Denial Reason(s) for the Action (select all that apply):
M MRO Confirmation 0 First drug or alcohol positive o Subversion E] Misuse 0 Violation of 5-hour abstinence rule 0 Sale, Use or Possession in PA E] ResignationrWithdrawal
[3 Subsequent positive test result from testing
[] Other:
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 perfornmed 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".
Michele A Click to Digitally Sign This Document Mannino
~SSend Rocbi tIo NRC
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Pfrrit this Report' Single Powt-~ T111 FoM -eolo. 1.1.2
NRC FFD Program Performance Data Reporting System Single Positive Test Form IhC sip Optional Reference Number for Licensee Use 12009-3C Select Facility Calvert Cliffs Nhte:
- 1) All fields are required except those marked 'optional'.
- 2) Entries In some form fields may result in information being auto-populated into other form fields.
- 3) Use Adobe Reader 9.3 to ensure this form works properly.
Date of Collection (mm/dd/yyyy)
Reason for Testing-26.717(b)(5)
Fre-Access I
I Employment Type-26.717(b)(3)
ContractorNendor Labor Category - 26.717(b)(3)
FOther Please elaborate (optional)
Laborer Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity Valid Test Type(s) for Result(s) Reported Drug Only Was this collection observed (Yes/No)?- 26.717(b)(7) & 26.1F II Substance-26.717(b)(2) & (b)(4) iMarijuana Use NRC Cutoff (Yes / No) [*
Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes / No)[FY*---
Drug Testing jUrine Additional Substance (as applicable)
LPlease Select Use NRC Cutoff (Yes / No)4[
iII 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
0 Refusal to Cooperate rn Other 0
Management Actions - 26.717(b)(8)
Disciplinary Action 1-Year Denial J
Reason(s) for the Action (select all that apply):
[@ MRO Confirmation SI First drug or alcohol positive o Subversion O Misuse C] Violation-of 5-hour abstinence rule 0
Sale, Use or Possession in PA O Resignation/Ntithdrawal C
Subsequent positive test result from testing C Other:
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".
Michele A.
Click to Digitally Sign This Document M ic o A.
Mannino tot.o..
l I Print
.thi§ssp ReNR sing&l Puýtve Tee. Fom verion 1.1.26
NKU FFP Program Pertormance Uata Reporting system Single Positive Test Form dni1p Optional Reference Number for Licensee Use 12009-4D
- 1) All fields are required except those marked 'optional'.
- 2) Entries in some form fields may result in Information being auto-populated into other form fields.
- 3) Use Adobe Reader 9.3 to ensure this form works properly.
Date of Collection (mm/dd/yyyy) 0//200 I
Select Facility Calvert Cliffs Reason for Testing-26.717(b)(5)
Pre-Access 7
Employment Type - 26.717(b)(3)
Contractor/Vendor I
Labor Category - 26.717(b)(3)
Please elab'
[other I
lMechanic orate (optional)
Refusal-26.717(b)(7) & 28.75 Was this collection refused (Yes / No)? No Test Results - 26.717(b)(4)
Test Validity V a.
lid Test Type(s) for Result(s) Reported Drug Only Was this collection observed (Yes / No)?- 26.717(b)(7) & 28.1 Substance - 26.717(b)(2) & (b)(4)
Additional Substance (as applicable)
IOpiates I
Please Select Drug Testing lUrine Additional Substance (as applicable) lPlease Select Use NRC Cutoff (Yes / No)[Yet Use NRC Cutoff (Yes / No) l[e Use NRC Cutoff (Yes I No)[
]
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 foltowing choices as applicable.
If not a subversion attempt, do not select any of the four boxes.
Physical Evidence Observed Actions/Behaviors El 0l Refusal to Cooperate 0
Other 0l Management Actions - 26.717(b)(8)
Disciplinary Action 1 -Year Denial Reason(s) for the Action (select all that apply):
0 MRO Confirmation 0
First drug or alcohol positive C] Subversion El Misuse
[3 Violation of 5-hour abstinence rule El Sale, Use or Possession in PA E] ResignabonfNithdrawal C] Subsequent positive test result from testing E] Other:
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 fonm 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",
Michele A.
Click to Digitally Sign This Document Mcnn A.
IManni no Single Pottw Teel Form version 1.1.26
NKIL FFU Program Pertormance Data Keporting System Single Positive Test Form CNet-Ip Optional Reference Number for Licensee Use I2009-SE N9.1e:
- 1) All fields are required except those marked 'optional'
- 2) Entries In some form fields may result in information being auto-populated into other form fields.
- 3) Use Adobe Reader 9.3 to ensure this form works properly.
Date of Collection (mrndddyyyy) i'/
00 I
Select Facility ICalvert Cliffs Reason for Testing - 26.717(b)(5)
Pre-Access Employment Type - 26,717(b)(3)
Contractor/Vendor Labor Category-26.717(b)(3)
FOther Please elaborate (optional)
Cafeteria Worker 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 Only Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4)
Additional Substance (as applicable)
[Marijuana
]
Please Select I
Drug Testing U~rine Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes / No) [es Use NRC Cutoff (Yes I No)*
Use NRC Cutoff (Yes / No)[FiiIIi]
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.
I not a subversion attempt, do not select any of the four boxes.
Physical Evidence Observed Actions/Behaviors 1:1 0
Refusal to Cooperate
-1 Other 0
Management Actions - 26.717(b)(8)
Disciplinary Action I-Yrenial ei Reason(s) for the Action (select all that apply):
R MRO Confirmation 0
First drug or alcohol positive o] Subversion o Misuse 0
Violation of 5-hour abstinence rule Q Sale, Use or Possession in PA C] ResignationlWthdrawal 0I Subsequent positive test result from testing
[3 Other:
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".
MMichele A.
Click to Digitally Sign This Document Mannino Save
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NRC FFD Program Performance Data Reporting System Single Positive Test Form Optional Reference Number for Licensee Use 12009-6F Note.:
- 1) Alti fields are required except those marked optionel.
- 2) Entries in some form fields may result in information being auto-populated into other form fields.
- 3) Use Adobe Reader 9.3 to ensure this form works property.
Date of Collection (mm/dd/yyyy) 5/2009iI Select Facility Calvert Cliffs Reason for Testing - 26.717(b)(5)
Pre-Access I
Employment Type-26.717(b)(3)
ContractorNendor Labor Category-26.717(b)(3)
Please elabo
)o-ther I
Electrician rate (optional)
Refusala-26.717(b)(7) & 20.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity Test Type(s) for Result(s) Reported I
I Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4)
Additional Substance (as applicable)
Use NRC Cutoff (Yes I No) l Use NRC Cutoff (Yes / No)
L Additional Substance (as applicable)
Use NRC Cutoff (Yes / No) i Is this a 24-Hour Reportable Event (Yes I 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 Please elaborate on the choice(s) selected:
0 h I0i n
ramn~rture out nf ranne Fnr Cause ('5h~roo~ immendioutely n,,fnnonod Refusal to Cooperate 0
Other El Observed immediatel -erformed Management Actions - 26.717(b)(8)
Disciplinary Action IPermanent Denial Reason(s) for the Action (select all that apply):
[] MRO Confirmation
[I First drug or alcohol positive El Resignation/Withdrawal 0
Subversion El Second drug or alcohol positive
[I Subsequent positive test result from testing El Misuse 0l Violation of 5-hour abstinence rule
[a ) 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 will be 1
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".
Michele A.
Click to Digitally Sign This Document Ma.nin.
Iannino Sinl P TE Send veriot toport
$inai. Po.i.. roe F.-, vr.in 1.1.26
NKC FFD Program Performance Data Reporting System Single Positive Test Form in Optional Reference Number for Ucensee Use 12009-6FA vOfe;:
- 1) Afl fields ar required except those marked 'optional'
- 2) Entries In some form fields may result in information being auto-populated Into other form fields.
- 3) Use Adobe Reader 9,3 to ensure this form works property.
Date of Collection (mm/dd/yyyy) 0/1/2009 Select Facility Calvert Cliffs Reason for Testing - 26.717(b)(5)
For Cause Testing Re For Cause FLo ;Temperature eason (optional)
Employment Type - 26.717(b)(3)
Contractor/Vendor Labor Category - 26.717(b)(3)
Please elabo Other Electrician rate (optional)
Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity
[Valid Test Type(s) for Result(s) Reported Drug Only Was this collectlon observed (Yes/No)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) i (b)(4)
Additional Substance (as applicable)
Marijuana I
1Please Select Drug Testing Urine Additional Substance (as applicable) 1Please Select Use NRC Cutoff (Yes / No)1Yes Use NRC Cutoff (Yes / No) [Z_7 Use NRC Cutoff (Yes / No)([
I]
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 Please elaborate on the choice(s) selected:
0 11 Pre Acces temerature out of ran u
Refusal to Cooperate 0
Other
[I Management Actions - 26.717(b)(8)
Disciplinary Action Permanent Denial I
Reason(s) for the Action (select all that apply):
0 MRO Confirmation
[] First drug or alcohol positive 0K Subversion 0 Second drug or alcohol positive o
Misuse C] Violation of 5-hour abstinence rule 0 Sale, Use or Possession in PA E] Resignation/Withdrawal E] Subsequent positive test result from testing C@ Other: Please elaborate Pre Access temperature out of range. Refusal to test permanent denial.
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".
Michele A.
Click to Digitally Sign This Document Mannino I
I Sa T~:LlP7C I Send Report toNRCJ IIPritthisi~
R212W Singl. Pof.vi T.e For-V--.on 1.1.26
.1r 0ctn 6~l wi te En 6iwiii NRC FFD Program Performance Dat Single Positive Test Fo a Reporting System Optional Reference Number for Licensee Use 12009-7G Select Facility Calvert Cliffs rm C,1-H-1p
- 1) All fields are required except those marked 'optional'.
- 2) Entries In some form fields may result in Information being auto-populated Into other form fields.
- 3) Use Adobe Reader 9.3 to ensure this form works properly.
Date of Collection (mm/dduyyyy) 027/
2 009jj Reason for Testing-26.717(b)(5)
Pre-Access Employment Type. 26.717(b)(3)
Contractor/Vendor Labor Category-26.717(b)(3)
O0ther Please elaborate (optional)
Carpenter I
Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity valid Test Type(s) for Result(s) Reported Drug Only Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.1 [N.
Substance - 26,717(b)(2) & (b)(4)
Additional Substance (as applicable)
Marijuana
]
1Please Select 1
Drug Testing lUrine Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes I No)Y Use NRC Cutoff (Yes I No)
IZ Use NRC Cutoff (Yes / No)
]
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
0 Refusal to Cooperate 0
Other 0
Management Actions - 26.717(b)(8)
Disciplinary Action 1 -Year Denial Reason(s) for the Action (select all that apply):
[K MRO Confirmation
[
First drug or alcohol positive C] Subversion 0] Misuse
[
Violation of 5-hour abstinence rule 0
Sale, Use or Possession in PA 0
ResignationWithdrawal C] Subsequent positive test result from testing
[] Other:
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 W1ll 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".
Michele A.
Click to Digitally Sign This Document Man nino Sav toLocFPT
ý end Report to NR7C
- ,Prnt this Report~
Sngl. PoitSm. Tel Fro v-r.ion 1.1.26
USARC Elcroi InfrSn IW&
xt ha NRC FFD Program Performance Data Single Positive Test For Reporting System
- 1) All fields are required except those marked 'optional'.
- 2) Entries in some form fields may result in information being auto-populated into other form fields.
- 3) Use Adobe Reader 9.3 to ensure this form works properly.
Date of Collection (mnmdddyyyy)
/9/2009I Optional Reference Number for Licensee Use I2009-8H Select Facility Calvert Cliffs Reason for Testing-26.717(b)(5)
Pre-Access Employment Type-26.717(b)(3)
Contractor/Vendor Labor Category - 26.717(b)(3)
Please elaborate (optional) jjtherj Field Service Representative Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity Valid Test Type(s) for Result(s) Reported Drug Only I
Was this collection observed (Yes/No)?- 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4)
Additional Substance (as applicable)
ICocaine I1Please Select Drug Testing jUrine Additional Substance (as applicable)
Please Select Use NRC Cutoff (Yes / No)Y Use NRC Cutoff (Yes / No)
[
Use NRC Cutoff (Yes / No)[
I 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 0
0l Refusal to Cooperate 0l Other El Management Actions - 26.717(b)(8)
Disciplinary Action 1 -Year Denial Reason(s) for the Action (select all that apply):
N MRO Confirmation 0R First drug or alcohol positive C] ResignationV/Withdrawal El Subversion C] Subsequent positive test result from testing El Misuse
[I 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 signature box and selecting "Clear Signature".
Michele A.
Click to Digitally Sign This Document Mannino Manni no ILSve o LcI
'In pot 7RC Print this Repp Sinr&, P.o-t, TneW For. version 1.1.26
NIK
--U Program Pertormance UatE Single Positive Test For Optional Reference Number for Licensee Use 12009-91 K
Reporting System Ntioe:
- 1) All fields are required except those marked 'optional'.
- 2) Entries in some form fields may result in information being auto-populated into other form fields.
- 3) Use Adobe Reader 9.3 to ensure this form works properly.
Date of Collection (mm/ddiyyyy)0 0
Select Facility Calvert Cliffs Reason for Testing-26.717(b)(5)
Pre-Access Employment Type - 26.717(b)(3)
Contractor/Vendor Labor Category-26.717(b)(3)
Please elaborate (optional)
Other ITeamster 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 Was this collection observed (Yes/No)?- 26.717(b)(7) & 26.1 Substance-26.717(b)(2) & (b)(4)
Additional Substance (as applicable) 1
_7 1
Additional Substance (as applicable)
Use NRC Cutoff (Yes / No)
J--
Use NRC Cutoff (Yes / No)
I-Use NRC Cutoff (Yes / No)J"i'-i 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 Please elaborate on the choice(s) selected:
0 13 Te mperature nu rine out of ranne Immedia is norCnr oIs* ohoervd wos ntot r.nm~itatd Refusal to Cooperate
[]
Other 0
individual declined.
Management Actions - 26.717(b)(8)
Disciplinary Action Permanent Denial Reason(s) for the Action (select all that apply):
o MRO Confirmation
[3 First drug or alcohol positive
[3 ResignationNIithdrawal 0 Subversion 0
Second drug or alcohol positive E] Subsequent positive test result from testing o Misuse Q Violation of 5-hour abstinence rule C 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 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".
Michele A.
Click to Digitally Sign This Document Man niZno
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Submission Update which case you must Select Facility Calvert Cliffs [50-317; NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note:
r e 2010-1 A
- 1) All fields are required except those marked 'optional'.
- 2) Entries In some form fields may result in information
- check this box only if this is an update to a previous submission, in being auto-populated Into other form fields, use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work property.
50-318]
Date of Collection (mm/dd/yyyy) Ii/1/2010i]
Reason for Testing - 26.717(b)(5)
Pre-Access Testing Reason (optional) ie-Access i
I Initial Authorization Employment Type - 26.717(b)(3)
ContractorNendor Labor Category. 26.717(b)(3)
Please elaborate Other I
Laborer Refusal-26.717(b)(7) & 28.675 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity lValid Test Type(s) for Result(s) Reported 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)
IMarijuana I Please Select Drug Testing Urine Additional Substance (as applicable)
Please Select Use NRC Cutoff (Yes / No) Yes Use NRC Cutoff (Yes / No)F[*i Use NRC Cutoff (Yes / No)l-l]
Is this a 24-Hour Reporting 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
[]
Refusal to Cooperate 0
Other 11 Management Actions - 26.717(b)(8)
Individual Sanction I1" Year Denial Reason(s) for the Action (select all that apply):
0 MRO Confirmation 0
First drug or alcohol positive
[3 Resignation/Withdrawal o Subversion
[3 Subsequent positive test result from testing O Misuse 0
Violation of 5-hour abstinence rule
[3 Other:
0 Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person t (required):
Miaheenino F
SpecialistI Michele.Mannlino@cengllc.com First Name ast Name Position Title Email Address Person 2 (optional):
First Name Last Name Position Tite 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" after the data validation process has been successfully completed and the form is ready for submission.
Form Locked On: Feb 17, 2011 at 4:19:46 PM I a.......
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Unique Reference Numb
-i Submission Update which case you mus Select Facility Calvert Cliffs (50-317 NRC FFD Program Performance Data Reporting System Single Positive Test Form for the ElE General Submission Portal Note:
t e 2010-1 B
- 1) All fields are required except those marked optional'.
S(2)
Entries in some form fields may result in information
- check this box only if this is an update to a previous submission, in being auto-populated into other form fields.
t use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work properly.
50-318]
Date of Collection (mm/ddiyyyy) [1]
Reason for Testing - 26.717(b)(5)
Pre-Access Testing Rea Pre-Access Inlntal Authorization Employment Type-26.717(b)(3)
Contractor/Vendor Labor Category-26,717(b)(3)
Please elaborate FOther
-Cdian Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes I No)?
son (optional)
Test Results - 26.717(b)(4)
Test Validity Test Type(s) for Result(s) Reported Drug Only Was this collection observed (Yes/lo)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4)
Additional Substance (as applicable)
Marijuana I
jPlease Select I
Drug Testing lUrine Additional Substance (as applicable) jPlease Select Use NRC Cutoff (Yes I No)4Ye
]
Use NRC Cutoff (Yes / No) e7III Use NRC Cutoff (Yes I No)IFj;---*
Is this a 24-Hour Reporting 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
[0 Refusal to Cooperate 0
Other EJ Management Actions - 26.717(b)(8)
Individual Sanction 1I" Year Denial Reason(s) for the Action (select all that apply):
0 MRO Confirmation 0
First drug or alcohol positive 0
Resignabon/Withdrawal O Subversion 0
Subsequent positive test result from testing O Misuse 0
Violation of 5-hour abstinence rule 0
Other:
[] Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required):
Michele oFF Specialist Michele.Mannino@cengllc.com First Name Last Name Position Title Email Address Persnn 2 (nptinal):
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" after the data validation process has been successfully completed and the form is ready for submission.
Form Locked On:lien 31, 2011 at 1:59:04 PM I e*ott.
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NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal N~ote:
Ui2010-C
- 1) All fields are required except those marked'optlonal' u R2)
Entries in some form fields may result in information E] Submission Update - check this box only if this is an update to a previous submission, in being auto-populated Into other form fields.
which case you must use the same Unique Reference Number,
- 3) Use Adobe Reader 8 or later for this form to work Select Facility
- properly, lCalvert Cliffs [50-317; 50-318)
Date of Collection (mmldd/yyyy) 10112010I Reason for Testing - 26.717(b)(5)
Pre-Access Test Pre-Access i
I Ilnitial Authori; Employment Type-26,717(b)(3)
Contractor/endor Labor Category-26.717(b)(3)
Please elaborate Other eta Wrker Refusal-26.717(b)(7) & 28,75 Was this collection refused (Yes / No)?
ing Reason (optional) zation Test Results - 26.717(b)(4)
Test Validity Test Type(s) for Result(s) Reported 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)
Imaruoana I
1 Drug Testing Urine Additional Substance (as applicable)
Use NRC Cutoff (Yes / No)
Use NRC Cutoff (Yes / No)F 1111]
Use NRC Cutoff (Yes / No)IFT---
Is this a 24-Hour Reporting 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 Please elaborate on the choice(s) selected:
00 INITIAL PRE ACCESS SAMPLE PROVIDED BY DONOR HAD TEMP OUT OF RANGE AT 87.5 DEGREES. MRO ORDERED SECOND SAMPLE COLLECTED UNDER DIRECT OBSERVATION.
Refusal to Cooperate Other SECOND SAMPLE RETURNED FROM LAB POSITIVE FOR MARIJUANA.
0 01 Management Actions - 26.717 *O(b)(8 Individual Sanction lPermanent Denial Reason(s) for the Action (select all that apply):
0 MRO Confirmation 0
First drug or alcohol positive 0
ResignationNrthdrawal 0 Subversion E0 Subsequent positive test result from testing E] Misuse EJ Violation of 5-hour abstinence rule
[3 Other:
[] Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required):
MI~l IZh Mann/no FFD Specialist Michele.Mannlno~cengllc.com First Name ast Name Position Title Email Address Person 2 (optional);
irst am 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" after the data validation process has been successfully completed and the form is ready for submission.
Form Locked On: Jan 31, 2011 at 5:33:14 PM S
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Unique Reference Numbe ri Submission Update which case you must Select Facility Calvert Cliffs [50-317; NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Norte:
( S 2010-1 D
- 1) All fields are required except those marked 'optional'.
i
- 2) Entries in some form fields may result in information
- check this box only if this is an update to a previous submission, in being auto-populated into other form fields, use the same Unique Reference Number.
- 3) Use A dobe Reader 8 or later for this form to work properly.
50-318)
Date of Collection (mm/dd/yyyy)
Reason for Testing - 26.717(b)(5)
Pre-Access Tes Pr-Access I
"nitial Author)
Employment Type - 26.717(b)(3)
ContractorNendor Labor Category-26.717(b)(3)
Please elaborate O0ether Cafeteria Worker Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
N.
FLL_..
ting Reason (optional) zation Test Results - 26.717(b)(4)
Test Validity IValid Test Type(s) for Result(s) Reported 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)
Marijuana 1PleaSe Select 7
Drug Testing lUrine Additional Substance (as applicable)
[Please Select Use NRC Cutoff (Yes / No) Ye Use NRC Cutoff (Yes / No)
L Use NRC Cutoff (Yes / No)'(----]
Is this a 24-Hour Reporting 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 In 0n Refusal to Cooperate 0n Other En Management Actions - 26.717(b)(8)
Individual Sanction 1 -Year Denial Reason(s) for the Action (select all that apply):
M MRO Confirmation 0
First drug or alcohol positive In ResignationVWithdrawal I] Subversion I] Subsequent positive test result from testing In Misuse In Violation of 5-hour abstinence rule In Other:
In Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person I (required):
IMichele
[Mannino FFD Specialist I
Michele.Mannino@cengAc.com First Name Last Name Position Title Email Address Person 2 (optional):
irst Name Last Name Position Tile 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" after the data validation process has been successfully completed and the form is ready for submission.
Form Locked On:jJan 31, 2011 at 5:03:20 PM Save to Local PC Prnt fth Rep.
Single Postiv. Tet Fror vrsion 1.2.24
NRC FFD Program Pertormance Data Reporting System Single Positive Test Form for the EIE General Submission Portal NOt'e:
Unique Reference Number (Licensee Supplied) 12010-1 E
- 1) All fields are required except those marked 'optional'.
i
- 2) Entries in some form fields may result In information Submission Update - check this box only if this is an update to a previous submission, in being auto-populated into other form fields.
which case you must use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work Select Facility properly.
Calvert Cliffs [50-317; 50-318]
Date of Collection (mrd dd/yyyy)00/20 Reason for Testing - 26.717(b)(5)
Employment Type - 26.717(b)(3)
[ContractrNendor Labor Category-26.717(b)(3)
Please elaborate Fot her ron Worker Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?F Test Results - 26,717(b)(4)
Test Validity Test Type(s) for Result(s) Reported Drug Testing Drug Only Urine Was this collection observed (YesaNo)? - 26.717(b)(7) & 26.1 Substance-26.717(b)(2) & (b)(4)
Additional Substance (as applicable)
Additional Substance (as applicable)
[Cocaine IPlease Select I
[Please Select Use NRC Cutoff (Yes I No)EF LIII- ]
Use NRC Cutoff (Yes / No)[e IZ Use NRC Cutoff (Yes I No) Yes Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b)
FNo 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 0l 0l Refusal to Cooperate Other o
11 Management Actions, 26.717(b)(8)
Individual Sanction 1-Year Denial Reason(s) for the Action (select all that apply):
M MRO Confirmation 0
First drug or alcohol positive El Resignation/Withdrawal
[3 Subversion El Subsequent positive test result from testing O Misuse E] Violation of 5-hour abstinence rule F] Other 0
Sale. Use or Possession in PA Person(s) Responsible for Information Provided Person I (required):
Mihele InMan[
[FF. Specialist Michele.Mannino@cengllc.c.m First Name ast Name Position Title Email Address Person 2 (optional):
First Name Lao ama Position Tiale 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" after the data validation process has been successfully completed and the form is ready for submission.
Form Locked On: Jan 31, 2011 at 5:04:19 PM
ý,e to~LocaP F't'his ep rt.
5ingl Po-t-v Test Form version 1.2.24
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6 6rivi NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note:
Unique Reference Number (Licensee Supplied) 2010-1 F
- 1) Al0 fields are required except those marked 'optional'.
id
- 2) Entries In some form fields may result in Information E-Submission Update - check this box only if this is an update to a previous submission, in being auto-populated into other form fields.
which case you must use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work Select Facility properly.
Calvert Cliffs [50-317; 50-318]
Date of Collection (mm/dd/yyyy) 06/1/2010II Reason for Testing-26.717(b)(5)
Followup Employment Type-26.717(b)(3)
Contractor/endor Labor Category-26.717(b)(3)
Please elaborate ther r Scfoder 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 (as applicable)
Additional Substance (as applicable) 1cocaine PleasseSeect Please Select Use NRC Cutoff (Yes / No)[
Use NRC Cutoff (Yes / No)4
'-]
Use NRC Cutoff (Yes I No)Yes Is this a 24-Hour Reporting 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 o
0 Refusal to Cooperate Other In 0]
.Management Actions - 26,717(b)(8)
Individual Sanction I" Year Denial Reason(s) for the Action (select all that apply):
0 MRO Confirmation 0
First drug or alcohol positive Q Resignation//ithdrawal o 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 Person(s) Responsible for Information Provided Person 1 (required):
IMichele I
a ni oFF D Specialist Michele.Mannino@ ceng nlc.com First Name Last Name Position Title Email Address Person 2 (optional):
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" after the data validation process has been successfully completed and the form is ready for submission.
Form Locked On:i Jan 31, 2011 at 5:07:38 PM l,
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NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note:
Unique Reference Number (Licensee Supplied) 2010-G
- 1) All fields are required except those marked 'optional' u R2)
Entries in some form fields may result in information
[7 Submission Update. check this box only if this is an update to a previous submission, in being auto-populated Into other form fields.
which case you must use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work Select Facility properly.
Calvert Cliffs [50-317; 50-318]
Date of Collection (mm/dd/yyyy)
Reason for Testing - 26.717(b)(5)
Pre-Access Testing Reason (optional)
Ir-Aclcess i
I Initial Authorization Employment Type-26.717(b)(3)
ContractorNendor Labor Category-261717(b)(3)
Please elaborate other Electician Refusal-26,717(b)(7) & 26.75
-7 Was this collection refused (Yes / No)?
Test Results-26.717(b)(4)
Test Validity lValid Test Type(s) for Result(s) Reported Drug Only Was this collection observed (YesfNo)?- 26.717(b)(7) & 26.1 Substance-26.717(b)(2) & (b)(4)
Additional Substance (as applicable)
Marijuana I Please Select I
I Drug Testing jUrine Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes / No)
Use NRC Cutoff (Yes / No) [FNTh--
Use NRC Cutoff (Yes I No)I'7 7
LOD (Limit of Detection) - as applicable Is this a 24-Hour Reporting Event (YeslNo)?- 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 Please elaborate on the choice(s) selected:
3
[INITIAL PRE ACCESS SAMPLE PROVIDED BY I MRO AND LAB CONCUR NO MEDICAL EXPLAN Refusal to Cooperate Other COLLECTED UNDER DIRECT OBSERVATION.
0J 0
ANALYTSS TESTED AT LOD POSITIVE FORMW DONOR WAS RETURNED FROM LAB AS INVALID.
NATION. MRO ORDERED SECOND SAMPLE SECOND SAMPLE RETURNED FROM LAB DILUTE.
tRIJUANA.
Management Actions - 26.717(b)(8)
Individual Sanction Permanent Denial Reason(s) for the Action (select all that apply):
MRO Confirmation 0
First drug or alcohol positive 0 Resignation/Vlthdrawal
- Subversion 0
Subsequent positive test result from testing O Misuse 0
Violation of 5-hour abstinence rule
[] Other:
[] Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required):
Michele
[oFF SpedialistI Michele.Mannino~cengllc.com First Name Last Name Position Tide Email Address Person 2 (optional):
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" after the data validation process has been successfully completed and the form is ready for submission.
Form Locked On: Jan 31, 2011 at 5:41:20 PM FS, aV to I Cý PrTnt thls p
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NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal eReference Number (Licensee Supplied) 201 0-H
- 1) All fields are required except those marked 'optional'.
i
- 2) Entries in some form fields may result in information
-- Submission Update - check this box only if this is an update to a previous submission, in being auto-populated into other form fields.
which case you must use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work Select Facility properly.
Calvert Cliffs (50-317; 50-318]
Date of Collection (mm/ddlyyyy)8//2010I Reason for Testing. 26.717(b)(5)
For Cause Testing Reason (optional)
Please elaborate (optional)
For Cause
]
Observed Beh Employment Type-26.717(b)(3) 1Licensee Employee Labor Category. 26.717(b)(3)
Please elaborate Other anTrainee Refusal-26,717(b))7) & 26875 Was this collection refused (Yes I No)? F.
avior Falling asleep in dlass.
Test Results - 26.717(b)(4)
Test Validity lValid]
Test Type(s) for Result(s) Reported Drug Only Was this collection observed (Yes No)? - 26.717(b)(7) & 26.1 F Substance - 26.717(b)(2) & (b)(4)
Additionaf Substance (as applicable) lCocaine 1 ~piates I
Drug Testing jUrine Additional Substance (as applicable)
[Please Select Use NRC Cutoff (Yes I No) yes Use NRC Cutoff (Yes / No)
I r
]--
ý Use NRC Cutoff (Yes I No) re--7 is this a 24-Hour Reporting 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 o
0 Refusal to Cooperate Other 0
17 Management Actions - 26.717(b)(8)
Individual Sanction I-Year Denial Reason(s) for the Action (select all that apply):
0 MRO Confirmation 0
First drug or alcohol positive Q Resignation/Withdrawal o
Subversion 0
Subsequent positive test result from testing
[I Misuse 0
Violation of 5-hour abstinence rule 0
Other:
0 Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person I (required):
M ichele l I
Macvies IF D eo i s ll I Michele.Manninou@
en,,ll...m First Name Last Name Position Title Email Address Person 2 (optional):
Firsot Name a
iNe LPosition Tite 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" after the data validation process has been successfully completed and the form is ready for submission.
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6 NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Nptl; Unique Reference Number (Licensee Supplied) 201 0-1 I) All fields are required except those marked 'optional'.
ie 1
- 2) Entries in some form fields may result in information Submission Update - check this box only if this is an update to a previous submission, in being autoopopulated into other form fields, which case you must use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work Select Facility properly.
Calvert Cliffs [50-317; 50-318)
Dal ofCollection (mmdd/yyyy)
Reason for Testing - 26.717(b)(5)
For Cause Testing Reason (optional)
Please elaborate (optional)
For Cause I
Other Odor of Alcohol Employment Type - 26.717(b)(3)
ContractorNendor Labor Category-26.717(b)(3)
Please elaborate Ithor II Laborer 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 Only
[Breath Substance-26.717(b)(2) & (b)(4) oAlcohol 7
Use NRC Cutoff (Yes / No)[-
Is this a 24-Hour Reporting 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 0
[
Refusal to Cooperate Other U
17 Management Actions - 26.717(b)(8)
Individual Sanction 1-Year Denial Reason(s) for the Action (select all that apply):
0 MRO Confirmation 0
First drug or alcohol positive 0
Resignation/Wthdrawaf E] Subversion U Subsequent positive test result from testing 0
Misuse 0
Violation of 5-hour abstinence rule F] Other:
[] Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person I (required):
MiOenioo FD SpeOialit Miohele.Mannino~ipcenol,,..om First Name Last Name Position Title Email Address Person 2 (optional):
Firs a
st 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" after the data validation process has been successfully completed and the form is ready for submission.
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0R NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Unique Reference Number (Licensee Supplied) 2010-J
- 1) All fields are required except those marked "optlonal'.
i
- 2) Entries in some form fields may result in information
['
Submission Update - check this box only if this is an update to a previous submission, in being auto-populated Into other form fields, which case you must use the same Unique Reference Number,
- 3) Use Adobe Reader 8 or later for this form to work Select Facility properly.
Calvert Cliffs (50-317; 50-318]
Date of Collection (mm/ddlyyyy),1020 10o I Reason for Testing - 26.717(b)(5)
Pre-Access Testing Reason (optional)
Pre-Access II Initial Authorization Employment Type-26,717(b)(3) lContractorNendcor Labor Category-26.717(b)(3)
Please elaborate 0ther I[Labor r Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity Valid Test Type(s) for Result(s) Reported
[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)
[Marijuana Pease Select I
I Drug Testing jurine Additional Substance (as applicable)
[Please Select Use NRC Cutoff (Yes / No) e Use NRC Cutoff (Yes / No)FYes Use NRC Cutoff (Yes / No)
I Is this a 24-Hour Reporting 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 13 0
Refusal to Cooperate In Other 0
Management Actions - 26.717(b)(8)
Individual Sanction 1-Year Denial 7
Reason(s) for the Action (select all that apply):
0 MRO Confirmation M First drug or alcohol positive
[3 ResignatontVithdrawal C Subversion
[I Subsequent positive test result from testing In Misuse In Violation of 5-hour abstinence rule C] Other:
0l Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required):
Michele
]l-I 7
Mannino FF ZeiaSpec!list I Michele.Mannino@cengetl..om First Name Last Name Position Title Email Address Person 2 (optional):
First Name Last Name Position Titl e 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" after the data validation process has been successfully completed and the form is ready for submission.
Form Locked On: Jan 31, 2011 at 5:54:39 PM Save t0 C
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NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Nzte:
eReference Number (Licensee Supplied) 2010-K
- 1) All fIelds'are required except those marked 'optional'.
- 2) Entries In some form fields may result in Information E-Submission Update - check this box only if this is an update to a previous submission, in being auto-populated Into other form fields.
L which case you must use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work Select Facility properly.
Calvert Cliffs [50-317; 50-3181 Date of Collection (mm/dd/yyyy) 09/0/2010 i Reason for Testing-26.717(b)(5)
Pre-Access Test Pre-Access
[Initial Authori; Employment Type-26.717(b)(3) contractdor/endor Labor Category-26.717(b)(3)
Please elaborate OtheMateal Processor Refusal-26.717(b)(7) & 26'75 Was this collection refused (Yes / No)?
No ing Reason (optional) zation Test Results - 26.717(b)(4)
Test Validity lValid Test Type(s) for Result(s) Reported 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)
Marijuana 1131ease Select Drug Testing
[Urine]
Additional Substance (as applicable) 1Please Select Use NRC Cutoff (Yes / No) e Use NRC Cutoff (Yes / No)[y"*
Use NRC Cutoff (Yes / No)
]
Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b)
No Subversion Attempts - 26.717(b)(7) and 26.75(b)
II this result relates to a subversion attempt, select one or more of the following choices as applicable.
,f not a subversion attempt, do not select any of the four boxes.
Physical Evidence Observed Actions/Behaviors 0
0 Refusal to Cooperate Other 0
0 Management Actions - 26.717(b)(8)
Individual Sanction I-Year Denial Reason(s) for the Action (select all that apply):
MRO Confirmation 0
First drug or alcohol positive 0
Resignatior/WAthdrawal O Subversion 0
Subsequent positive test result from testing O Misuse 0
Violation of 5-hour abstinence rule
[] Other:
0 Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required):
Mihele
][
nnn]FF$piastJMich eleMan nino@cengIl.....
First Name Last Name Position Title Email Address Person 2 (optional):
First Name Las Name iositon Tide 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" after the data validation process has been successfully completed and the form is ready for submission.
Form Locked On: Jaen 31, 2011 at 5:55:14 PM
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--' Submission Update which case you must Select Facility Calvert Cliffs [50-317; NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal No.t ie 2010-L
- 1) All fields are required except those marked 'optional'.
id
- 2) Entries In some form fields may result in information
- check this box only if this is an update to a previous submission, in being auto-populated Into other form fields.
use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work properly.
50-318]
Date of Collection (mm/dd/yyyy)[02/0101 Reason for Testing-26.717(b)(5)
Pre-Access Testing Rea Pre-Access F Initial Authorization Employment Type-26.717(b)(3)
Contractor/Vendor Labor Category-26.717(b)(3)
Please elaborate ther Cafetea Wurker Refusal-26.717(b)(7) & 26'75 Was this collection refused (Yes / No)?
son (optional)
Test Results - 26.717(b)(4)
Test Validity Dilute Test Type(s) for Result(s) Reported 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)
Marijuana IPlease Select I
Drug Testing Urine Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes / No)Y Use NRC Cutoff (Yes I No)
Use NRC Cutoff (Yes / No) l--
LOD (Limit of Detection) - as applicable 118 1
]-
Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b)
N 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 13 0
Refusal to Cooperate 0
Other 0
Management Actions - 26.717(b)(8)
Individual Sanction I-Year Denial Reason(s) for the Action (select all that apply):
0 MRO Confirmation 0
First drug or alcohol positive
[3 Resignation/Withdrawal C] Subversion 03 Subsequent positive test result from testing O3 Misuse
[0 Violation of 5-hour abstinence rule
[3 Other:
[0 Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required):
Itil X IIIhhII Mniot u is I l I Mivhlel.Mavnnmo@cenglv.com First Name Last Name Position Title Email Address Peoson 2 (optional):
I I
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" after the data validation process has been successfully completed and the form is ready for submission.
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r e 201 0-M
- 1) All fields are required except those marked optional'.
r
- 2) Entries in some form fields may result in Information
- check this box only if this is an update to a previous submission, in being auto-populated into other form fields.
use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work property.
50-3181 Date of Collection (mm/dd/yyyy)[02/O/2Ol
]
Reason for Testing - 26.717(b)(5)
Pre-Access Teas Pre-Access l
Initial Authori Employment Type-26.717(b)(3)
ContractorNendor I
Labor Category-26.717(b)(3)
Please elaborate other eera Worker Refusal-26.717(b)(7) & 26875 Was this collection refused (Yes I No)?
N.
F.L__
ting Reason (optional) zation Test Results - 26.717(b)(4)
Test Validity lValid Test Type(s) for Result(s) Reported Drug Only 7
Was this collection observed (Yes 1/No)?- 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4)
Additional Substance (as applicable)
Marijuana 1Opiates Drug Testing lUrne Additional Substance (as applicable) 1Please Select Use NRC Cutoff (Yes I No) Yes Use NRC Cutoff (Yes / No)[
Z--*
Use NRC Cutoff (Yes / No)lj-e--7 Is this a 24-Hour Reporting Event (Ves/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 EJ
[]
Refusal to Cooperate El Other 0l Management Actions - 26.717(b)(8)
Individual Sanction 1-Year Denial Reason(s) for the Action (select all that apply):
I] MRO Confirmation
[
First drug or alcohol positive
[E Resignation/Withdrawal
[3 Subversion El Subsequent positive test result from testing
[3 Misuse E] Violation of 5-hour abstinence rule E] Other:
[] Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person t (required):
IM ichele I
a n~ oFFD Speci al st M ichele.M annino@ ceng tlc.com First Name Last Name Position Tile Email Address Person 2 (optional):
First Name Last Name Position Tide 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" after the data validation process has been successfully completed and the form is ready for submission.
Form Loc3ed 1, 2011 at 6:02:47 p ve toLocale PC PimTet Fhor Repr,,
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Unique Reference Numbe D Submission Update which case you must Select Facility Calvert Cliffs [50-317; NKC FFU Program Performance Uata Keporting bystem Single Positive Test Form for the EIE General Submission Portal Note:
r(i e 2010-N
- 1) All fields are required except those marked 'optional'.
i
- 2) Entries in some form fields may result in information
- check this box only if this is an update to a previous submission, in being auto-populated into other form fields.
use the same Unique Reference Number.
- 3) Use Adobe Reader 8 or later for this form to work properly.
50-318]
Date of Collection (mmldd/yyyy)0 1
Reason for Testing - 26.717(b)(5)
Pre-Access Testing Rea FP-re
-Access Initial Authorization Employment Type - 26.717(b)(3)
ContractorNendor Labor Category-26.717(b)(3)
Please elaborate Pother
)Icafeteria Worker Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
son (optional)
Test Results - 26.717(b)(4)
Test Validity Valid Test Type(s) for Result(s) Reported Drug Only Was this collection observed (Yes/Ne)? - 26.717(b)(7) & 26.1 Substance - 26.717(b)(2) & (b)(4)
Additional Substance (as applicable)
Marijuana IPlease Select Drug Testing I°"ineI Additional Substance (as applicable)
JPlease Select 7
Use NRC Cutoff (Yes I No) IYes Use NRC Cutoff (Yes / No)[Yes III]
Use NRC Cutoff (Yes / No)FZI"I"-]
Is this a 24-Hour Reporting 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 l
[0 Refusal to Cooperate 0
Other 13 Management Actions - 26.717(b)(8)
Individual Sanction II" Year Denial Reason(s) for the Action (select all that apply):
MRO Confirmation 9
First drug or alcohol positive 0
Resignation/%ithdrawal O Subversion 0
Subsequent positive test result from testing O Misuse 0
Violation of 5-hour abstinence rule
[] Other:
0 Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person I (required):
IMichele E Sooeuo ZpecMt icele.Mn.onoilo0,englic.c.m First Name LsName Position Title Email Address Person 2 (optional):
First Name Last ama Position Tie 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 iLocked" after the data validation process has been successfully completed and the form is ready for submission.
Form Locked On: Jan 31, 2011 at 6:03:21 PM U,
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Singl. Poutii Test Fo.r version 1.2,24
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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 Note:
[
Submission This is not a submission update; the form auto-populated
- 1) All fields required except those marked 'optional' Update "Submission Update" in error. This is our original submission for
- 2) Use Adobe Reader 8 or later for this form to work properly.
CY 2011. The NRC is aware of this problem.
- 3) Hold your mouse over a form field to view additional information.
Select Facility Period of Report
]
2011 Calvert Cliffs [50-317; 50-318]
Tests Conducted in the Calendar Year Total Number of Tests Conducted Total Number of Positive, Adulterated, Licensee Employees Contractors/Vendors Substituted, and Refusal to Test Results Pre-Access 75 1,085 I5]
Random 6551 21 2 23 For Cause 16 81 2
- 1 Post-Event 4
4 21 0 OI Followup' 87 55 Total (Calculated) 1 1 I 82 31I1 1,4021 1I 15]l FFD Program Random Testing Population and Rate Average number of Average number of Total size of the random testing pool Annual random testing percentage licensee employees contractors/vendors throughout the period (Calculated) achieved for the testing pool Laboratory Testing Does your program use a Licensee Testing Facility?IN o (Yes / No)
Identify your HHS-Certified Laboratory(ies)
IQUEST DIAGNOSTICS, 400 Egypt Road, Norristown, PA,.
Identify your Blind Performance Test Sample supplier(s)
Elsohly Laboratories, Incorporated, 5 Industrial Dnve, Oxford, MS 38655 Substances Tested Did your program only test for NRC-required substances
'"Does your program conduct LOD testing y AND at the NRC-specified minimum cutoff levels? (Yes / No) Yes permitted in 26.163(a)(2)? (Yes / No)
Substance Use Only NRC Cutoff Initial Confirmatory LOD Testing?
Comment Levels? (Yes I No)
Cutoff Cutoff (Yes I No)
(Optional)
Alcohol Yes Nqt Applicable:,:,.
Cocaine_____
LOD TESTING PERFORMED ON DILUTE Cocaine YsYes SPECIMENS ONLY.
LODTESTING PERFORMED ON DILUTE marijna s
I I
SPECIMENS ONLY.
Amphetamines Yes[I Yes LOD TESTING PERFORMED ON DILUTE I
Ie SPECIMENS ONLY.
YeSLOD TESTING PERFORMED ON DILUTE Opiates Yes es SPECIMENS ONLY.
PCP YeS LOD TESTING PERFORMED ON DILUTE SPECIMENS ONLY.
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 3 to report any additional topics.
Topic 1 Description Topic 1 Program and System Management 1 Contractor-Initial Pre-Access specimen temp was out of range. Second specimen collected under direct observation and both specimens were returned from lab positive same drug different levels of metabolites. MRO deemed Pre-Access Refusal (Substituted) and For-Cause Positive. UAA/UA was permanently denied.
2.Contractor-Initial Pre-Access specimen temp was out of range. Second specimen collected under direct observation. Specimen collected under direct observation was returned from lab positive. MRO deemed Pre-Access Refusal (Substituted) and For-Cause Positive. UAA/UA was permanently denied.
3.Two (2) Contractors-Initial Pre-Access-Drug Positive-UAA/UA denied for one year.
4.Contractor-Initial Pre-Access-Alcohol Positive-.040 confirmed. UAAIUA denied for one year.
5.Employee -Random-Alcohol Positive-.024 confirmed, in a work status for at least two hours. UAAIUA terminated/denied for 14 days. Completed 28 day in house treatment plan. RTW Observed testing, Determination of Fitness performed by SAE and placed in Follow Up Program per 10 CFR 26.
6.Employee-Random-Drug Positive-UAA/UA terminated/denied for one year.
[] Add an additional Topic Person(s) Responsible for Information Provided Person 1 (required):
MICHELE IMANNINO FFD SPECIALIST MICHELE.MANNINO@CENGLLC.COM First Name Last Name Position Title Company Email Address Person 2 (optional):
First Name Last Name Position Title Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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.
r IForm Locked On: Jan 23, 2012 at 3:25:00 PM Set ~LoaiPC
'Prýmt thisýRepdrt Annual Report Form (version 1.3.0 - Nov 6, 2011)
ICalvert Cliffs [50-317; 50-318j j Period of RePort:[~~J
- Page 2 of 2-Annual Report Form (version 1.3.0 - Nov 8, 2011)
ICalvert Cliffs [50-317; 50-318]
Period of Report:F20171
- Page 2 of 2 -
U etn epeadieEvrpmn S
S-0
-- Submission Update Unique Reference Numbe 2011-A Select Facility Calvert Cliffs [50-317; NRC FFD Program Performance Data Reporting System Single Positive Test Form for the HIE General Submission Portal fterg:
- 1) All fields are required except these ankred 'optional.
- 2) Entries In some form folds may result in infotrmation being auto-er Licensee Supplied) populated into ether latm fields.
- 3) Use Adobe Reader 8 or later for this ferm te work property,
- 4) Hold your nous*e over a form field to view additional Information.
50-318]
Date of Collection (mm/dd/yyyy)[91/2011
]
Reason for Testing - 26.717(b)(5)
Please elaborat Followup Employment Type - 26.717(b)(3) lContractor/Vendor Please elaborate Labor Category-26.717(b)(3)
Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity Valid Test Type(s) for Result(s) Reported - 26.717(b)(2) a on the reason for testing (optional)
Drug Testing Drug Only I
[Urine Was this collection observed (Yes /No)? -26.717(b)(7) & 26,75 Substance - 26.717(b)(2) & (b)(6)
Additional Substance (as applicable)
Marijuana I Please Select Additional Substance (as applicable)
Please Select Use NRC Cutoff (Yes / No)? e, Use NRC Cutoff (Yes / No)? EyiZ]
Use NRC Cutoff (Yes / No)?
Is this a 24-Hour Reporting Event (YealNo)?. 26.719(b)FNo Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
Management Actions - 26.717(b)(8) & 26.75 Reason for the Action IFirst drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)
Licensee Administrated Specific Sanction Applied 1-Year Denial Person(s) Responsible for Information Provided Person I (required):
- Foi, F.o.
IFFD SPECIALIST MICHELE.MANNINO@CENGLLC.COM First Name Last Name Position TiOe Company Email Address Person 2 (optional):
rt Name Last Name osition Tie Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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: Jan 23, 2012 at 10:35:27 AM ISave IoLoal PC, Pt "ho, Single Po-e Te* Fom vreion 1.3.0 - Nov S, 2011
efft kkai ieEvplriu S
S D Submission Update Select Facility NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Nota:
r) All fields are required except those marked optional'.
- 2) Entries in so-e forn. fields may result In let ornifaen being auto-er (Licensee Supplied populated into other fort fields.
- 3) Use Adobe Reader s or later for is fern te work properly.
- 4) Hold your mouse over a form fCold to view additional infonnation.
ICalvert Cliffs [50-317; 50-318]
Date of Collection (mm/ddiyyyy) [081/21 Reason for Testing - 26.717(b)(5)
Please elaborate on the reason for testing (optional)
Followup Employment Type. 26.717(b)(3)
ContractorNendor P
Please elaborate Labor Category. 26.717(b)(3)
FIELD SERVICE REP.
Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes I No)?
No Test Results - 26.717(b)(4)
Test Validity lValid
]
Test Type(s) for Result(s) Reported - 26.717(b)(2)
Alcohol Testing Drug Testing Drug and Alcohol
[IBreath I
[Urine I]
Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.75 FN.
Substance-26.717(b)(2) & (b)(6)
Additional Substance (as applicable)
Alcohol
]0ther 7
Please identify the substance No drug identified thelab. Thisis What 26.103 BAC level was exceeded?
0.03 and in workstatusat least 1 hr Use NRC Cutoff (Yes / No)?
Initial Cutoff Confirmatory Cutoff Is this a 24-Hour Reporting Event (Yes/No)?. 26.719(b)FNo I
II Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes / No)? Yes Subversion Attempts-26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
Management Actions - 26.717(b)(8) & 26.75 Reason for the Action
[First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)
Licensee Administrated Specific Sanction Applied 1-Year Denial Person(s) Responsible for Information Provided Person 1 (requlred):
CELE L
II FM-/IIN IFDSEILS MICHELE.MANNINO@CENGLLC.COM First Name Las Name Position Title Company Email Address Person 2 (optional):
i irstNaeLast NPosition Title Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 only when the 'Validate & Lock" button has been selected and all errors (i.e., those hightighted 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: Feb 9, 2012 at 10:17:59AM SOV~l Pos-s. Tles Fo
-rso 13.0 - NOv 8, 2011
D] Submission Update Unique Reference Number (Lic 2011 -C Select Facility Calvert Cliffs (50-317; 50-3
,% t-ru r'rogram rernormance uaia meporung aysxem Single Positive Test Form for the EIE General Submission Portal (Note:
I) All fields are required except those marked 'optionar.
- 2) Entries in some form fitld., may result In Information being auto-censee Supplied populated into ether tor- 0.lds.
- 3) Use Adobe Reader 8 or later for this form to work property,
- 4) Hold your mouse over a form field to View additional infonnation.
181 Date of Collection (mm/dd/yyyy) 02082011ZI Reason for Testing - 26.717(b)(5)
Pre-Access Testing Reason (optional)
Pre-Access il i
]Z Ilnitial Authorization Employment Type-26.717(b)(3)
Contractor/endor Please elaborate Labor Category-26.717(b)(3)
LABORER FOther Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes (No)?
Test Results - 26.717(b)(4)
Test Validity Valid I
Test Type(s) for Result(s) Reported - 26.717(b)(2)
Drug Testing Drug Only Urine Was this collection observed (Yes lNo)? - 26.717(b)(7) & 26.75 Substance-26.717(b)(2) & (b)(6)
Additional Substance (as applicable)
Marijuana I Please Select Please elaborate (optional)
Additional Substance (as applicable) 1Please Select Use NRC Cutoff (Yes / No)? Yes Use NRC Cutoff (Yes / No)? Yes Use NRC Cutoff (Yes ( No)?
Is this a 24-Hour Reporting Event (Yes/No)?- 26.719(b) No--.7 Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
Management Actions - 26.717(b)(8) & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)
Licensee Administrated Specific Sanction Applied 11-Year Denial 7
Person(s) Responsible for Information Provided Person 1 (required):
1-A.N.NF SPECIALIST MICHELE.MANNINO@MCENGLL.C.COM First Name ast Name Position Title Company Email Address Person 2 (optional):
I F
First Name Last Position Title Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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: Jan 23, 2012 at 10:36:16 AM Save to L Prn i Repast Single Poestiv Tort Form vrsion 1.3.0. Nov 0, 2011
r
. rruJ ri U1 krill rtr lurm IR2111Un UEcd ruu ju F
LIuIr U Oy*LZ IT Single Positive Test Form for the EIE General Submission Portal Submission Update
- 1) All fields are required except those tarMed "optional:
- 2) Entrles in some torm fields may result In Information being auto-Unique Reference Number (Licensee Supplied) populated tlno other ror-fields.
2011 -D
- 3) use Adobe Reader 8 or later for this form to work properly.
20 1 -D
- 4) Hold your mouse over a form field to view additional Infotrmaion.
Select Facility Palvert Cliffs [50-317; 50-318]
Date of Collection (mm/dd/yyyy) 0'0/2011 Reason for Testing - 26.717(b)(5)
Please elab Followup Employment Type-26.717(b)(3)
Licensee Employee Labor Category-26.717(b)(3)
FSecurity Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
No Test Results - 26.717(b)(4)
Test Validity Valid
]
Test Type(s) for Result(s) Reported - 26.717(b)(2) orate on the reason for testing (optional)
Drug Testing Drug Only
]Une Was this collection observed (Yes / No)? - 26.717(b)(7) & 26,75 Substance - 26.717(b)(2) & (b)(6)
Additional Substance (as applicable) lCocaine
]1Please select Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes / No)? FYe Use NRC Cutoff (Yes / No)? esZ]
Use NRC Cutoff (Yes I No)? eTZI Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) NoLN7 Subversion Attempts. 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
Management Actions - 26.717(b)(8) & 26.75 Reason for the Action IFirst drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)
Licensee Administrated Specific Sanction Applied 1-Year Denial Person(s) Responsible for Information Provided Person t (required):
IMCEL~E MfPF.N PEIliT MICHELE.MANNINOCCENGLL-C.COM First Name Last Name Positon Tide Company Email Address Person 2 (optional):
First Name Last Name Position Tile Company Email Address Final Step (Required) -NRC will consider this form authentic in accordance with 26.11 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: Jan 23, 2012 at 10:36:44 AML Prin¶ Itgl Single Postive Tell Form version 1.3.0- Nov S, 2011
F Submission Update Unique Reference Numb 2011 -E Select Facility Calvert Cliffs [50-317; rmi* rru rrogram rerTormance uata meporung oysTem Single Positive Test Form for the EIE General Submission Portal
- 1) All field. are required except those marked ptional'.
- 2) Entries in some form fields may rult In t nfornation being aout-aer Licensee Supplied) populated Into other form fields.
- 3) Use Adobe Reader e or later for this form to work properly.
- 4) Hold your mo...
over a form field to view addIftIonal Information.
50-318]
Date Of Collection (mm/dd/yyyy) 06/1/201 i
Reason for Testing - 26.717(b)(5)
Pre-Access Testing Reason (optional)
FIPr' cces l
II FInitial Authorization Employment Type - 26.717(b)(3)
Please elaborate Labor Category - 26.717(b)(3)
ROOFER 1-0therIl Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
No Test Results - 26.717(b)(4)
Test Validity Test Type(s) for Result(s) Reported - 26.717(b)(2)
Drug Testing Drug Only m.
Was this collection observed (Yes/No)?- 26.717(b)(7) & 26.75 Substance - 26.717(b)(2) & (b)(6)
Additional Substance (as applicable)
IPCP
-7 1
IPlease Select Please elaborate (optional)
J Additional Substance (as applicable)
[Please Select Use NRC Cutoff (Yes / No)?
Yes Use NRC Cutoff (Yes / No)? eZ]
Use NRC Cutoff (Yes / No)? e-7-7 Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) NoL.7 Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
Management Actions - 26.717(b)(8) & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied NRC Minimum or Licensee Administrated)
Licensee Administrated Specific Sanction Applied 1-Year Denial Person(s) Responsible for Information Provided Person I (required):
ME~ LEIJ
[MANNINO FFD SPECIALIST MICHELE.MANNINO@CENGLLC,COM First Name Last Name Position Title Company Email Address Person 2 (optional):
FirstLst Name ot ama os Company Email Address Final Stop (Required) -NRC will consider this form authentic in accordance with 26.11 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: Jan 23, 2012 at 10:37:05 AMW FSJV8 oLooWPC PYt Singl. Po-dtiv Test Fo-m verion 1.30. No.v 8 2011
D Submission Update Unique Reference Numb 1201 1-F Select Facility Falvert Cliffs (50-317; Nr¶, rru rrogram rernormance uaya rmeporung aystem Single Positive Test Form for the EIE General Submission Portal I) Ali fields are required except those marked 'optional'.
- 2) Entries In some form fitlds may result In Information being auto-er (Licensee Supplied) populated into othe, fotr-field.,
- 3) Use Adobe Reader 8 or later for this form to work property,
- 4) Hold your mouse over a serm field to view additional information.
50-3181 Date of Collection (mnVdd/yyyy)
Reason for Testing - 26.717(b)(5)
Pre-Access Testing Reason (optional)
P FP-re-Access I
Initial Authorization Employment Type-26.717(b)(3) lContractor/Vendlor Labor Category-26.717(b)(3)
[Engineering Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity FValid
]
Test Type(s) for Result(s) Reported - 26.717(b)(2)
Alcohol Testing Drug Testing Drug and Alcohol I 1reath jIUrine Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.75 [N.
Substance-26.717(b)(2) & (b)(6)
Additional Substance (as applicable)
Alcohol
]Other
]
Please identity the substance Noe drug identified by the lab. Thin is What 26.103 BAC level was exceeded?
0.04 or greater Use NRC Cutoff (Yes / No)? No Initial Cutoff Confirmatory Cutoff Is this a 24-Hour Reporting Event (es/No)?.- 26.719(b)[No -"
lease elaborate (optional)
Additional Substance (as applicable) jPlease Select Use NRC Cutoff (Yes / No)? es Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
Management Actions - 26.717(b)(8) & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied NRC Minimum or Licensee Administrated)
ILicensee Administrated Specific Sanction Applied 1-Year Denial Person(s) Responsible for Information Provided Person I (required):
MICHLE I I I MANiN SP~ECIALISTl MICHELEMANNINOCCENOLLC.COM First Name Last Name Position Tile Company Email Address Person 2 (optional):
irst ama Last Name osition Tile Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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:FFeb 9, 2012 at 2:54:34 PM W Lc tL.ocel P
, irnt ts IRepott Single Postove Test Form " lon 1.3.0- Nov s, 2011
C Poe-tit eieai h
5-iibole R-Submission Update Unique Reference Numb 2011-G NRC FFD Program Perfor Single Positive Test Form foi er (Licensee Supplied )
-mance Data Reporting System r the EIE General Submission Portal NOV:
f) All fields are required except those marked 'optional'.
- 2) Entre in so oma f fields may result In Iformnation being auto-populated istl ether torm fields.
31 Use Adobe Reader s or later for this form to work properly.
- 4) Hold your mouse ever a form field to view additional information.
Date of Collection (mm/dd/yyyy) 0//2011 optional)
Please elaborate (optional)
Select Facility Calvert Cliffs [50-317; 50-318]
Reason for Testing - 26.717(b)(5)
Pre-Access Testing Reason (
IPre-Access Fsl lnitial Authorization Employment Type-26.717(b)(3)
IContractor/vendor I
Pease elaborate Labor Category-26.717(b)(3) 10ther I t 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 - 26.717(b)(2)
Drug Testing Drug Only Urine Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.75 Substance - 26.717(b)(2) & (b)(6)
Additional Substance (as applicable)
Cocaine
]Please Select ::
Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes / No)? Yes Use NRC Cutoff (Yes / No)? eTI]
Use NRC Cutoff (Yes t No)?
Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b)FNo Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
N Management Actions - 26.717(b)(8) & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)
Licensee Administrated Specific Sanction Applied 1-Year Denial Person(s) Responsible for Information Provided Person I (required):
F-HL A..
FDSPECIALIST MICHELE.MANNINOOCENGLLC.COM First Name
- Las, Position Title Company Email Address Person 2 (optional):
First Name Last Name Position Title Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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.
99M --
Form Locked On:Ilan 23, 2012 at 10:37:55 AM I S-QI tol_.IFPC]
Prinrt this
- Report, bingfl Postive Test IsoM versen 1.4.0 -soc Al 211
eri., rru rrogram rer-ormance uaw rmeporlung oystem Single Positive Test Form for the EIE General Submission Portal
-UI t:
D Submission Update
- 1) All fields are required except those marked optional'.
- 2) Entries in some torm fields may result In lnfornaflon being auto-Unique Reference Number (Licensee Supplied) populated into other form fields.
12011_-H
- 3) Use Adobe Reader 8 or later for this ferm to work properly, 2011 -H
- 4) Hold your mouse over a ferm field to view additional Infoermation.
Select Facility Calvert Cliffs [50-317; 50-318]
Date of Collection (mm/dd/yyyy)
Reason for Testing-26.717(b)(5)
Please elab
[Random]
Employment Type-26.717(b)(3)
Licensee Employee Labor Category-26.717(b)(3)
Maintenance (Craft)
Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes I No)?
No Test Results - 26.717(b)(4)
Test Validity Test Type(s) for Result(s) Reported - 26.717(b)(2) orate (optional)
Drug Testing Drug Only I
Iurine Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.75 Substance - 26.717(b)(2) & (b)(6)
Additional Substance (as applicable)
ICocaine I
IPlease Select I
Additional Substance (as applicable)
IPlease Select
]
Use NRC Cutoff (Yes / No)? Yes Use NRC Cutoff (Yes / No)? Ey ZI]
Use NRC Cutoff (Yes / No)?
Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) NoL -
Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)? jNo Management Actions - 26.717(b)(8) & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)
Licensee Administrated Specific Sanction Applied 1-Year Denial Person(s) Responsible for Information Provided Person 1 (required):
MICHELE mANNINO FFD SPECIALIST MICHELE.MANNINO@CENGLLC.COM First Name Last aam Position Tide Company Email Address person 2 (optionaol:
rt Name ast Name osi ion Title Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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: Jan 23, 2012 at 10:38:29 AM Sa.,
toA7Locl PC thW
ý Rep.,t Single Po.-t Tret Form v.rsion 1.3,0-Nov 8, 2011
' -Submission Update Unique Reference Number (Li 12011-1 Select Facility Calvert Cliffs [50-317; 50-3 Reason for Testing - 26.717(
%1-rru rrogram rerTormance uata reporung aystem Single Positive Test Form for the EIE General Submission Portal I) All fields are required eacept those marked 'aptionar,
- 2) Entries in see, form fields may result In Information being auto-censee Supplied) populated Into other farm fields.
Sl3)
Use Adobe Reader 8 or later for this frnm to work property.
- 4) Hold your mouse over a form field to oiew additional information.
18]
Date of Collection (mm/dd/yyyy) 0/9/2011 bb)(5)
Pre-Access Testing Reason (optional)
Please elaborate (optional)
Pe-Access I l Ilnitial Authori Employment Type-26.717(b)(3)
ContractorNendor Please elaborate Labor Category-26.717(b)(3)
ROOFER O0ther Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity Substituted 7 Test Type(s) for Result(s) Reported - 26.717(b)(2)
I Drug Testing Drug Only
[ Iurine Was this collection observed (yeas/No)? - 26.717(b)(7) & 26.75 [N.Ii]
Substance-26.717(b)(2) & (b)(6)
[Not applicable Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b)b[.--7 Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
i~es IJ o) Refused to provide initial specimen 0 Specimen characteristics (e.g., color, odor, precipitant)
- Refused to provide second specimen 01 Invalid test result (initial specimen collected) - 26.185(o 0 Specimen temperature (out of range) 0 Refused to follow directions 0 Specimen paraphernalia identified 0 Other Please elaborate on the choice(s) selected:
TEMP OUT OF RANGE AT 88 DEGREES. RETURNED NEGATIVE FROM LAB. IMMEDIATE OBSERVED WAS PERFORMED.
OeSERVED TEST WAS POSITIVE FOR THC.
Management Actions - 26.717(b)(8) & 26.75 Reason for the Action Subversion attempt Sanction Applied (NRC Minimum or Ucensee Administrated)
NRC Minimum Specific Sanction Applied Permanent Denial Person(s) Responsible for Information Provided Person I (required):
ICHELEI MANNINGF SPECIALIST MICHELE.MANNINO@CENGLLC.COM First Name Last Name Position Tite Company Email Address Person 2 (optional):
First Name Last Name Position Title Company Email Address Final Stlp (Required) - NRC will consider this form authentic in accordance with 26.11 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: Jan 23, 2012 at 10:38:53 AM I.
tLcl PC P
Sinole Positi To F-r erson 131 -N-ov 8, 2011
N RU-j~e-il e l n
b ~zionel
-i s
S.E S
D Submission Update Unique Reference Numb 12011 -J Select Facility Calvert Cliffs [50-317; NRC FF0 Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal t~tefm
- 1) All field. are required ecept these arnked optional'.
- 2) Entries In S.rr tor., fields may result In Informataon being auto-ar (Licensee Supplied populated into oM.ier iarm fields.
- 3) Use Adobe Reader 8 or later for this form to work property.
- 4) Hold your mouse over a form field to view additional infornnatoe.
50-3181 Date of Collection (mm/dd/yyyy) j0/72O1 1 Reason for Testing - 26.717(b)(5)
Please elaborate lRandom Employment Type-26.717(b)(3)
FContractor/vendor Please elaborate Labor Category - 26.717(b)(3)
Grounds Keeper 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 - 26.717(b)(2)
(optional)
I Drug Testing Drug Only Urine Was this collection observed (Yes /No)? - 26.717(b)(7) & 26.75 Substance - 26.717(b)(2) & (b)(6)
Additional Substance (as applicable)
Mar,)uana JPlease Select Additional Substance (as applicable)
[Please Select d
Use NRC Cutoff (Yes / No)? [LII Use NRC Cutoff (Yes / No)? FY-7-7 Use NRC Cutoff (Yes / No)? eIII Is this a 24-Hour Reporting Event (YeslNo)?- 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
I Io Management Actions - 26.717(b)(8) & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)
Licensee Administrated Specific Sanction Applied 1-Year Denial Person(s) Responsible for Information Provided Person 1 (required),
IliZMichele n1FFECIALIST m
Michele.Mannino@cengll..c.m First Name Last Name vPositon Tite Company Email Address Person 2 (optional):
First Name Last Name Position Title Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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.
ForLoeOn n2, 2at3257ave t
o ioLocal PC.........'
Form Lock~ed On: jJan 23, 201201t 10:32:57 AMý Single Posji. Test Form vorsion 1.3.0. Nov u, 2011
P aetigBSl wi i-Ei7-o S.i~
Submission Update Unique Reference Numb 2011-K Select Facility Calvert Cliffs [50-317, NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal
- 1) All field are required except those marked 'optional'.
- 2) Entries In some form fields may result in Information being auto-er (Licensee Supplied populated into o.her lo-m field..
e d
- 3) Ule Adobe Reader 8 or later for this form to work property.
- 4) Hold your mouse over a far. field to view additional infonatlion.
50-3181 Date of Collection (mm/dd/yyyy) 105/2/2071 Reason for Testing-26.717(b)(5)
Please elaborat Followup Employment Type-26.717(b)(3) lContractor/Vendor
!~~a tor endo nII Please elaborate Labor Category. 26.717(b)(3)
Other Refusal-26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
No Test Results - 26.717(b)(4)
Test Validity TValid Test Type(s) for Result(s) Reported - 26.717(b)(2) e on the reason for testing (optional)
Drug Testing Drug Only I
rr'e Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.75 Substance - 26.717(b)(2) & (b)(6)
Additional Substance (as applicable) 1C1caine I
IPlease Select I
Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes I No)? e I Use NRC Cutoff (Yes / No)? 5-7-7 Use NRC Cutoff (Yes / No)?
Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
Management Actions - 26.717(b)(8) & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Ucensee Administrated)
Licensee Administrated Specific Sanction Applied 1-Year Denial Person(s) Responsible for Information Provided Person I (required):
FHL MANNINO FFD-SECILZSl MICHELE.MANNINOi5CENGLL.C.COM First Name Last ama Position Title Company Email Address Person 2 (optional):
First Name Lal ae Position Title Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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: Jan 23, 2012 at 10:46:31 AM SatLO"aI'PC
=rl.nt t*
,FeOt' Singi Po.Av Test= Form version 1.3.0.- Nov 8, 2011i
l'4lN%. rrF F1 VU1j d1ill rw lUl VI 1 IP..o IUdLO F~::JVl LIIIUj QyZixiU1 Single Positive Test Form for the EIE General Submission Portal Submission Update
- 1) All fields are required eouept those marked 'eptinai-.
- 2) Entries in so-m form fields may result In Infornafon being auto-Unique Reference Number (Licensee Suppliedl populated Into other for" fields.
201 J-L
- 3) Use Adobe Reader 8 or later for this form to work properly.
- 4) Hold your mouse over a form field to vew addifional Information.
Select Facility Calvert Cliffs (50-317; 50-3181 Date of Collection (mmldd/yyyy)
Reason for Testing - 26.717(b)(5)
Please elaborat Followup Employment Type - 26.717(b)(3)
Contractor/Vendor I
Please elaborate Labor Category-26.717(b)(3)
ROOFER O0ther
[
Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Results - 26.717(b)(4)
Test Validity Valid Test Type(s) for Result(s) Reported - 26.717(b)(2) e on the reason for testing (optional)
Drug Testing Drug Only I
jUrine Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.75 Substance - 26.717(b)(2) & (b)(6)
Additional Substance (as applicable)
Cocaine I
IPlease Select Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes / No)? [y-III]
Use NRC Cutoff (Yes / No)? [e Use NRC Cutoff (Yes / No)? Yet Is this a 24-Hour Reporting Event (Yes/No)? - 20.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)? [~o Management Actions - 26,717(b)(8) & 26.75 Reason for the Action
[First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)
Licensee Administrated Specific Sanction Applied 1-Year Denial Person(s) Responsible for Information Provided Person I (required):
MICHELE MANNINO FF-SPECIALIST MICHELE.MANNINO@
CENGLLC.COM First Name Last Name Position Title Company Email Address Petson 2 (optionsl):
First Name Last Name Position Tile Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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 Looked On: Jan 23, 2012 at 10:48:50 AM ae 6LIIP
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Single Postiv Teel Form version 1.30- Nov 8, 2011
rNiti r--u rrogram rerTormance uat,meporting lys1em Single Positive Test Form for the EIE General Submission Portal 0
Submission Update
- 1) All fields -re required except those warked optional"
- 2) Entris in some form field. may result In infomtison being aito-Unique Reference Number (Licensee Suppliedi populated It.o oiher.,
f/eld#.
2011 -M__
- 3) Use Adobe Reader 8 or later for this form to work properly.
- 4) Hold your mo.se over a form field to v/ew additional Wnforma-Iont Select Facility Calvert Cliffs [50-317; 50-3 18]
Date of Collection (mnrydd/yyyy)
Reason for Testing - 26.717(b)(5)
Please elaborate (optional)
[Random Employment Type - 26.717(b)(3)
Licensee Employee I
Please elaborate Labor Category-26.717(b)(3)
IFINANCE Refusal-26,717(b)(7) & 26.75 Was this collection refused (Yes / No)?
Test Resut/s - 26.717(b)(4)
Test Validity FValid
]-
Test Type(s) for Result(s) Reported - 26.717(b)(2)
Alcohol Testing Drug Testing Drug and Alcohol I 1Breath
[rine Was this collection observed (Yes / No)?- 26.717(b)(7) & 26.75 Substance - 26.717(b)(2) & (b)(6)
Additional Substance (as applicable)
Alcohol 1Other Please identify the substance No drug identified by the lab. This is What 26.103 BAC level was exceeded?
0,02 and in work status at least 2 hrs Use NRC Cutoff (Yes / No)?
Initial Cutoff Confirmatory Cutoff Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b)Fi"No Additional Substance (as appflicable)
IPlease Select Use NRC Cutoff (Yes / No)? [eTL7 Subversion Attempts - 26.717(b)(7) and 26.75(b)
Did this collection involve a subversion attempt (Yes/No)?
Management Actions - 26.717(b)(8) & 26,75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated NRC Minimum Specific Sanction Applied 14-Day Denial Person(s) Responsible for Information Provided Person I (required):
MAICNINO F
PECILI5T MICHELE.MANNINOCCENGLL.C.COM First Name Last Name Position Title Company Email Address Person 2 (optional):
First ama L
N ei on Title Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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.
FForm Locked On:[Feb 9, 2012 at 2:58:18 PM P tSvet*EpaVt COal* Poetry. 50 rein, o.r.en i.J.U.Noo 5, anti Singli PO -~
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