ML14057A390

Single Positive Test Form, for Random, Collected on 12/16/2013

ML14057A390
Person / Time
Site:	Palisades
Issue date:	02/13/2014
From:	Dotson B, Rabideau B Entergy Nuclear Operations
To:	Document Control Desk, Office of Nuclear Security and Incident Response
Shared Package
ML14057A574	List: ML14057A389 ML14057A390 ML14057A391 ML14057A392 ML14057A393 ML14057A395 ML14057A397 ML14057A398 ML14057A399 PNP 2014-016, Single Positive Test Form, for Pre-Access, Collected on 11/25/2013
References
2013-PAL-005, PNP 2014-016
Download: ML14057A390 (1)

Text

Ursgue Reference Nixnber (Licensee Suppled) 2013-PAL-005 Select Facilfy Palisades [50-255]

Reason for Testing-26.717(b)(5)

Random Employment Type - 26.71 7(b) (3) f ContractorNendor I

Labor Cafegeiy-26.7 17(b)(3)

Maintenance (Craft)

Test Results - 26.717(b)(4)

Test Validity Valid Test Type(s) for Result(s) Reported

- 26.717(b)(2)

Drug Only Please elaborate (optional)

Drug Testing Urine Was this coftecfion obseeved (Yes / No)? - 26.717(b)(7) & 26.75 No Substance - 26.717lb)(2) & (b)l6)

Additional Substance (as applicable) j Marijuana Please Select Date of Colection )mm/dd/yyyy) 12/16/2013 Use NRC Cutoff (Yes / No)?

Yes I

Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b)INo Subversion Attempts

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

Did this cottection involve a subversion attempt (Yes/No)? [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 3-Year Denial I

I Supersisor, Anness AutiiorizationiFtD brabide@enteeey.nom First Name Last Name Position Title Person 2 (optonall:

Company Email Address Dotson Licensing Spenielist bdotsonthenteray.oors 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.

nnkaH Form Locked On Feb 13.2014 at 1:58:15 PM Save to Local PC Print this Report Note:

[] Submission Delete

5) Al fields see required except thou. ms,*.d optional.

Update Submission

2) &,ebm In some torn, fields may reault in information being auto popudat.d Into other ram, fields.

3) Lisa Adobe Readers., later to, this form to worn properly,

4) Held your n,euoe arena fern, Cold to view additional info.msiion.

Refusal - 26.717(b)(7) & 26.76 Was this collection refused (Yes / No)?

No Additional Substance (as applicable)

I Please Select Person(s) Responsible for Information Provided Person I (required).

Barb Single Positive Test Form (version 1.5.0 - January 1, 2014)

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Select Facility Ipalisades [50-255]

I Date of Collection (mmld<llyyyy) 112116/2013 I Reason fo, T_ng - 26.717(b)(5)

Please elaborate (optional)

IRandom I

I I

Emp/oytMnl Type - 26.717(b)(3)

IContractorNendor I

Labor~ -26.717(b)(3)

IMaintenance (Craft)

I Refusal

• 26.717(b)(7) & 26.75 EJ was this collection refu.ed (ye.' No)?

Test Reaulta - 26.717(b)(4)

Test Validity IValid I

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

Drug Testing IDrug Only I

lurine I

Wa. thIs collection o_twd (yea' No)? - 26.717(b)(7) & 26.75 INo I

Sub.mnce - 26.717(b)(2) & (b)(6)

Additional Sub.r.nca (a. appllcabla)

Additional Sub.r.nca (.. applicable)

IMarijUana I

I Please Select I

Iplease Select I

Use NRC Cutoff (yes' No)? ~

Is this a Z4-Hou, Reporting Event (YasINo)? - 26.719(b)~

Subve",'on Attempts - 26.717(b)(7) and 26.75(b)

Old this coHaction involve a subversion allampl (Yes/No)? INO I

Manal18lfl8lll Attlona - 26.717(b)(8) & 26.75 Reason for the Action IFirst drug or alcohol positive I

Sanction Applied (NRC Minimum or Licensee Administrated)

I Licensee Administrated I

Specific Sanction Applied 13-Year Denial I

Pel'lJOn(s) Reapons/bla fo, Information Provided Person 1 (requfred):

IBrion First Name IIR'~d'au list Name IISUpotVlo.r. A<ce.. AutharizotianIFFO PositionTIlla I brabideGentergy.cam Company Email Addre.s Person 2 (optional):

IBa~

First Name Iloo~an Last Name II Utenslng Speclollst Position Tide I bd.tsonlltentorgy.com Company Email Addres.

Final Step (RequIred) - NRC will consider this form authentic in accordance with 2B.11 only when the 'Validate & Loci<" bullon has been selected and all errors (i.e.. those highlighted in red) have been corrected. The 'Validate & LocI<- bullon will change to -LocI<ed" after the data validation process has bean successfully completed and the fonn is ready for submission.

Form Locked on:IFeb 13. 2014 at 1:56:15 PM I I Save \\0 Local PC I I Print this Report I Single Positive Test Form (version 1.5.0 - January 1. 2014)