ML14057A392

Single Positive Test Form, for Pre-Access, Collected on 09/09/2013

ML14057A392
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-002, PNP 2014-016
Download: ML14057A392 (1)

Text

" L I.S. N I{ FFD Ploglam Pelfolmallce Deltel I\eportlllg System -!:>ll(]ln l'oSIII":

I t I ,,,I , , O Submission Updato Seleel Facility Ipalisades

[50-255] O Ooleto Submission Rea.on for Tat/ng-26.717(b)(5) 1 Pre-Access Pf&.Access Testing Reason (optionaO Employment Type -26.717(b)(3)

IContractorNendor Labor Cefegory -26.717(b)(3)

IMaintenance (Craft) IUpdate Authorization Refu .. ,-26.717(b)(7)

& 26.75 EJ Was this collection refused (yes' No)? No Test R ** u/ta" 26.717(b)(4)

Test Validity Ivalid Test Type(s) for ResuK(s) Reported -26.717(b)(2)

IDrUgOnly Drug Testing !Urine W ** III/. collodion ON.twd (y ** 1 No)?" 26.717(b)(7)

& 26.75 ... !No ___ ...J Subatance" 26.717(b)(2)

& (b)(6) AddltJonal Sul>a1ance (a. applicable)

!MarijUana

! Please Select U.e NRC Cutoff (Yes I No)? Is 111/. a UHour Reporting Evant (y.slNo)?"

SubversIon A_pr." 26.717(b)(7) and 26.75(b) Did this coHection involve a subversion attempt (yeslNo)?

I ... N_o _____ -' Manltfl8l"ont Ac1Ions* 26.717(b)(6)

& 26.75 Reason for the Action IFirst drug or alcohol positive Sanction Applied (NRC Minimum or Weensee Administrated) !licensee Administrated Specific Sanction Applied 13-Year Denial Person(.)

Reopenalb/e for Inform<<1on Provided Person 1 (required)

.,., f) All"., * .,. teq_ ex ** ". __ od '0"""'. 1J-.'n_rom."., ..... I"nlnf_onl>ol'

...... popoIotod

"' _ rom. ,,<In. J)IINA_R ...... ",_"""".rom.",,,,,,,*-'Y.

4J Hold YOUI' wet'. fonn field to "'.w atld1t1on.1lnfomtallon.

Date of Collection (mmiddlyyyy) 109/912013 Please elaborate (optionaO AddltJonal Sul>a1anca (aa applicable)

Iplease Select IBrian IIRablde..

Iisupervisor. Acea .. Au1horizationlFFO

'----"F"'irs::Ot"NO':acom"'e,-----'

'----TLi;;Cs;;t'iNr;;a;;;me;;;-----'

POSition Tille brab i deGentergy.c am Company Ema il Addres. Person 2 (optional)

1 .. 80_11> ___ ..... ====-___ -'11 ... 0_0 .. _00 __ =====-___ -' '-----..:==..,.",r.;----'

bdotIonllentergy.co m First Name List Name ---....,.C"'om=pa:::n"'y"E"'m:::"

• Ir.Ar::dd

res-=-.

---FInal Sfep (Required) " NRC will consider this form authentic in accordanee with 26.11 only when the "Validate

& Lock" button has been .elected and all errors O.e" thosa h i ghl i ghted 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 i. ready for subm i ss io n. Form Locked On: IFeb 13. 2014 at 1:47:07 PM I Save 10 Local PC I I Prlnl this Report Single Positive Test Form (version 1.5.0" January 1 , 2014)