ML14057A392

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Single Positive Test Form, for Pre-Access, Collected on 09/09/2013
ML14057A392
Person / Time
Site: Palisades Entergy icon.png
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:
References
2013-PAL-002, PNP 2014-016
Download: ML14057A392 (1)
v • d • e


Text

Unique Reference Number (Licensee Supplied) 201 3-PAL-002 Select Facility Palisades [50-255]

Date of Collection (mm/dd/yyyy) 09/9/2013 Reason for Testing - 26.71 7(b)(5)

Pre-Access Employment Type -26.71 7(b)(3)

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

Maintenance (Craft)

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

No Test Results - 26.717(b)(4)

Test Validity

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

- 26.717(b((2(

[ Drug Only Drug Testing Urine Was this collection observed (Yes / No)? -26.71 7)b))7) & 26.75 [No Substance - 26.717)b))2) & )b)(6)

Additional Substance (as applicable)

Marijuana Please select Use NRC Cutoff (Yen / No)? Iyes Is this a 24-Hour Reporting Event (Yes/No)? -26.71 9)b)JNo Subversion Attempts - 26.717(b)(7) and 26.75(b)

Did this collection 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 Specitic Sanction Applied

[ 3-Year Denial I [supervisor. Assess AUiOsiFFO First Name Last Name Position Title Person 2 (optional) j Barb lootson ms0utsitgsr bdotsoo@ent,rgy,sorn First name Last name ioslson line i.ompany Email AoOress Final Step (Required)

- NRC mill consider this form authentic in accordance with 26.11 only when the Validate & LocIc button has been selected and all errOrs (i.e., those highlighted in red) have been corrected. The Validate & Lock button wit change to Locked after the data validation process has been successfully completed and the form is ready for submission.

ke Form Locked On:IFeb 13. 2014 at 1:47:07 PM Save to Local PC Print thIs Report

[E Submission Delete All fields are required except those marked optional.

Update Submission

2) Enleies in,o,ne fern, field, may moult in Information being auto-populated into ether form field,.
3) Use Adobe Reader S or later for this fern, to work properly.
4) Hold your mouse over. form field to ricer additional mlonnathnn.

Pro-Access Testing Reason (optional)

Please elaborate (optional)

Iupdate Authorization I

Additional Substance (as applicable)

I Please Select Person(s) Responsible for Information Provided Person 1 (reqsired):

Company Email Address Single Positive Test Form )version 1.5.0

- January 1,2014)

" L I.S. N I{ C~

FFD Ploglam Pelfolmallce Deltel I\\eportlllg System

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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)? " 26.719(b)~

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):

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

Iplease Select IBrian IIRablde..

Iisupervisor. Acea.. Au1horizationlFFO

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POSition Tille brabideGentergy.cam Company Email Addres.

Person 2 (optional):

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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 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 i. ready for submission.

Form Locked On:IFeb 13. 2014 at 1:47:07 PM I Save 10 Local PC II Prlnl this Report Single Positive Test Form (version 1.5.0" January 1, 2014)

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