Text

Single Positive Test Form, for Pre Access, Collected on 10/15/2013
	ML14057A393
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-003, PNP 2014-016
	Download: ML14057A393 (1)
	v • d • e

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li'*st I ( Iii D Submission o Delete -Updete Submission f) All tI.,rIo aN ,..,111,._

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Unique Reference Number (Weensee Supplied)

/>OfHIWod Info _""", tI-. 12013-PAl-003 I ,}u..A_R_'.,._""IIII.""", ... of} Hold your mouN tN.,. fotm ""d to vI .. ..."",.1rIIom:aefon.

Select Facility Ipalisades

[50-255] I Date of Collection (mmiddlyyyy) 11 0/15/2013 I R ** on for T_nll-26.717(b)(5)

Pr&-Access Testing Reason (optional)

Please elaborete (optional)

I Pre-Access I IUpdate Authorization I I I Employment Type -26.717(b)(3)

ILicensee Employee I Labo, Cat.goIy -26.717(b)(3)

ISecurity I Rerun/-26.717(b)(7)

& 26.75 E:J was this collection refused (yes t No)? Te" Re.ull8 -26.717(b)(4)

Test Validity IVaiid I Test Type(s) for Result(s)

Reported -26.717(b)(2)

Drug Testing !Drugonly I IUrine I W .. thl. coli_on observed (ye.1 No)? -26.717(b)(7)

& 26.75 INO I Substance

-26.717(b)(2)

& (b)(6) Addltlon.'

SulJaUnce ( ** applicable)

Additional Substance (a. eppllcable)

IAmphetamines I IPlease Select I I Please Select I Use NRC Cutoff (Yes I No)? Is thIs a UHourReportlnll Evenf (Yu/No)? -

SubversIon A_pta -26.717(b)(7) and 26.75(b) D i d this collection inyolve a subversion attempt (yesINo)?

INO I MMr/Jf1ement Acf/on. -26.717(b)(6)

& 26.75 Reason for the Action IFirst drug or alcohol positive I Sanction Applied (NRC Minimum or Ucens .. Adm i nistrated) INRC Minimum I Specific Sanction Applied /14-Day Denial I Peraon{.)

Re.pon.lbI.

for 'nfonn"'on ProvIded Penson 1 (reqJtr,d)

len,n F i rst Name List Name IlsuPervisor. Aoce ** AulhortzationIFFO PositionTrtle I bnlbideQenterl/Y

.com Company Email Addres. Person 2 (option.l)

IBam Ilooman II Ue .. slng Spatlalls1 I bdotson@enle'l/Y

.eom First Name Last Name Position lide C ompany E mail Addross Flnel Step (RequIred)

NRC will consider this form authentic in accordance with 26.11 only when tha 'Validate

& Lock" button has b""n selected and all errors (i.e .. those highlighted in red) have b""n corrected.

The 'Validate

& Lock" button will change to "L ocked" after the data val i dation process has been successfully complated and the form is roaely for submission.

_ Form LoCkedOn:IFeb 13,2014 at 1:50: 11 PM I I Save to Local PC I I Prfnt this Report I Singla Positive Test Form (yersion 1.5.0 -January 1, 2014) " U.S.N H(-: f-FO PrO<jIClIll PClfollllCll1ce 0;-]1;-1 System -Sr.1Jlc /)0:':;1;1\/-'