ML14057A397

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Single Positive Test Form, for Pre-Access, Collected on 12/18/2013
ML14057A397
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-006, PNP 2014-016
Download: ML14057A397 (1)
v • d • e


Text

1201 3-PAL-006 Select Facility j Palisades [50-255]

Date of Collection (mm/ddlyyyy) 112/18/2013 Drug Testing Urine Was this collection observed (Yes/No)? - 26.717(b)(7) & 26.75 No Substance - 26.717(b)(2) & (b)(6(

Additional Substance (as applicable)

I Marijuana UseNRCCutoff (Yes/No)?

Yes I

Please Select Is this a 24-Hour Reporting Event (Yes/No)? -25.71 9(b(INo Subversion Attempts

- 26.717(b)(7) and 26,75(b)

Did this collection involve a subversion attempt (Yes/No)? fro I

Management Actions

- 26.717(b)(8) & 26.75 Reason for the Action I First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Specific Sanction Applied I 3-YearDenial Person(s) Responsible for Information Provided Person I (required);

First Name Last Name Position Title Person 2 (opoonall:

j Barb I lDoE0n Limnsing Spenialist I

bdotaon@entergy.mm first Name L5t Name losition 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 Validale & LociC button will change to LockeE after the data validation process has been successfully completed and the fornr is ready for submission.

Form Locked On:jFeb 13.2014 at 2:02:01 PM Save to Local PC Print this Report_I Submission Delete I) fi tledds are required.avept those marked epdlenaf.

Update Submission

2) &,u in some fan,, fields may result ut informatIon being auto populated into ether farm fields.

Unique Reference Number (Licensee Supplied)

3) Use Adobe Reader S or later fo, this fon,, to omt* prepeety.
4) Hold your mouse ove, a tens field is view addItional intom,adon.

Reason for Testing - 26.717(b)(5(

Pre-Access Pre-Access Testing Reason (optional)

Initial Authorization Employment Type - 26.717(b)(3(

ContractorNendor Labor Category - 26.7 17(b((3)

Maintenance (Craft)

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

No Please elaborate (optional)

Test Results - 26.717(b((4(

Test Validity Valid Test Type(s) for Result(s) Reported - 26.717(b)(2(

Drug Only Additional Substance (as applicable)

[iSeIect I

Brian I

Isupeivisur. Assess Aullrorization/FFD brabide@enteroy.mm Company Email Address Single Positive Test Form (version 1.5.0 - January 1, 2014)

",' LJS. N I~ (~

FFD Proglam F)elfollllclllCC Data Repoltlng System

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D Submi.slon Update 2013-PAL~06 Select Facility Ipalisades [50-2551 D~r:sslon R..... n fo, TMltnll - 26.717(b)(5)

I Pre-Access P.... Acce ** Testing Reason (optional)

Employment Ty". - 26,717(b)(3)

IContractorNendor Ubor CarillOI)' - 26.717(b)(3)

IMaintenance (Craft)

Iinitial Authorization Refu.., - 26,717(b)(7) & 26.75 r.;::----]

Was this collection refused (Yes I No)? ~

Teat Reau/t8 - 26.717(b)(4)

Te.t Validity IVaiid Te.t Type(.) for Resutt(.) Reported - 26,717(b)(2)

IDrugOnly Drug Testing IUrine W.. III/. coli_on observed (ye.' No)? - 26,717(b)(7) & 26.75 LIN_o __ --'

Substance - 26.717(b)(2) & (b)(6)

Addltlon.' Substance (.a app/te."/.)

IMarijuana Iplease Select Use NRC Cutoff (Yes I No)? ~

1.111/. a UHour Reporting Evwnt (YasINo)? - 26.719(b)~

Su"vers/on Aflempm - 26.717(b)(7) and 26,75(b)

Did this co.action involve a.ubversion allempl (Yes/No)? LIN_o _____

.....J Management Action *

  • 26.717(b)(8) & 26.75 Reason for the Action IFirst drug or akohol positive Sanction Applied (NRC Minimum or Licen.ee Administrated)

ILicensee Administrated Specific Sanction Applied 13-Year Denial Pe,.on(a, Raapon.'. fo, InformatIon Provided Person 1 (required):

1}1II1f1 _

_.......-.xcopt_..-.., *opf/oMl".

lJ_tn....... _".,,,. __ tn_...... _

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1}IIHA_R._'OI'_frwthl._to __

4) HoId)'Out' mouu O¥". fotm "eld to vI.w.dd1IIanallntonn.tIon.

Date 01 Collection (mmiddlyyyy) 112118/201 3 Please elaborate (optional)

Additional Su_nca (ee appl/ca"/e)

I Please Select LIBri_an __ -.===,--__ ---J1 LIR_._bl_d._._"_r.:===-___

.....J L ___....-:===::-__ --' brebtde@entergy.com First Name Last Name

C"'o-m-p-a-n-y-=E"'m-a"'il-:A"d"'dre-ss----

Person 2 (opUonaJ):

IBarb liDo....

Ilu ** n'lng Spedali.t I bd..... @entergy.com L-------~F~"~~~NT.am=e,..-------JL-------TLa~.t~Nr.a~me~------.....J~------,p~o~.~ffiO'-n~TI~lij'-e-------J-------CO~m==pe~n~y*E~m~~3

.I~A~dd~re~s~s-------

FInal Step (Roqulrad)

  • NRC win con.ider this lonn authentic in accordance with 26.11 only when the 'Validate & Lock" bullon has been.elected and all errors (i.e.. tho.e highlighted in red) have been corrected. The "Validate & Lock" bullon will change to "Locked' aller the data validation proce.s has been.ucces.fully completed and the form is ready for submission.

Form Locked On:IFeb 13, 2014 812:02:01 PM I Save to Local PC II Print this Report Single Positive Test Form (version 1,5.0 - January 1. 2014)

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