ML14057A397

Single Positive Test Form, for Pre-Access, Collected on 12/18/2013

ML14057A397
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-006, PNP 2014-016
Download: ML14057A397 (1)

Text

" ,' L J S. N FFD Proglam F)elfollllclllCC Data Repoltlng System -'->111\]10 I-'OSIII'!I' lost I Oil' , ,'" 1 ! D Submi.slon Update Select Facility Ipalisades

[50-2551 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)?-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_ ...... _ ____ "oI .. 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 Sp ed ali.t I bd ..... @entergy.com 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 I I Print this Report Single Positive Test Form (version 1 , 5.0 -January 1. 2014)