ML14057A398

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

ML14057A398
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-007, PNP 2014-016
Download: ML14057A398 (1)

Text

Unique Reference Number (Ucensee Supplied>

201 3-PAL-007 Select Facility Palisades [50-255]

Date of Collection (mnr/dd/yyyy) [i 2/18/2013 Use NRC Cutoff (Yes I No)? IYes Is this a 24-Hour Reporting Event (Yes/No)? - 26.71 9(b)I No Subversion Attempts - 26.717(b)(7) and 26.75(b)

Drug Testing Urine Did this collection involve a subversion attempt (Yes/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 Specific Sanction Applied 3-Year Denial First Name Last Name Position Trite Person 2 (optional>:

Urens.rg Spesratst bdotsonl5entergy.corr First Name Last Name Position Title Company Email Address Final Step (Required) - NRC will consider this loris authevtic in accordance with 26.11 only when the Validate & Lock button has been selected and all errors (i.e., those high5ghted in red) have been corrected. The Validate & Lock button will cliange to Locked after the data validation process has been successfully completed and the form is ready for submission.

Locked Form Locked On:IFeb 13, 2014at 2:03:55 PM Save to Local PC Print this Report fl Submission Delete I),4Jl fields are required except those mashed optional Update Submission

2) Ent,iea in some ferns fields may result in information being auto populated into other term fields.

3)5/,. Adobe Reader Bar later for this form to.soe*proporly.

4) Held your mouse osera torn, field to Wew additional lnfo,mation.

Reason for Testing-26,717(b))5)

Pre-Access Testing Reason (optional)

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

ContractorNendor Labor Category - 26.71 7(b)(3)

Maintenance (Craft>

Please elaborate (optional)

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

- 26.7 17(bl(2)

Drug Only Was this collection observed (Yes/No)? - 26.717)b)(7( & 2675 INo Substance - 26717)b))21 & (b)(6)

Additional Substance (as applicable)

Marijuana I

Please Select Additional Substance (as applicable)

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

I° IRsbdeohi Barb Dvtson I Superesar, PxroSsAuthonZstisnlpFO brubidoootergysoei Company Email Address Sirigte Positive Test Form (version 15.0- January 1, 2014)

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Unique Reference Number (Ucansaa SIJI)Pliedl

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12013-PAL-007 I

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Select Facility Ipalisades [50-255]

I Date 01 Collaction (mmiddlyyyy) 112118/2013 I R.. aon for T_nt/ - 26.717(b)(5)

P.... Access Testing Raeson (optionaQ Plaese elaborate (optional)

I Pre-Access I Iinitial Authorization I

I I

Employment Type - 26.717(b)(3)

IcontractorNendor I

I.abor Ca1ef101Y-26.717(b)(3)

IMaintenance (Craft)

I Refuaa/

• 26.717(b)(7) & 26.75

~

Was this collection refusod (yos' No)?

Tuf R.. ub - 26.717(b)(4)

Test Validity IVaiid I

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

Drug Testing IDrugonly I

IUrine I

We.ttl/a collection aba.1Wd (Yu I No}1 - 26.717(b)(7) & 26.75 INo I

Suba1ance - 26.717(b)(2) & (b)(6)

Addltlona' Suba1ance (a. appllcab'e)

Additional Subatenee (u applicable)

IMarijuana I

/Please Select I

/Please Select I

Use NRC Cutoff (yes' No)? ~

I. thl ** Z4-HourReportlnt/ EII8n1 (Y *.mo}1 - 26.719(b)~

Sub"",'on Attempta - 26.717(b)(7) and 26.75(b)

Did this coRaction involve a subvorsion attempt (Yes/No)? INO I

""'ef18tJl8n1 A_. - 26.717(b)(8) & 26.75 Roason lor the Action IFirst drug or alcohol positive I

Sanction Applied (NRC Minimum or Ucens.. Administrated)

ILicensee Administrated I

Specific Sanction Appliod 13-Year Denial I

Person(a} Reapona/b/. for Inform81lon Provided Person 1 (required):

IBrion IIR.b~.U IlsuPervisor. Aoce.. Authoriz._FD I bnlbide,;.ntefgy.com First Name cast Name PositionTltla Company Email Address Person 2 (optional):

IBam

!leomon Iluconli1D Sp.cllllst I

bdotson@ent~rgy.com First Name LSstName t'osition nus Company Email Address Flnel sr.p (Required) - NRC will consider this form authentic in accordance with 26.11 only when the "Validate & Lock" bulton has been selected and all errors (i.e.* those highNghted in red) have been corrected. The "Validate & Lock" button will change to "Locked" alter the data validation procass has boan successtuny completed and the form is ready for submission.

Form Locked On: I Feb 13, 2014 at 2:03:55 PM I I

Seve to Local PC II Print this Report I Single Positive Test Form (version 1.5.0 - January 1, 2014)