ML14118A416

Single Positive Test Form Collected on 02/19/2013

ML14118A416
Person / Time
Site:	Quad Cities
Issue date:	04/28/2014
From:	Exelon Generation Co
To:	Document Control Desk, Office of Nuclear Security and Incident Response
Paul Harris - 287-9294
References
Download: ML14118A416 (1)

Text

NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Please explain the change(s) to the form Note:

Submission Update correction required 1) All fields are required except those marked 'optional'.

2) Entries in some form fields may result in information being auto-Unique Reference Number (Licensee Supplied) populated into other form fields.

3) Use Adobe Reader 8 or later for this form to work properly.

2013-QAD-5 4) Hold your mouse over a form field to view additional information.

Select Facility Quad Cities [50-254; 50-265] Date of Collection (mm/dd/yyyy) 02/19/2013 Reason for Testing - 26.717(b)(5) Pre-Access Testing Reason (optional) Please elaborate (optional)

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

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

Maintenance (Craft)

Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)? Yes Test Results - 26.717(b)(4)

Test Validity Test Type(s) for Result(s) Reported - 26.717(b)(2) Alcohol Testing Drug Testing Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.75 Substance - 26.717(b)(2) & (b)(6) Additional Substance (as applicable) Additional Substance (as applicable)

Use NRC Cutoff (Yes / No)? Use NRC Cutoff (Yes / No)? Use NRC Cutoff (Yes / No)?

Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

Did this collection involve a subversion attempt (Yes/No)? Please elaborate on the choice(s) selected:

Yes Low temp. 86 .4 temp. Stopped collection process due to low temp.

Refused to provide initial specimen Specimen characteristics (e.g., color, odor, precipitant)

Refused to provide second specimen Invalid test result (initial specimen collected) - 26.185(f)

Specimen temperature (out of range) Refused to follow directions Specimen paraphernalia identified Other Management Actions - 26.717(b)(8) & 26.75 Reason for the Action Subversion attempt Sanction Applied (NRC Minimum or Licensee Administrated)

NRC Minimum Specific Sanction Applied Permanent Denial Person(s) Responsible for Information Provided Person 1 (required):

Vicki Farbo FFD Analyst-West vicki.farbo@exeloncorp.com First Name Last Name Position Title Company Email Address Person 2 (optional):

First Name Last Name Position 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 Validate & Lock button will change to Locked after the data validation process has been successfully completed and the form is ready for submission.

Locked Form Locked On: Apr 28, 2014 at 11:38:55 AM Save to Local PC Print this Report Single Positive Test Form version 1.4.0 - Oct 31, 2012