ML18058A907
| ML18058A907 | |
| Person / Time | |
|---|---|
| Site: | Palisades  |
| Issue date: | 02/14/2017 |
| From: | Dotson B, Rabideau B Entergy Nuclear Operations |
| To: | Document Control Desk, Office of Nuclear Security and Incident Response |
| Shared Package | |
| ML18058A902 | List: |
| References | |
| 2017-PAL-001 | |
| Download: ML18058A907 (1) | |
Text
Select Facility Palisades [50-255]
Reason for Testing - 26.717(b)(5)
Pre-Access Pre-Access Testing Reason (optional)
Initial Authorization Please elaborate (optional)
Employment Type - 26.717(b)(3)
Contractor/Vendor Labor Category - 26.717(b)(3)
Facility Support Was this collection refused? - 26.717(b)(7) & 26.75 Test Results - 26.717(b)(4)
Test Validity Valid Test Type(s) for Result(s) Reported - 26.717(b)(2)
Drug Only Drug Specimen Tested Urine Was this collection observed? - 26.717(b)(7) & 26.75 Management Actions - 26.717(b)(8) & 26.75 Specific Sanction Applied 3-Year Denial Save to Local PC Print this Report Unique Reference ID (License Supplied) 2017-PAL-001
- 1) All fields required except those marked 'optional'
- 2) Entries in some fields auto-populate information in other fields
- 3) Mouse over form fields to view additional information
- 4) Use of Adobe Reader 8 or later is required No No 01/25/2017 Submission Update Person(s) Responsible for Information Provided Company Email Address brabide@entergy.com First Name Brian Position Title Supervisor Access Authorization/FFD Position Title Licensing Specialist First Name Barb Last Name Dotson Last Name Rabideau Company Email Address bdotson@entergy.com Person 1 (required):
Person 2 (optional):
Single Positive Test Form (version 1.7.0 - December 2016)
Final Step (Required) - NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the Validate & Lock button is clicked and all errors (highlighted in red) have been corrected. The Validate & Lock button will change to Locked after the data validation process has been successfully completed indicating the form is ready for submission.
Locked Form Locked On: Feb 14, 2017 at 1:55:58 PM Reason for the Action First drug or alcohol positive Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b)
No Subversion Attempt -
Sanction Applied (NRC Minimum or Licensee Administrated)
Licensee Administrated Delete Submission FFD Program Performance Data Reporting System APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 11/30/2017 Estimated burden per response to comply with this collection request is 30 minutes. This form is a voluntary means of reporting the information required under 10 CFR 26.717. The information is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFD) program performance data on drug and alcohol programs from licensees and other entities. Send comments regarding burden estimate to the FOIA, Privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.
NRC Form 890, Single Positive Test Form (EIE General Submission Portal)
NRC Form 890 (12/2014)
Is this a 24-hour reporting event? - 26.719(b)
No No How many substances were confirmed positive for this individual?
1 Substance - 26.717(b)(2) & (b)(6)
Use NRC Cutoffs?
Initial Cutoff Confirmatory Cutoff Limit of Detection Marijuana Yes Date of Collection (mm/dd/yyyy)
Outage Worker (optional)?