ML18060A238

Single Positive Test Form, for Pre-Access, Collected on 02/27/17

ML18060A238
Person / Time
Site:	Indian Point
Issue date:	02/15/2018
From:	Griffin W, Pettus K Entergy Nuclear Northeast
To:	Office of Nuclear Security and Incident Response
References
IPEC 2017-002, NL-18-011
Download: ML18060A238 (1)

Text

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U.S.NRC '

FFD Program Performance Data Reporting System NRC Form 890 Single Pos1t1ve Test Form I

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1) All fields required exnpt thoH marked 'option*/'

APPROVED BY 0MB: CLEARANCE NO. 31 50-0146 EXPIRES: 11/30/2017

2) Entries in some fields *uto-populate Information In other fields Estimated burden per response to comply with this collection request is 30 minutes. This

3) Mouse over form fields to view *ddltlonal Information form is a voluntary means of reporting the information required under 10 CFR 26.717. The

4) Use of Adobe Reader 8 or later Is required 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 D Submission D ~~~e~~ssion entities. Send comments regarding burden estimate to the FOIA, Privacy and Information Update Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission. Washington DC 20555-0001, or by e-mail to lofocoUects Besource@NBC QOY, and to the Desk Officer, Unlaue Reference ID (License Suoolied)

Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of IIPEC 2017-002 I

Management and Budget, Washington DC 20503. 1f a means used to Impose information collection does not display a currently valid 0MB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

Select Facility I

Indian Point [50-247; 50-286]

I Date of Collection I I

(mmldd/yyyy) 02/2712017 Reason for Testing - 26.717(b)(S)

Pre-Access Testing Reason (optional)

Please elaborate (optional}

I Pre-Access I I Reinstatement (Between 31 and 365 days)

I I

I Employment Type - 26. 717(b)(3)

Outage Worker (optional)?

IContractorNendor I Ives I

Labor Category - 26. 717(b)(3)

I Maintenance (general facility)

I Is this a 24-hour reporting event? - 26.719(b) ~

Was this collect/on refused? - 26.717(b)(7) & 26.75 ~

Test Results - 26.717(b)(4)

Test Type(s) for Result(s) Reported - 26.71 7(b)(2)

Drug Specimen Tested lorug Only I

I Urine I

Test Validity Jvalid I

Was this collect/on observed? - 26. 717(b)(7) & 26. 75 ~

How many substances were confirmed positive for this individual? I 1

I Substance - 26. 717(b)(2) & (b)(6)

Use NRC Initial Confirmatory Limit of Cutoffs?

Cutoff Cutoff Detedion I

Marijuana I

I~

Subversion Attempt

• Did this collection involve a subversion attempt?- 26.717(b)(7) and 26.75(b) I Yes I

D Did not appear for testing D Specimen characteristics (e.g., color, odor, precipitant)

Please elaborate on the choicefsl selected:

D Shy-bladder (no medical condition)

D Invalid test result (initial specimen collected)* 26.18S(f)

This specimen was out of temp range. Sent to lab and D Refused to provide initial specimen D Refused to follow directions returned confirmed positive for Marij..lana.

D Refused to provide second specimen D Donor admitted to subversion attempt Donor agreed to second collection under observation and this specimen was returned as a negative.

181 Specimen temperature (out of range)

D Other D Specimen paraphernalia identified Management Actions - 26.717(b)(8) & 26.75 Reason for the Action I Subversion attempt I

Sanction Applied (NRC Minimum or Licensee Administrated)

INRC Minimum I

Specific Sanction Applied

!Permanent Denial I

Person(s) Responsible for Information Provided Person 1 (required):

I Kelty I

!Pettus I

lsr. Securi1y C00<dinator. Access/FFD I kpettus@entergy.com First Name Last Name Position Title Company Email Address Person 2 (optional):

lwayne I

IGdffin 11 Supervisor, Access/FFD I wgriff1@entergy.com First Name Last Name Position Title Company Email Address 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.

Form Locked On: [Feb 15, 2018 at 10:10:50 AM I I Save to Local PC 11 Print this Report I Single Positive Test Form (version 1.7.0. December 2016)

NRC Form 890 (1212014)