ML18060A239

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

ML18060A239
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 2017-003, NL-18-011
Download: ML18060A239 (1)

Text

, l U.S.NRC \\

FFD Program Performance Data Reporting System NRC Form 890. Single Pos1t1ve Test Form l,

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l'r,,lt'I flll}: />c*oplc mu/ tltr I tu,r""""' 111 1 E.11::_ C,eneral Submission Portal 1

1) All fields required except those marlutd 'optional' APPROVED BY 0MB: CLEARANCE NO. 3150-0146 EXPIRES: 11/30/2017

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

3) Mouse over fonn fields to view additional 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 (FFO) 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 FOlA, Privacy and Information Update Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to lofocollects Resource@NBC gov. and to the Desk Officer, Unique Reference ID (License Suoolied)

Office of Information and Regulatory Affairs, NEOB-1020, (3150-01 46), Office of Management and Budget, Washington DC 20503. lf a means used to impose information IIPEC 2017-003 I

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 Fac/1/ty I

Indian Point (50-247; 50-286)

I Date of Collect/on I 0212712017 I (mm/dd/yyyy)

Reason for Testing - 26.717(b)(5)

Pre-Access Testing Reason (optional)

Please elaborate (optional)

I Pre-Access I I Initial Authorization I

I I

Employment Type - 26.717(b)(3)

Outage Worker (optional)?

IContractorNendor I Jves I

Labor Category - 26.717(b)(3)

I Maintenance (general facility)

I Is this a 24-hour reporting event? - 26. 719(b) ~

Was this collection refused? - 26 717(b)(7) & 26.75 ~

Test Results - 26.717(b)(4)

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

Drug Specimen Tested I

Drug Only I

IUrine I

Test Validity lvalid I

Was this collection 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)

UseNRC Initial Confirmatory limit of Cutoffs?

Cutoff Cutoff Detection

!Marijuana I

IGJ Subversion Attempt

• Did this collection involve a subversion attempt?- 26.717(b)(7) and 26.75(b) I No I

Management Actions - 26.717(b)(8) & 26.75 Reason for the Action I

First drug or alcohol positive I

Sanction Applied (NRC Minimum or Licensee Administrated) jLicensee Administrated I

Specific Sanction Applied 13-Year Denial I

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

I Kelly I

!Pettus I lsr. Security Coordinator, Access/FFD I kpettus@entergy.com First Name Last Name Position Title Company Email Address Person 2 (optional):

!Wayne I !Griffin I I 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 1 O CFR 26.11 only when the -Validate & Lock* button is clicked and al1 errors (highlighted in red) have been corrected. The "Validate & Lock" button wilt change to "Locked" after the data validation process has been successfully completed indicating the form is ready for submission.

FormlockedOn:jFeb15, 2018at10:11 :37AMI I Save to Local PC 11 Print this Report I Single Positive Test Form (version 1.7.0- December 2016)

NRC Form 890 (12/2014)