ML18060A241

Single Positive Test Form, for Pre-Access, Collected on 03/02/17

ML18060A241
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 2017-004, NL-18-011
Download: ML18060A241 (1)

Text

.-1 U.S.NRC '

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

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1 EI E General Submission Portal)

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

2) Entries In sonNt fields auto-populate Information In other fields Estimated burden per respon se to comply with this collection request is 30 minutes. This

3) Mouse over form 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 FOIA, Privacy and Information Update Collection Branch (TS-F53). U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to lofocoUects Resource@NRC ODY, and to the Desk Officer, Un/Que Reference ID (License Supplied)

Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of IIPEC 2017-004 I

Management and Budget, Washington DC 20503. If 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 Dato of Collect/on I 0310212017 \\

(mmldd/yyyy)

Reason for Testing - 26.717(b)(5)

Pre-Access Testing Reason (optional)

Please elaborate (optional)

I Pre-Access I

!Initial Authorization I

I I

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

Outage Worker (optional)?

lcontractorNendor 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 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 lorug Only I

jurine I

Test Validity lvalid I

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

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

I Substance - 26.717(b)(2) & (b)(6)

Use NRC Initial Confirmatory Limit of Cutoffs?

Cutoff Cutoff Detection I

Marijuana I

I~

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)(B) & 26. 75 Reason for the Action I

second drug or alcohol positive I

Sanction Applied (NRC Minimum or Licensee Administrated)

I Licensee Administrated I

Specific Sanction Applied jPermanent Denial I

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

I Kelly I

!Pettus I ls,. Secur;ty Coord;nator, Access/FFD kpettus@entergy.com First Name Last Name Position Title Company Email Address Person 2 (optional):

lwayne I

IG,;ffin I lsupeiv;sor. Access/FFD I wgr;ff1@entergy.com First Name Last Name Position Title Company Email Address Final Step (Required)

• NRG 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.

FormlockedOn:IFeb15, 2018at 10:13:16AMI J Save to Local PC J J Print this Report I Single Positive Test Form (version 1.7.0 - December 2016)

NRC Form 890 (12/2014)