ML18060A243

Single Positive Test Form, for Pre-Access, Collected on 07/10/17

ML18060A243
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 2017-006, NL-18-011
Download: ML18060A243 (1)

Text

.l U.S.NRC \\

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

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(E:lf:: General Subm ission Portal1 J,roh'< 1111:: I', t1/th' am/ the I m lf1111111t 111

1) All fields required except those marked 'optional' APPROVED BY 0MB: CLEARANCE NO. 3150-01'6 EXPIRES: 11/30/2017

2) Entries in some fields auto-populate information in other fields Estimated burden per response to compfy 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 (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001. or by e-mail to lofocollects Besouru@NBC goy, and to the Desk Officer, Un/Que Reference ID (license Suoclied)

Office of Information and Regulatory Affairs. NEOB-1020, (3150-0146), Office of IIPEC 201 7-006 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 Date of Collect/on I (mm/dd/yyyy) 7/10/2017 I Reason for Testing - 26.717(b)(5)

Pre-Access Testing Reason (optional)

Ptease elaborate (optional)

I Pre-Access I I Initial Authorization I

I I

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

Outage Worker (optional)?

IContractorNendor I INo I

Labor Category - 26.717(b)(3)

I Facility Support 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 - 26.717(b)(2)

Drug Specimen Tested I

Drug Only I

I Urine 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? I 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)(8) & 26.75 Reason for the Action I

First drug or alcohol positive I

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

Specific Sanction Applied 13-Year Denial I

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

!Kelly I

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

jwayne IIGriffin 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 10 CFR 26.11 only 'Nhen 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:IFeb 15, 2018 at 10:26:32 AM I I Save to Local PC 11 Print this Report I Single Positive Test Fonn (version 1. 7.0 - December 2016)

NRC Form 890 (12/2014)