ML18060A244

Single Positive Test Form, for Pre-Access, Collected on 10/11/17

ML18060A244
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 2017-007, NL-18-011
Download: ML18060A244 (1)

Text

.1 U.S.NRC \\

FFD Program Performance Data Reporting System I '-.,

NRC F o rm 890. Single P o s1t1ve Tes t Form 1,

I'-,,,\\.ul,"k' 11, l'r111t*1flllf;f l'coph.: mullltt* fmrr,,mu,,u (EIE General Subn11ss1on Portal)

1) All llelds required except those marlced '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 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 (FFD) program performance data on drug and alcohol programs from licensees and other 0 Submission D ~~~e!~ssion entities. Send comments regarding burden estimate to the FOIA, Privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC Update 20555-0001, or by e-mail to lofocollects Resource@NRC gov, and to the Desk Officer, Unique Reference ID (License Supplied)

Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of IIPEC 2017-007 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 Facllity

!Indian Point [50-247; 50-286)

I Date of Collection I (mmlddlyyyy) 1011112017 I Reason for Testing. 26.717(b)(5)

Pre-Access Testing Reason (optional)

Please elaborate (optional)

!Pre-Access I I Initial Authorization I

I I

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

Outage Worker (optional)?

IContractorNendor I !No I

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

!Facility Support 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

Junne I

Test Validity jvalid 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 I

Marijuana I

I~

Subversion Attempt* Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b) [

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 Pro~lded Person 1 (required):

I Kelly I

I Pettus I is'- Security Coordinato,, Access/FFD I kpettus@entergy.com First Name Last Name Position Title Company Email Address Person 2 (optional):

lwayne I IGdffin I lsupe,viso,, Access/FFD I wg,iff1@ente,gy.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:jFeb 15, 2018 at 10:34:05 AM I I Save to Local PC 1 1 Print this Report I Single Positive Test Form (version 1.7.0 - December 2016)

NRG Form 890 (12/2014)