ML18060A245
| ML18060A245 | |
| 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 2017-008, NL-18-011 | |
| Download: ML18060A245 (1) | |
Text
-I! US NR C '
FFD Program Performance Data Reporting System
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NRG Form 890 Single Pos1t1ve Test Form l'mlt'<IIIIJl P,*opkaml tlu* I m,romm,u 1EIE. General Subni1ss1on Portal1
- 1) All fields required except those marlced 'optional'
- 2) Entries in some ffelds auto--populat* lnformatlon in other fields
- 3) Mouse over form flelda to view additional Information
- 4) Use of Adobe Read.r I or l*t.r ls r*quired D
Submission Update Uni ue Reference ID License Su lied IPEC 2017-008 Select Fac/1/ty llndian Point(S0-247; 50-286]
APPROVED BY 0 MB: CLEARANCE NO. 3150-01<16 EXPIRES: 11/30/2017 Estimated burden per response to comply with this collection request is 30 minutes. This form is a voluntary means of reporting the information required under 10 CFR 26.717. The 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 entities. Send comments regarding burden estimate to the FOIA, Privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to lofocoUccts Rc:rnurcc@NRC gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of 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.
Date of Collect/on I I
(mm/dd/yyyy) 10/16/2017 Reason for Testing - 26. 717(b)(5)
I Pre-Access Pre-Access Testing Reason (optional)
Please elaborate (optional)
Employment Type - 26. 717(b)(3)
!contractorNendor Labor Category - 26. 717(b)(3)
I Facility Support I
Initial Authorization Outage Worker (optional)?
!No 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 lorugOnly
!Urine I
Test Validity lvalid Was this collect/on obseNed? - 26. 717(b)(7) & 26. 75 ~
How many substances were confirmed positive for this individual? L.I _ _ _ _ _
Substance - 26.717(b)(2) & (b)(6) jMarijuana UseNRC Cutoffs?
Initial Confirmatory Limit of Cutoff Cutoff Detection Subversion Attempt -
Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b) L.I _ _ _
N_o __
Management Actions - 26.717(b)(8) & 26.75 Reason for the Action I
First drug or alcohol positive Sanction Applied (NRG Minimum or Licensee Administrated) jucensee Administrated Specific Sanction Applied 13-Year Denial Person(s) Responsible for Information Provided Person 1 (required):
~'K_e_nv _________ ~j 0\\P_*_ttu_* _________ ~ I Sr. Security Coordinator, Access/FFD First Name Last Name Position Title Person 2 (optional):
kpettus@entergy.com Company Email Address
~lw_*_v_**--=~~----~I L.IG_ri_ffi_* __ ~~~-----'1 lsupervisor, Access/FFD I
wgriff1@entergy.com First Name Last Name
'----P~o-s~i,-io-n"T~it~le ___
_J -----c-o_m_p-an-y~E~m~ ai-1 A~d~d~re_s_s ___ _
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 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 10:34:37 AM I Single Positive Test Form (version 1.7.0 - December 2016)
I Save to Local PC I l Print this Report l NRC Form 890 (12/2014)