ML18060A246
| ML18060A246 | |
| 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 2017-009, NL-18-011 | |
| Download: ML18060A246 (1) | |
Text
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.1 U.S.NRC '
FFD Program Performance Data Reporting System I '-'
NRC Form 890 Single Pos1t1ve Test Form I,
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1EIE General Submission Portal1 l'r11t1*, t111g l'1*oph' mul the I m,r111u1t1,,,
- 1) All fields required except those marked 'opUonal' APPROVED BY 0MB: CLEARANCE NO. 3150-01 46 EXPIRES: 11130/2017
- 2) Entries in some fields auto--populate informaUon 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 (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 lnfocoUects Resource@NRC gov. and to the Desk Officer, Unlaue Reference ID /License Suoolied\\
Office of Information and Regulatory Affairs, NEDB-1020. (3150-0146), Office of IIPEC 2017-009 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 Fac/1/ty I
Indian Point [50-247; 50-286)
I Date of Collection I (mm/dd/yyyy) 10/16/2017 I Reason for Testing - 26.717(bl(5)
Please elaborate (optional)
I Random I I I
Employment Type - 26. 717(b)(3)
Outage Worker (optional) ?
I Licensee Employee I
INo I
Labor Category - 26.717(bl(3)
I Maintenance (general facility)
I Is this a 24-hour reporting event? - 26. 719(b) ~
Was this collection refused? - 26.717(bl(7) & 26.75 ~
Test Results - 26.717(b)(4)
Test Type(s) for Result(s) Reported* 26.717(bl(2)
Drug Specimen Tested lonug Only I
junne 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 Umitof Cutoffs?
Cutoff Cutoff Detection jcocaine I
lc;J 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)
INRC Minimum I
Specific Sanction Applied 114-Day Denial I
Person(s) Responsible for Information Provided Person 1 (required):
I Kelly I I Pettus I lsr. Secun1y Coordinator, Access/FFD I kpettus@entergy.com First Name Last Name Position Title Company Email Address Person 2 (optional):
lwayne IIGriffin I I supervisor. AccesslFFD 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 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 10:35:12 AM [
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)