ML18060A246

Single Positive Test Form, Random, Collected on 10/16/17

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)

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, .1 U.S.NRC ' FFD Program Performance Data Reporting System I'-' NRC Form 890 Singl e P os1t1ve Test F o rm I, ,, ,, '\.u I k, " -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: CLEARANC E N O. 3 1 50-01 46 E X P I RE S: 11 1 30/2017 2) Entries in some fields auto--populate informaUon in other field s Estimated burden per response to co mply with this co lle ction reque st 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 info rmati on is required by NRC to obtain on an annual basis site speci fi c fitness-for

-duty (F FO) program performance data on drug and alcoho l p r ograms from lice n sees and other D Submission D ~~~e~~ssion entities. Send comments regarding burden estimate to the FOIA , Privacy and Information U pdate Collection Bran c h (T5-F53), U.S. Nuclear Regula t ory Comm i ssion , Washington DC 20555-0001 , or by e-mail to lnfocoUects Resource@NRC gov. and to the Desk Officer , Unlaue Reference ID /Lice n se Suoo li ed\ Office of Inform atio n and Regulatory Affairs , NEDB-1020. (3150-0146), Office o f IIPEC 2017-009 I Management and Budget , Washington DC 20503. If a means used to i mpose information collection does not display a cu r rently valid 0MB control number , the NRC may n o t co n duct or sponsor , and a person is not requ ire d to respond to , the information collection. Select Fac/1/ty I Indian Po i nt [50-247; 50-286) I Date of Collect i on I (mm/dd/yyyy) 10/1 6/2017 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 (ge neral 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 con fi rmed positive for this individual?

I 1 I Substance-26.717(b)(2)

& (b)(6) UseNRC Initial Co nfirmatory Umitof Cutoffs? Cuto ff Cutoff Detection jcocaine I lc;J Subversion Attempt* Did this collection involve a subversion attemp t?-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 (N R C M in imum or Licensee Adm i nistrated) INRC M i nimum I Specific Sanction Applied 114-Day Denial I Person(s)

Responsible for Information Provided Person 1 (requi re d): I Kelly I I Pettu s I l sr. Secun1y Coordinator , Access/FFD I kpettus@entergy

.com F i r st Name Last Name Position Title Company Ema il Address P erson 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 consi der this form authentic in accordance with 10 CFR 26.11 only when the "Vali dat e & lock" button is clicked and all errors (highlighted in r ed) hav e been corrected. The " Validate & lock" butto n will change to " Locked" a ft er the data validation proces s ha s been success fully completed indicating the form is r eady for submission. -Form Locked On:!Feb 15 , 2018 at 10: 35: 12 AM [ I Save to Loca l P C 11 Print t h i s R ep o rt I Single Positive T est Form (version 1.7.0 December 2016) NRC Form 890 (12/2014)