ML18060A247

Single Positive Test Form, for Pre-Access, Collected on 12/12/17

ML18060A247
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 2017-0010, NL-18-011
Download: ML18060A247 (1)

Text

. l U.S.NRC '

FFD Program Performance Data Reporting System NRC Form 890 Single Pos1t1ve Test Form h,.

l'rolt'1llllJ: /1,011/t'multht' I 111,r,,11m,111 1EII::.. r>eneral Subrrnss1on Portal

1) AJI fields requirN except those marked 'optional' APPROVED BY 0MB: CLEARANCE NO, 3150-'>146 EXPIRES: 11/30/2017 Z) Entries in some fields auto-populate Information in oth.,- fields Estimated burden per response to comply with this collection request is 30 minutes. This

3) Mouse over form fields to view *dditional Information form is a voluntary means of reporting the information required under 10 CFR 26.717. The

4) Use of Adobe Reader 3 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 lnfocoOects Resourcc@NRC gov, and to the Desk Officer, Unlc,ue Reference ID (License Supplied)

Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of IIPEC 2017-0010 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 (mmldd/yyyy) 12/12/2017 I Reason for Testing - 26.717(b)(5)

Pre-Access Testing Reason (optional)

Please elaborate (optional)

I Pre-Access I

I Reinstatement (Between 31 and 365 days)

I I

I Employment Type - 26.717(b)(3)

Outage Worker (optional)?

IContractorNendor I INo I

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

I Maintenance (general facility)

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

IUrine I

Test Validity

!valid 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)

Use NRC Initial Confirmatory Umitof 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) j Yes I

D Did not appear for testing D Specimen characteristics (e.g., color, odor, precipitant)

Please elaborate on the choice(s) selected:

D Shy-bladder (no medical condition) 181 Invalid test result (initial specimen collected) - 26.185(n Initial specimen collected was returned from lab as invalid.

D Refused to provide initial specimen D Refused to follow directions Donor agreed to observed collection. Second collection which was an observed collection was confirmed positive D Refused to provide second specimen D Donor admitted to subversion attempt for marijuana. MRO deemed first collection a subversion attempt.

D Specimen temperature (out of range)

OOther D Specimen paraphernalia identified Management Actions - 26.717(b)(8) & 26.75 Reason for the Action I subversion attempt I

Sanction Applied (NRC Minimum or Licensee Administrated)

INRC Minimum I

Specific Sanction Applied I

Permanent Denial I

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

I Kelty I I Pettus I lsr. Secudty Coordinator, Access/FFO I kpettus@enlergy.com First Name Last Name Position Title Company Email Address Person 2 (optional}:

lwayne IIGriffin I I supervisor, Access/FFO 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:IFeb 15, 2018 at 10:41 :04 AM I I Save to Local P C 11 Print this Report I Single Positive Test Form (version 1.7.0 - December 2016)

NRC Form 890 (12/2014)