ML18060A248

Single Positive Test Form, for Cause, Collected on 12/13/17

ML18060A248
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 2017-0011, NL-18-011
Download: ML18060A248 (1)

Text

.1 U.S.NRC '

FFD Program Performance Data Reporting System NRC Form 890, Single Pos1t1ve Test Form 1,

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1EIE General Submission Portal1

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1) All fields required except tho&e marked 'optlom,r APPROVED BY 0MB: CLEARANCE NO, 3150-0146 EXPIRES: 11/30/2017

2) Entries In some flelds 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 B 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 D Submission D ~~~e~~ssion entities. Send comments regarding burden estimate to the FOIA, Privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regutatory Commission, Washington DC Update 20555-0001, or by e-mail to lofocoUects Besource@NBC gov. and to the Desk Officer, Unlaue Reference ID (License Suoolied)

Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of IIPEC 2017-0011 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) 12/13/2017 1 Reason for Testing

• 26.717(b)(5)

For Cause Testing Reason Please elaborate (optional)

!For Cause I

!observed Behavior I

I Employment Type - 26.717(b)(3)

Outage Worker (optional)?

I Licensee Employee 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 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 I Drug Only I I Urine 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 2

I Substance. 26.717(b)(2) & (b)(6)

UseNRC Initial Confirmatory Limit of Cutoffs?

Cutoff Cutoff Detection

!cocaine I

~

lopia1e: Morphine I

~

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)

JNRC Minimum I

Specific Sanction Applied 114-Day Denial I

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

!Kelty I I Pettus I lsr. Security Coordinator, Access/FFD I kpettus@entergy.com First Name Last Name Position Title Company Email Address Person 2 (optional):

lwayne IIGriffin I I supervisor, Access/FFD 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 & l ock* button is clicked and all errors (highlighted in red) have been corrected. The *validate & lock" button will change to *l ocked" after the data validation process has been successfully completed indicating the form is ready to, submission.

Form Locked On:IFeb 15, 2018 at 10:42:27 AM I I Save to Local PC 11 Print this Report I Single Positive Test Form (version 1.7.0 - December 2016)

NRG Form 890 (1212014)