ML18060A249

Single Positive Test Form, for Pre-Access, Collected on 12/18/17

ML18060A249
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 2017-0012, NL-18-011
Download: ML18060A249 (1)

Text

. l U.S.NRC '

FFD Program Performance Data Reporting System NRG F orm 890 Sin gle P os1t1ve T est F o rm

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1) All fields r&quired except those marlced 'optJonal' APPROVED BY 0MB: CLEARANCE NO. 31 50-0146 EXPIRES: 11/30/2017

2) Entries in some fields *uto*,populate Information In other fields Estimated burden per response to compfy 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

.f) Use of Adobe Readw a or later I* r~ulred 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 Regulatory Commission, Washington DC Update 20555-0001, or by e-mail to lntocoUects Bcsource@NBC QOY, and to the Desk Officer, Uniaue Reference ID {License Suoolied)

Office of Information and Regulatory Affairs, NEOB-1020, (3150-01 46), Office of IIPEC 2017-0012 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; 50-206)

I Date of Collect/on I (mm/dd/yyyy) 12/1B/2017 1 Reason for Testing

• 26. 717(b)(5)

Pre-Access Testing Reason (optional)

Please elaborate (optional)

I Pre-Access I I Initial Authorization I

I I

Employment Type - 26.717(b)(3)

Outage Worker (optional)?

\\contractorNendor I !No 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 jorug Only I

junne I

Test Validity Jvalid I

Was this collect/on 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 Limit of Cutoffs?

Cutoff Cutoff Detection

!Marijuana I

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) lucensee Administrated I

Specific Sanction Applied 13-Year Denial I

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

I Kelly I I Pettus I ls,-Securi1y Coordina10<, Access/FFD I kpettus@enterfff.com First Name Last Name Position Title Company Email Address Person 2 (optional):

lwayne I !Griffin 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 & 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 10:44:16 AM I J Save to Local PC 11 Print this Report I Single Positive Test Form (version 1.7.0. December 2016)

NRC Form 890 (1212014)