ML19058A540

Single Positive Test Form Collected on 03/21/2018

ML19058A540
Person / Time
Site:	Wolf Creek
Issue date:	02/19/2019
From:	Black P, Tate M Wolf Creek
To:	Office of Nuclear Security and Incident Response
Shared Package
ML19058A542	List: ML19058A539 ML19058A540 ML19058A541 ML19058A543 ML19058A544 ML19058A545 ML19058A546 ML19058A547 ML19058A548 ML19058A549 ML19058A550 ML19058A551
References
A1-18, RA 19-0030
Download: ML19058A540 (1)

Text

• U.S.NRC \\

FFD Program Performance Data Repor*trng System NRC Fo1*11 -l(*fJ S1 11::ire f'c1s,t1Je Test Fo,111 I '

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1) All field* required except thoH marked 'optlon.r APPROVED BY 0 MB: CLEARANCE NO. 3150-014' EXPIRES: 04/30/2021

2) Entrlu In *ome fields auto-populate Information In oth.,. field*

Estimated burden per response to comply with this collection request Is 30 minutes. This JJ Mouse over form fields to view additional lnformatloo form is a voluntary means of reporting the Information required under 10 CFR 26.417(b){2)

4) Use of AdotH Ruder I or later I* required and 26.717. The information is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFO) program performance data on drug and alcohoi programs from D Submission D ~~~e!~ssion licensees and other entities. Send comments regarding burden estimate to the FOIA.

Update Privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to lofocollects Re1ource:@NRC goy and to the Unlaue Reference ID (Licensee Suonliedl Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-01..S), Office IA1-18 I

of 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 Facility collection.

IWolf Creek [50-482)

I Date of Collect/on I I

(mm/dd/yyyy) 03/21/2018 Reason for Testing - 26.71 7(b)(5)

Please elaborate (optional)

!Random I I I

Employment Type. 26.717(b)(3)

Outage Worker (optlonaQ 7 I

LicenHe Employee I INo I

LaborCategory -26.717(b)(3)

Please elaborate on the Labor Category seleded

!Other I

!Training Instructor I

Is this a 24-hour reportable event under 26. 719(b)7 ~

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)

!Alcohol Only I

Substance-26.717(b)(2) & (b)(6)

!Alcohol I

Alcohol Specimen Tested

!Breath I

What 26.103 BAC level was exceeded?

10.02 and in work status at least 2 hrs 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)

INRC Minimum I

Specific Sanction Applied 114-Day Denial I

Person(s) Responsible for Information Provided Person 1 (requi"ed):

I Pamela I

!alack I

!Access Specialist I

pablack@wcnoe.com First Name Last Name Position Title Company Email Address Person 2 (optional):

I Michael (Kenn)

IITate I

!superintendent Security I mitate@wcnoc.com First Name Last Name Position Title Company Email Address Final Step (Required) - NRC will consider this form authentic in accordance with 1 O CFR 26.11 only when the '\\lalidate & 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 19, 2019 at 4:24:55 PM I I Save to Local PC 11 Print this Report I Single Positive Test Form (version 1.8.0

• April 2018)

NRC Form 890 (12/2014)