ML19058A541
| ML19058A541 | |
| 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: |
| References | |
| D2-18, RA 19-0030 | |
| Download: ML19058A541 (1) | |
Text
- U.S.NRC '
FFD Program Performance Data Reporting System NRC Fo,111 c/t"J S111gle P o~rtrve Te~t Fo,111 I
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- 1) All fl.,d*,-.quired except those,,,.riced 'optlonaf APPROVED BY 0MB: CLEARANCE NO. 3150-414' EXPIRES: 04/30/2021
- 2) EntrlH In aome fields *uto-populat* 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 fofm is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2)
- 4) Use of Adobe Ruder I or l*ter Is,-qulrad and 26.717. The information is required by NRC to obtain on an annual basis aite apedfic fitness-for-duty (FFO) program performance data on drug and alcohol 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 (TS..F53), U.S. Nuclear Regulatory Comrrission, Washington DC 20555-0001, or by e*mail to lofocoHects Reaource@NRC goy and to the Un/Qua Reference ID /Licensee Suoolied)
Desk Officer, Office of Information and Regulatory Affairs, NEOB--1020, {3150.0146), Office JD2-18 I
of Management and Budget, Washington DC 20503.
If a means used to impose information collection does not display a o.mently valid 0MB control number, the NRC may not conduct or sponsor, and a person la not required to respond to, the lnfonnation Faclllty collection.
IWolf Creek (50-482]
I Date of Collect/on J 04/
8 I (mm/dd/yyyy) 07/201 Reason for Tasting - 26.717(b)(5)
Pr&-Access Testing Reason (optional)
Please elaborate (optional)
IPr&-Access I I Initial Authorization I
I I
Employment Type - 26. 717(b)(3)
Outage Worker (optlonaQ?
IContraclorNendor I Ives I
LaborCata{Jory - 26.717(b)(3)
IMai- (general facility)
I Is this a 24-hour reportable event under 26. 719/b)? ~
Was this collect/on refused? - 26.717(b)(7) & 26.75 ~
Test Resulta - 26. 717(b)(4)
Test Type(s) for Result(s) Reported-26.717(b)(2)
Drug Specimen Tested I Drug Only I !Urine I
Test Validity lvalid I
Was this collect/on observed7 -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)
UseNRC Initial Confirmatory Limit of Cutoffs?
Cutoff Cutoff Detedion I
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)
INRC Minimum I
Specific Sanction Applied j 14-Day Denial I
Person(s) Responsible for Information Provided Person 1 (requi"ed}:
!Pamela I
lsrack I
IAceess Specialist I
pablack@wcnoc.com First Name Last Name Position Title Company Email Address Person 2 (optional):
I Michael (Kenn)
JITate 11 Superintendent Security mitate@wcnoc.com First Name Last Name Position TIiie Company Email Address Final Step (Required)* NRC 'Nill consider tht. form authentic in accordance with 10 CFR 26.11 only when the 'Validate & Loct( button 19 dicked 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:jFeb 19, 2019 at 1 :35:22 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)