ML19058A543
| ML19058A543 | |
| 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 | |
| D6-18, RA 19-0030 | |
| Download: ML19058A543 (1) | |
Text
- U.S.NRC '
FFD Pr ogram Periormance Data Reporting System NRCf c;,11~
- l, S1*1 Jlt":" Pos :1\\t:' Test F )1111 I '
'~ I' ' /'I 1/lllth, 1*1*11
- 1) All fields required axe.pt thoH marlced 'optional' APPROVED BY 0MB: CLEARANCE NO. 3150-01" EXPIRES: 04/30/2021
- 2) EntrlH In some fl*lda auto-populate Information In other fl*ld*
Estimated burden per response to comply with this collection request is 30 minutes. This
- 3) MouH over fonn fl.,d* to view additional lntorm.tlon form is a voluntary means of reporting the information required under 10 CFR 26.-417(b)(2)
.f) UH or AdolM RNder 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 {FFD) program performance data on drug and alcohol programs from 0 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. Nudear Regulatory Commission, Washington DC 20555-0001, or by e-mail to lnfucoflecta Rn ource@NBC goy and to the Un/aue Reference ID (Licensee Suooliedl Desk Officer, Office of Information and Regulatory Affairs, NEOB-1 020, (3150-0146), Office 100-18 I
of Management and Budget, Washington DC 20503.
If a means used to impose information coflection does not display a currently valid 0MB control number, the NRC may not conduct or aponaor, and a person is not required to respond to, the information Faclllty coflection.
1wo11 Creek [50-482)
I D11te of Collection I I
(mm/dd/yyyy) 10/29/2018 Reason for Testing - 26. 717(b)(5)
Pre-Access Testing Reason (optional)
Please elaborate (optional) 1P~Access I I Initial Authorization I
I I
Employment Type - 26.717(b)(3)
Outage Worl<er (optlonaQ?
ICoolrac'aNendor I
INo I
Labor Category - 26. 717(b)(3)
I Maintenance (_.,i facility)
I Is this a 24-hour reportable event under 28.719(b)7 ~
WH this collect/on refused7 - 26.717(b)(7) & 26.75 ~
Test Rasu/ts - 26.717(b)(4)
Test Type(s) for Result(s) Reported - 26.717(b)(2)
Drug Specimen Tested I
Drug Only I Junne I
Test Validity lvalid 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)
UseNRC Initial Confirmatory Limit of Cutoffs?
Cutoff Cutoff Detedion
!cocaine 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 a lcohol positive I
Sanction Applied (NRC Minimum or Licensee Administrated)
INRC Minimum I
Specific Sanction Applied 114-Day Denial I
Person(s) Responsible for lnformllflon Provided Person 1 (required):
!Pamela I
le1ack I
!Access Specailist I
pablack@waioc.com First Name Last Name Position Title Company Email Address Person 2 (optional):
lt.11chael (Kenn)
IIT*te 11 Superintendent Security mttate@waioc.com First Name Last Name Position Title Company Email Address Fina/ SNp (Required}
- NRC will consider this form authentic in accordance with 10 CFR 26.11 only 'ltilen the "Validate & Lock" button ia dicked and all errors (highlighted in red) have been corrected. The "Valldate & Lock* button will change to *Locked" after the data validation process has been successfully completed indicating the form Is ready for submission.
Fomi Loci<ed On:jFeb 19, 2019 at 2:01:40 PM I I Save to Local PC j [ Print this Report I Single Positive Test Form (version 1.8.0- April 2018)
NRG Fom, 890 (12/2014)