ML19058A546
| ML19058A546 | |
| 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 | |
| A3-18, RA 19-0030 | |
| Download: ML19058A546 (1) | |
Text
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- U.S.NRC FFD Prog1am Pe1io1111ance Data Repo1t1ng System NRC Forrn ?**D S11irJle t'os,trvf' Test Fo,rn I
,, I'*/" 111/1/r, /,, 11,,
- 1) All fields required except thoH tNrt-.1 'optJon.r APPROVED BY 0MB: CLEARANCE NO. 3190-0141 EXPIRES: 04/30/2021
- 2) Entries In some fields auto-populat. /nformatlon In other field*
Estimated burden per response to compty with this collection request is 30 minutes. This
- 3) MouH over fonn field* to view additional Information form la a voluntary means of reporting the Information required under 10 CFR 26.417{b){2)
- 4) Use of Adobe Reeder I or leter I* requlrad 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 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 (T5-F53), U.S. Nuclear Regulatory Comrrission, Washington DC 20555--0001, or by e-mail to tnfocoHects Buource@NBC qoy and to the Unlaue Reference ID /Licensee SuP< lied)
Desk Officer, Office of Information and Regulatory Affaira, NEOB-1020, (3150-0146), Office IA3-18 I
of Management and Budget, Washington DC 20503.
If a means used to impose information collection does not display a correntty valid 0MB control number, the NRC may not conduct or sponsor, and a peraon Is not required to respond to, the Information Fac/1/ty collection.
!Wolf Creek (50-482)
I (mm/dd/yyyy) 12/10/201~
Date of Collect/on '
Reason for Testing - 26. 717(b)(5)
For Cause Testing Reason Please elaborate (optional)
I For Cause I
'Physical Condition/Smell of Alcohol I
I I
Employment Type - 26. 717(b)(3)
Outage Worker (optlonaQ7 I Ucensee Employee I INo I
Labor Category - 26. 717(b)(3)
IHP/RP I
Is this a Uhour reportable event under 26.719(b)7 ~
Was this collect/on refused7 - 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
Su/Jsfance - 26.717(b)(2) & (b)(6)
'Alcohol I
Alcohol Specimen Tested I
Breath I
What 26.103 BAC level was exceeded?
jo.04 or greater 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 lnformllflon Provided Person 1 (required):
I Pamela I I Black I !Access Specialist I
pablack@wa,oc.com First Name Last Name Position Title Company Email Address Person 2 (optional):
I Michael (Kenn)
I Irate 11 Superintendent I
rm:ate@wcnoc.com First Name Last Name Position T1fle Company Email Address Fina/ Step (Required)
- NRC will consider this form authentic in accordance with 10 CFR 26.11 onty when the "Validate & Lock" button is clicked and all efTOfS {highlighted In red) have been corrected. The "Validate & Lock* button will change to
- Locked* after the data validation process has been successfulty completed Indicating the form is ready for submission.
Fonn Locked On: !Feb 19, 2019 at 4:04:05 PM I I Saye to Local PC II Print this Report I Single Positive Test Form (version 1.8.0 - April 2018)
NRC Fonn 890 (12/2014)