ML19058A549

Single Positive Test Form Collected on 04/12/2018

ML19058A549
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
D5-18, RA 19-0030
Download: ML19058A549 (1)

Text

• U.S.NRC '

FFD Program Perior mance Data Reporting System NRC Fo 1111 c'1CJ S111ql, P o<-;1 t1ve T e~I f 01111 I

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1) All fields,-quired except thoH,,,.rited 'opt/on.r APPROVED BY 0MB: CLEARANCE NO. 3150.01441 EXPIRES: IM/30/2021

2) EntrlH In some fields auto-populate Information In other ffeld*

Estimated burden per response to compty with this collection request Is 30 minutes. This

3) MouH over form fffj/d* to view *ddltlonal lnfomv,tlon form is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2)

4) U.* of Adobe RNder I or later I* requlnd 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 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 lofocollocta Ronource@NRC ggy and to the Unlauo Refe1'911co 1D (Licensee Supplied)

Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-01-46), Office 105-18 I

of Management and Budget, Washington DC 20503.

If a means used to impose Information collection does not display a currentty valid 0MB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information Facll/ty collection.

IWolf Creek [50-482]

I Date of Collect/on I 04/1212018 I (mm/dd/yyyy)

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 Typ,, - 26.717(b)(3)

Outage Worl<er (optional)?

leontraaorNendor I Jves I

LaborCategory -26.717(b)(3)

IMai- (general fllcility)

I Is this a U-hour reportable event under 26.719(b)7 ~

Was this collect/on,efused? - 26.717(b)(7) & 26.75 ~

Test Resu/t3-26.717(b)(4)

Test Type{s) for Result(s) Reported - 26.717(b)(2)

Drug Specimen Tested lorug Only I

IUrine I

Test Validity I

substituted I

Was this collect/on observed? - 26.717(b)(7) & 26.75 ~

Subversion Attempt -

Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b) I Yes I

D Did not appear for testing D Specimen characteristics (e.g., color, odor, precipitant)

Please elaborate on the choice(s) selected:

D Shy-bladder (no medical condition)

(!!I Invalid test result (initial specimen collected) - 26.185(1)

ORUG RESULTS REPORTED AS SUBSTITUTED BY MRO. CONSIDERED AN ATIEMPT TO SUBVERT THE D Refused to provide initial specimen D Refused to follow directions TESTING PROCESS.

D Refused to provide second specimen D Donor admitted to subversion attempt D Specimen temperature (out of range) 001her D Specimen paraphernalia identified Management Actions - 26.717(b)(8) & 26.75 Reason for the Action I

Subversion attempt I

Sanction Applied (NRC Minimum or Licensee Administrated)

INRC Minimum I

Specific Sanction Applied I

Penn anent Denial I

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

IPamefa I lsrack I

IAccen SpecialCSt I

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

I Michael (Kenn)

I IT*~

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 10 CFR 26.11 onty when the "Validate & Lock* button is dicked and a11 erron (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 ls ready for submission.

Fann Locked On:!Feb 19, 2019 at 1:56:00 PM I I Save to Local PC 11 Print this Report I Single Positive Test Form (version 1.8.0 -April 2018)

NRC Fann 890 (1212014)