ML20036D580

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Single Positive Test Form Collected on 03/13/2019
ML20036D580
Person / Time
Site: River Bend Entergy icon.png
Issue date: 02/04/2020
From: Deignan M, Noland K
Entergy Operations
To:
Document Control Desk, Office of Nuclear Security and Incident Response
References
RBS-2019-007
Download: ML20036D580 (1)


Text

Facility River Bend [50-458]

Reason for Testing - 26.717(b)(5)

Pre-Access Pre-Access Testing Reason (optional)

Please Select Employment Type - 26.717(b)(3)

Contractor/Vendor Labor Category - 26.717(b)(3)

Other Was this collection refused? - 26.717(b)(7) & 26.75 Test Results - 26.717(b)(4)

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

Drug Only Drug Specimen Tested Urine Was this collection observed? - 26.717(b)(7) & 26.75 Management Actions - 26.717(b)(8) & 26.75 Specific Sanction Applied 3-Year Denial Save to Local PC Print this Report Unique Reference ID (Licensee Supplied)

RBS-2019-007 Please elaborate on the Labor Category selected millwright contractor turbine outage

1) All fields required except those marked 'optional'
2) Entries in some fields auto-populate information in other fields
3) Mouse over form fields to view additional information
4) Use of Adobe Reader 8 or later is required No No 03/13/2019 Submission Update Person(s) Responsible for Information Provided Company Email Address mdeigna@entergy.com First Name Matthew Position Title Supervisor AA/FFD Position Title Sr. Security Coordinator First Name Kelly Last Name Noland Last Name Deignan Company Email Address knoland@entergy.com Person 1 (required):

Person 2 (optional):

Single Positive Test Form (version 1.8.0 - April 2018)

Final Step (Required) - NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the Validate & 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.

Locked Form Locked On: Feb 4, 2020 at 11:37:56 AM Reason for the Action First drug or alcohol positive Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b)

No Subversion Attempt -

Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Delete Submission FFD Program Performance Data Reporting System APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 04/30/2021 Estimated burden per response to comply with this collection request is 30 minutes. This form is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2) 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 licensees and other entities. Send comments regarding burden estimate to the FOIA, Privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

NRC Form 890, Single Positive Test Form (EIE General Submission Portal)

NRC Form 890 (12/2014)

Is this a 24-hour reportable event under 26.719(b)?

No Yes How many substances were confirmed positive for this individual?

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

Use NRC Cutoffs?

Initial Cutoff Confirmatory Cutoff Limit of Detection Marijuana Yes Date of Collection (mm/dd/yyyy)

Outage Worker (optional)?