ML20057C817
| ML20057C817 | |
| Person / Time | |
|---|---|
| Site: | Palisades  |
| Issue date: | 02/24/2020 |
| From: | Summers S Entergy Nuclear Operations |
| To: | Document Control Desk, Office of Nuclear Security and Incident Response |
| Shared Package | |
| ML20057C816 | List: |
| References | |
| PAL-2019-01 | |
| Download: ML20057C817 (1) | |
Text
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FFD Program Performance Data Repor:1rig System
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NRC Forr11 890 S.r*g e Posit ve Test Fo*rn l'r11f1, 1111;: /',*,111/L*o1,d t!t,* / 1111(<1,,r 1 '/1,
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- 1) All fields requ/r~ except those mar*ed 'aptlonar
- 2) Entries In some fields auto-populate Information in other fields
- 3) Mouse over form fields to view addiflonal Information
- 4) Use of Adobe RHder 8 or later is required D
Submission Update D ~~~~~ssion Uni ue Reference ID Licensee Su lied PAL-2019-01 Facility jPafisades (50-255}
APPROVED BY 0MB: CLEARANCE NO. 3150.Q146 EXPIRES: 04130/2021 Eslimated burden per response to comply v.ilh lhtS eolection request is 30 rrinutes This form is a vok.lnta,y means offeportrlg the information requi"ed under 10 CFR 26.417{bX2J and 26 717 The information is,equlred by NRC to obtain on an annual basts site specific frtness-for-duty (FFD) program pelformance data on drug and a'cohot programs from licensees and other enlihs. Send comments regarding burden estimate to the FOIA, Privacy and Information Collection Bnmdi (T5-F53), U.S. Nucfear Regulatory Comnission.
Washi'lgton DC 20555-0001, or by e-mail to lnfo,:PAcc;ts BtH1,HU!@NBC QD.)I, 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 in-.,ose information collection does not display a cuuendy valid 0MB control number, the NRC may not conduct or sponsor, and a person is not requiled to respond to, the information collection.
Date of Col/action I 0210412019 J (mmlddlyyyy)
Reason for Testing - 26. 717(b)(5)
I Pre-Access Pre-Access Testing Reason (optional)
Please elaborate (optional)
Employment Type
- 26 717(b)(3) lcontractorNendor Labor Category
- 26.717(b)(3)
!Maintenance (general facility)
!Reinstatement (Between 31 and 365 days)
Outage Worker (options/)?
!No Is this a 24-hour reportable event under 26.719/b)? ~
Was this collection refused?
- 26.717(b)(7) & 26 75 ~
Test Resuns
- 26.717(b)(4)
Test Type(s) for Result(s) Reported* 26 717(b)(2)
!Alcohol Only Substance. 26 717(b)(2) & (b)(6)
Alcohol Specimen Tested
!Breath IMlat 26 103 BAC level was exceeded?
\\o.04 Of greater Subversion Attempt
- Did this collection involve a subversion attempt?* 26.717(bX7) and 26.75(b) LI ___
N_o __
ManBQement Actions
- 26.717(b)(6) & 26 75 Reason for the Action
! First drug or alcohol pos~ive Sanction Applied (NRC Minimum Of Licensee Administrated)
!Licensee Administrated Specific Sanction Applied j1-Year Denial Person(s) Responsible for Information Provided Person 1 (required)
~ls_,o_*--~------~11 Summers I
AA/FFD Supe,-y~or First Name
~---~L-a-st~N-a_m_e ___ ~.._--~~o-,-rt,-on~Ti~tle ___ __,
Person 2 (optional};
saumme1@entergy.com Company Email Addrass
...._--=_____,!l.___-.,,..,..,.,~___,!I.___ ~~__, -~~~-
First Name Last Name Position Title Company Email Address Final Step (Requ;r*d)
- NRC will consider this form authentic in accordance with 10 CFR 26.11 onty 'Mlen the "Validate & Lock* button is clicked and all errors (highlighted in red} have been corrected. The "Validate & Lock* button will change to *Locked" after 1he data validation process has been successfully completed indicating the form is ready tor submission.
Form Locked on,!Feb 24, 2020 at 3*20 39 PM Single Positive Test Form (version 1.6.0. April 2018)
! Save to Local PC j j Print this Report i NRC Form 890 (1212014)