ML20057C822
| ML20057C822 | |
| Person / Time | |
|---|---|
| Site: | Palisades  |
| Issue date: | 02/24/2020 |
| From: | Summers S Entergy Nuclear Operations |
| To: | Office of Nuclear Security and Incident Response |
| Shared Package | |
| ML20057C816 | List: |
| References | |
| PAL-2019-04 | |
| Download: ML20057C822 (1) | |
Text
~ I lJ S N p (' ' FFD Program Perfo*mance Data Repo1 ng System
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~ -' \ NRC Forr1 800 Single Pos1 t1 ve Te s* r o1*11 r f , - ( , < 1 "
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- 1) All fields required exnpl those marted 'optlonar APPROVED BY 0MB: CLEARANCE NO. 3150.0144 EXPIRES: IMI.I0/2021
- 2) Entries in some fields auto-populate information In other fields Estimated burden per response to comply 'Mlh lhb colection request is 30 ninules. This
- 3) Mouse over form fields lo view additional information form is a voh.mtary means of reporting the inf01mation required unde, 10 CFR 26.417(b)(2)
- 4) Use of Adobe Reader 8 or latttr is required 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 licensees and other enlilies. Send comments regarding burden estimate to the FOIA, Submission Delete D Update D Submission Privacy and Information Collection Branch (T5-F53) , US Nud ea.r Regulatory ComlTisslon ,
Washington DC 20555-0001 , or by e-mail to lnloccritccb 8 Cl9YrGt@NBC gqy and to the Desk Officer, Office oflnformation and Regulatory Affairs , NEOB-1020, (3150-0146). Office Uni ue Reference ID Licensee Su lied of Management and Budget , Washington DC 20503 If a means used to impose PAL-2019-04 information colection does not Oisplay a currendy vaid 0MB control number , the NRC may not conduct or sponsor. and a person is not requited to respond to, the information collection.
Facilh.y IPatisades (50-255) Date of Collect/on (mm/ddlyyyy)
I 0212112019 I
Reason for Testing - 26 717(b)(5) Please elaborate (op~onal)
!Random (oav and Zimmerman-Craft Employment Type - 26. 717(b)(3) Outage Worker (optional) 7 jcontractorNendor !No Labor Category - 26.717(b)(3)
I Maintenance (general facilny)
Is this a 24-hour reportable event under 26.719(b)7 ~
Was this collection refuS'1d7 - 26.717(b)(7) & 26 75 ~
Test Results
- 26.717(b)(4)
Test Type(s) for Resul~s) Reported - 26.71 7(b)(2) Drug Spe c,men Te sted
!Drug Only j,_u_n_n_e_ __ __ _,
Test Validity
!valid Was this collection observed? - 26.717(b)(7) & 26. 75 ~
How many substances were confirmed positive for this individual?._!- - - - - ~
Use NRC Initial Confinnatory Limit of Substance - 26 717(b)(2) & (b)(6)
Cutoffs? Cutoff Cutoff Detection
'Marijuana Subversion Attempt- Did th,s collect1on involve a subversion attempt? - 26.717(b)(7) and 26 75(b)I,__ _v_e_s_ _ ~
D Did not appear for testing D Specimen characteristics (e g., color, odor, prec,pitant) Please elaborate on the ehoiceCsl selected.
D Shy-bladder (no medical condition) D Invalid test result (initial specimen collected) - 26.185(1) Temperature out of range on Spedmen 1 Under direct observation , Specimen 2 was positive for THC, D Refused to provide initial speamen D Refused to foHow directions D Refused to provide second specimen D Donor admitted to subversion attempt
!!!I Specimen temperature (out of range) OOther D Specimen paraphernalia identified Management Actions
- 26 717(bl(8) & 26 75 Reason for the Action ISubversion attempt Sanction Applied (NRC Minimum or Licensee Admin,strated)
!NRCM1mmum Specific Sanction Applied
!Permanent Denial Person(a) Responsible for Information Provided Person 1 (required);
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j *sunvnel@enlergy com Company Email Address Person 2 (optional):
~.a=~I ~I-------====c---~I ~I First Name Last Name
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Position Title
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Company Email Address Final Step (Required). NRC will consider this form authentic in accordance with 10 CFR 26.11 only 'illhen the "Validate & Lock* button is dicked and all errors (highlighted in red) have been corrected The "Validate & Lock* button will change to *tocked* after the data validation process has been successfully completed indicating the form is ready for submission ,
Form Locked On:!Feb 24, 2020 at 3:56:26 PM I Save to Local PC 11 Print this Report I Single Positive Test Fonn (version 1.8.0 - April 2018) NRC Fonn 890 (12/2014)