ML20057C822

Single Positive Test Form Collected on 02/21/2019

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: ML20057C817 ML20057C818 ML20057C819 ML20057C822 ML20057C824 ML20057C826 ML20057C828 ML20057C829
References
PAL-2019-04
Download: ML20057C822 (1)

Text

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FFD Program Perfo*mance Data Repo1 ng System

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NRC Forr1 800 Single Pos1 t1ve Te s* r o1*11

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1) All fields required exnpl those marted 'optlonar

2) Entries in some fields auto-populate information In other fields

3) Mouse over form fields lo view additional information

4) Use of Adobe Reader 8 or latttr is required D

Submission Update D

Delete Submission Uni ue Reference ID Licensee Su lied PAL-2019-04 Facilh.y IPatisades (50-255)

Reason for Testing - 26 717(b)(5)

!Random Employment Type - 26. 717(b)(3) jcontractorNendor Labor Category - 26.717(b)(3)

I Maintenance (general facilny)

Please elaborate (op~onal)

(oav and Zimmerman-Craft Outage Worker (optional) 7

!No 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)

APPROVED BY 0MB: CLEARANCE NO. 3150.0144 EXPIRES: IMI.I0/2021 Estimated burden per response to comply 'Mlh lhb colection request is 30 ninules. This form is a voh.mtary means of reporting the inf01mation required unde, 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 (FFO) program performance data on drug and alcohol programs from licensees and other enlilies. Send comments regarding burden estimate to the FOIA, Privacy and Information Collection Branch (T5-F53), US Nud ea.r Regulatory ComlTisslon, Washington DC 20555-0001, or by e-mail to lnloccritccb 8Cl9YrGt@NBC gqy and to the Desk Officer, Office oflnformation and Regulatory Affairs, NEOB-1020, (3150-0146). Office of Management and Budget, Washington DC 20503 If a means used to impose 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.

Date of Collect/on I 0212112019 I (mm/ddlyyyy)

Test Type(s) for Resul~s) Reported - 26.717(b)(2)

Drug Spec,men Tested

!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?._! -----~

Substance - 26 717(b)(2) & (b)(6)

Use NRC Cutoffs?

Initial Confinnatory Limit of 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 Shy-bladder (no medical condition)

D Refused to provide initial speamen D Refused to provide second specimen

!!!I Specimen temperature (out of range)

D Specimen paraphernalia identified D Specimen characteristics (e g., color, odor, prec,pitant)

D Invalid test result (initial specimen collected) - 26.185(1)

D Refused to foHow directions D Donor admitted to subversion attempt OOther Management Actions

• 26 717(bl(8) & 26 75 Reason for the Action I

Subversion attempt Sanction Applied (NRC Minimum or Licensee Admin,strated)

!NRCM1mmum Specific Sanction Applied

!Permanent Denial Person(a) Responsible for Information Provided Person 1 (required);

Please elaborate on the ehoiceCsl selected.

Temperature out of range on Spedmen 1 Under direct observation, Specimen 2 was positive for THC, l~s_eo_u __ ~~=----~11 Ls_u_m_me_,_*-~=~-----'I IAAIFFD SupeMSor j *sunvnel@enlergy com First Name Last Name

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Company Email Address Person 2 (optional):

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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 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 Single Positive Test Fonn (version 1.8.0 - April 2018)

I Save to Local PC 11 Print this Report I NRC Fonn 890 (12/2014)