ML20057C824
| ML20057C824 | |
| 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-2019-05 | |
| Download: ML20057C824 (1) | |
Text
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FFD Program Performarce Data Reporting System
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- NRC Form 890 S1*1gle Pas :,ve Tes! Farr" l'r, ti, 1111~ t'.*1*11/r,111,I r!1,* I,,, " 1 1111.*11
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- 1) All nelds required except those marted 'optlonar
- 2) Entries In some nelds auto--populare Information in other fields JJ Mouse over form fields to view additional Information
- 4) Use of Adobe Reader a or later ls rt>quired D
Submission Update D
Oelete Submission Uni ue Reference ID Licensee Su lied PAL-2019-05 Facility 1Pa6sades [50-255]
APPROVED BY 0MB: CLEARANCE NO. 3150.014' EXPIRES: 04130/2021 Estimated burden per response to comply will Olis coDection,equest is 30 ninutes. This form is a voluntary means of 1eportJng 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-dufy (FFD) program performance data on drug and alcohol programs from licensees and other entities. Send comments regamf111g burden estimate to the FOIA, Privacy and Information Collection B,anch (TS-F53), US Nudear Regulatory Commission, Washington DC 2055S-0001, or by e*mail to 1ofocPlletl$ Roowcc@NBC oov. and to the Desk Officer, Office of Information and Regulatory Affatrs, NEOB-1020, (3150,0146), Office of Management and Budget, Washington DC 20503, If a means used to irr.,ose Information collection does not display a currenlSy va6d 0MB control number, the NRC may not conduct or sponsor, and a person is not requl,ed to respond to, lhe information collection.
Date of Collection I 0212512019 I (mm/dd/yyyy)
Reason for Testing
- 26. 717(b)(5)
I Pre-Access Pre-Access Testing Reason (opUonal)
Please elaborate (optional)
Employment Type - 26.717(b)(3)
!ContractorNendor Labor Category - 26.717(b)(3)
!Maintenance (general facil~y)
I Initial Authorization Outage Worl<er (optlonal/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)
Test Type(s} for Result(s} Reported* 26.717(b)(2)
Drug Specimen Tested I
Drug Only Liu_"_"_" _____ _,
Test Validity
!valid Was this collection observed?
- 26 717(b)(7) & 26.75 ~
How many substances were confirmed positive for this individual? Ll -------'
Vendor-Huskins floor Covenng Substance - 26,717(b)(2) & (b)(6)
Use NRC Initial Confirmatory Limit of Cutoffs?
Cutoff Cutoff Detection IManJuana Subversion Attempt* Old this collect1on involve a subversion attempt? - 26 717(b)(7) and 26 75(b) LI ___
No __ __,
Management Actions
- 26.717(b)(8) & 26.75 Reason for the Action
!First drug or alcohol positive Sancbon Applied (NRC Minimum or Licensee Administrated)
I Licensee Administrated Specific Sanction Applied (3-Year Denial Person(s) Responsible for Information Provided Person 1 (required) l~s_,o_*--~~~----~l 1Summe,s J IAA/FFD Supervisor j *suJM1el@enlergy.e<>m First Name
'-----.L-as~t"N'a_m_e ___ __, '-----,P"'o"'s"'rt1"on"""n"'ue,-----'
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 lhis form authentic in accordance with 10 CFR 25.1 1 onty when lhe 'Validate & Lock" button is dicked and all errors (highlighted in red) have been corrected. The "Vahdate & Lock" button will change to "Locked" after lhe data validation p,ocess has been successfulty completed indicating the form ti ready for submission.
Form Locked On:!Feb 24, 2020 at 4:05:01 PM Single Pos1bve Test Form (version 1.8.0 - April 2018)
I Save to local PC ! I Print this Report !
NRC Form 890 (12/2014)