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Category:License-Fitness for Duty (FFD) Performance Report
MONTHYEARML24052A2992024-02-21021 February 2024
Annual Fatigue Form for 2023
ML24052A3012024-02-20020 February 2024
Single Positive Test Form Collected on 05/17/2023
ML24052A3022024-02-20020 February 2024
Single Positive Test Form Collected on 10/18/2023
ML24052A3002024-02-20020 February 2024
Single Positive Test Form Collected on 02/14/2023
ML24052A2972024-02-20020 February 2024
Annual Reporting Form for Drug and Alcohol Tests for 2023
ML24052A3042024-02-20020 February 2024
Single Positive Test Form Collected on 12/06/2023
ML24052A3032024-02-20020 February 2024
Single Positive Test Form Collected on 11/28/2023
ML23058A2912023-02-27027 February 2023
Annual Report Form for Drug and Alcohol Tests for 2022
ML23051A0232023-02-20020 February 2023
Single Positive Test Form Collected on 03/15/2022
ML23051A0302023-02-17017 February 2023
Annual Fatigue Reporting Form for 2022
ML23051A0262023-02-16016 February 2023
Single Positive Test Form Collected on 05/11/2022
ML23051A0282023-02-16016 February 2023
Single Positive Test Form Collected on 07/25/2022
ML23051A0242023-02-16016 February 2023
Single Positive Test Form Collected on 04/28/2022
ML23051A0212023-02-16016 February 2023
Single Positive Test Form Collected on 01/26/2022
ML23051A0272023-02-16016 February 2023
Single Positive Test Form Collected on 06/22/2022
ML23051A0292023-02-16016 February 2023
Annual Reporting Form for Drug and Alcohol Tests for 2022
ML23051A0252023-02-16016 February 2023
Single Positive Test Form Collected on 05/09/2022
ML23051A0222023-02-16016 February 2023
Single Positive Test Form Collected on 03/07/2022
ML23051A0202023-02-16016 February 2023
Single Positive Test Form Collected on 01/05/2022
ML22054A1362022-02-23023 February 2022
Annual Fatigue Form for 2021
ML22054A1312022-02-17017 February 2022
Single Positive Test Form Collected on 07/12/2021
ML22054A0872022-02-17017 February 2022
Single Positive Test Form Collected on 07/12/2021
ML22054A1322022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0892022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0912022-02-17017 February 2022
Single Positive Test Form Collected on 10/07/2021
ML22054A0852022-02-17017 February 2022
Single Positive Test Form Collected on 04/05/2021
ML22054A0842022-02-17017 February 2022
Single Positive Test Form Collected on 03/31/2021
ML22054A0862022-02-17017 February 2022
Single Positive Test Form Collected on 07/06/2021
ML22054A0882022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0902022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0832022-02-17017 February 2022
Single Positive Test Form Collected on 03/15/2021
ML22054A1332022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A1352022-02-17017 February 2022
Single Positive Test Form Collected on 10/07/2021
ML22054A1292022-02-17017 February 2022
Single Positive Test Form Collected on 04/05/2021
ML22054A1282022-02-17017 February 2022
Single Positive Test Form Collected on 03/31/2021
ML22054A1272022-02-17017 February 2022
Single Positive Test Form Collected on 03/15/2021
ML22054A1302022-02-17017 February 2022
Single Positive Test Form Collected on 07/06/2021
ML22054A1342022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A1262022-02-16016 February 2022
Annual Reporting Form for Drug and Alcohol Tests for 2021
ML22054A0822022-02-16016 February 2022
Annual Reporting Form for Drug and Alcohol Tests for 2021
ML21055A7892021-02-24024 February 2021
Single Positive Test Form Collected on 08/30/2020
ML21055A7852021-02-24024 February 2021
Single Positive Test Form Collected on 06/30/2020
ML21055A7862021-02-24024 February 2021
Single Positive Test Form Collected on 08/10/2020
ML21055A7872021-02-24024 February 2021
Single Positive Test Form Collected on 08/17/2020
ML21055A7882021-02-24024 February 2021
Single Positive Test Form Collected on 08/24/2020
ML21055A7902021-02-24024 February 2021
Single Positive Test Form Collected on 09/15/2020
ML21055A7912021-02-24024 February 2021
Single Positive Test Form Collected on 09/17/2020
ML21055A7922021-02-24024 February 2021
Single Positive Test Form Collected on 09/21/2020
ML21055A7932021-02-24024 February 2021
Single Positive Test Form Collected on 12/03/2020
ML21055A7942021-02-24024 February 2021
Annual Report Form for Drug and Alcohol Tests for 2020
2024-02-21
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Text
- , 1 LJ S N p (' \ FFD Prog ram Performarce Data Reporting System
'-' , *'--; "**- \. -
- NRC Form 890 S1*1gle Pas :,ve Te s! Farr" l'r, ti, 1111~ t'.*1*11/r ,111,I r!1,* I ,,, " 1 1111 .*11 - i* - ' '"
- 1) All nelds required except those marted 'optlonar APPROVED BY 0MB: CLEARANCE NO. 3150.014' EXPIRES: 04130/2021
- 2) Entries In some nelds auto--populare Information in other fields Estimated burden per response to comply will Olis coDection ,equest is 30 ninutes. This JJ Mouse over form fields to view additional Information form is a voluntary means of 1eportJng the information required under 10 CFR 26.417(b){2)
- 4) Use of Adobe Reader a or later ls rt>quired 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, Submission Oelete D Update D Submission 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 Uni ue Reference ID Licensee Su lied of Management and Budget, Washington DC 20503 , If a means used to irr.,ose PAL-2019-05 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.
Facility 1Pa6sades [50-255] Date of Collection (mm/dd/yyyy)
I 0212512019 I
Reason for Testing
- 26. 717(b)(5) Pre-Access Testing Reason (opUonal) Please elaborate (optional)
I Pre-Access IInitial Authorization Vendor-Huskins floor Covenng Employment Type - 26.717(b)(3) Outage Worl<er (optlonal/ 7
!ContractorNendor !No Labor Category - 26.717(b)(3)
!Maintenance (general facil~y)
Is this a 24-hour reportable event under 26.719(b)7 ~
Was this collection refuS<1d7
Test Results
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?
How many substances were confirmed positive for this individual? Ll- - - - - - - '
Use NRC Initial Confirmatory Limit of Substance - 26,717(b)(2) & (b)(6)
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)
ILicensee 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)
~=-~l~l-.-=,-,=-~l~l---=-==~~ - - = ~ ~ -
First Name Last Name Position Title Company Email Address Final Step (Required)
- NRC will consider lhis form authentic in accordance with 10 CFR 25.11 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 ISave to local PC !I Print this Report !
Single Pos1bve Test Form (version 1.8.0 - April 2018) NRC Form 890 (12/2014)
