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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
[Table view] |
Text
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FFD Program Performance Data Report ng System
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NRC Forr1 890 S nglc Pos '1ve Test For*11
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- 1) All fields required except thou marked 'optionar
- 1) Entries In some fields auto-populate Information in other fields JJ Mouse over form fields to view additional Information
.fJ Use of Adobe RHdtr 8 or later Is required D
Submission Update Uni ue Reference ID Licensee Su lied PAL-2019-06 Facility jPai sades [50-255]
APPROVED BY 0MB: CLEARANCE NO. 31S0-0148 EXPIRES: 04/30/2021 Estimated burden per response to compfy with thi& colection request is 30 rrinutes. TM form II a voluntary means ofreporting the information required under 10 CFR 26.417(b)(2) and 26.717. The Information iuequired by NRC to obtain on an annual basis site specific fitness-for-duty (FFD) prog,am pertormance data on drug and alcohol p,og,ams from licensees and othe, entities. Send comments rega,ding butden estimate to the FOIA, Privacy and Information Collection Bfanch (TS.-F53), US Nuclear Regulatory ComlRssion, Washington oc 20555.0001. or by e-mail to lnfocoJlrai:t$ Rcsouruu@tfflC goi, and to lhe Desk Officer, Office of lnfo,mation and Regulatory Affairs, NEOB-1020, (3150-0146). Office of Management and Budget, Washington DC 20503.
If a means used to irl'4)ose information conection does not display a currently vatid 0MB control number, lhe NRC may not conduct or sponso,. and a person is not required to,espond to, lhe information collection Date of Collection I 0412212019 I (mmldd/yyyy)
Pre-Access Testing Reason (optional)
Please elaborate (optional)
Reason for Testing - 26. 717(b)(5)
I Pre-Access jReinstatement (Between 31 and 365 days)
Day and Z1mme1man.Craft Employment Type - 26.717(b)(3) lcontractorNendor Labor Category
!Other Outage Worker (optional)?
jNo Please elaborate on the Labor Category selected Ironworker Is this a 24-hour reportable event under 26.719(b)? ~
Was this collection refused?. 26.717(b)(7) & 26 75 ~
Subversion Attempt
- Did this collect1on involve a subversion attempt? - 26 717(bK7) and 26.75(b) LI __
v_e_s __ ~
D Did not appear for testing D Shy-bladder (no medical condotion)
D Refused to provide initial specimen 181 Refused to provide second specimen 181 Specimen temperature (out of range)
D Specimen paraphernalia identified D Specimen characteristics (e g, color, odor. proopitant) 0 Invalid test result (initial specimen collected)
- 26 18S(n D Refused to follow dlrecbons D Donor admitted to subversion attempt OOther Management Actions. 26.717(b)(8) & 26 75 Reason tor the Action lsubversion attempt Sancbon Applied (NRG Minimum or Licensee Administrated)
INRC Minimum Specific Sanction Appl,ed
'Permanent Oe 111al Person(s) Responsible for Information Provided Pe,son 1 (1equired);
Please elaborate on the cholcetsl selected.
Specimen presented to collector had a temp out of range lndiVldual refused to submit to second tesl unde, direct observation ILs_c*_* __ ~~=-----1 lsummers I
IAAIFFO Supervisor I
ssumme1@entergy.com F(rst Name
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Pe,son 2 (optional):
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First Name Last Name Position Title Company Email Address Final Step (Requfred)
- NRC wi11 consider lhis form authentic in accordance wilh 10 CFR 26. 11 onty when lhe "Va6date & Lock" button Is clicked and all errors (highlighted In 1ed) have been corrected. The "Validate & Lock" button will change to "Locked* after the data validation process has been successfully completed indicating the form is ready for submission.
Form Locked On:!Feb 24, 2020 at 4.14:19 PM Single Positive Test Fann (version 1.8.0 - April 2018) j Save to Local PC 11 Print this Report j NRC Fann 890 (12/2014)
