ML20063J228

Single Positive Test Form Collected on 09/18/2019

ML20063J228
Person / Time
Site:	Wolf Creek
Issue date:	02/13/2020
From:	Black P Wolf Creek
To:	Office of Nuclear Reactor Regulation, Office of Nuclear Security and Incident Response
Shared Package
ML20063J382	List: ML20063J228 ML20063J232 ML20063J234 ML20063J237 ML20063J240 ML20063J247 ML20063J252 ML20063J265 ML20063J273
References
D4-19, RA 20-0016
Download: ML20063J228 (1)

Text

• , U.S. N RC ' FFD Program Performance Data Reporting System

"-- NRC Form 8~0 Single Posrtrve Test Form

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1) All flold* required except-.. malfled 'optlono/' APPROVED BY 0 MB: CLEARANCE NO. 3150.01 '8 EXPIRES: 04/:lll/2021

2) EntrlH In some "*'* *u~ulate lntorm.tlon In olhr tlellM Estimated burden per response to comply with this collection request It 30 minutes . This

3) Moua* ovw fonn ff-'d* to view MtMtlonlll lnfonnetlon form It I voklntllry means of reporting the Information requtred under 10 CFR 26 .417(b)(2)

4) U.* of Adobe Reeder I or later,. required and 26.717. The information is required by NRC to obtain on an annual bHis site specific fitness-for-duty (FFD) pro"am performance data on drug and alcohol progran. from licensees and other entities. Send comments regarclng burden estimate to 1he FOIA, D Submission Update D ~~~~~ssion Privacy and Information Cotlecilon Bnlnch (T5-F!53), U.S. Nuclear Regulatory Comminlon ,

Washington OC 20555-0001 , or by e-mail to lnfocollcctB Raouccc@NBC gov and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office Unique Reference ID (Licensee SUpelied) of Management and Budget, Washington DC 20503. If a mean, used to Impose 104-19 I information collection does not display a currently valid 0MB control number, the NRC may not conduct or sponsor, and a per.on 11 not required to respond to, ttie information collection.

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'Woll Creek (50-482] D- of Col/action (mm/dd/yyyy)

I 091 18/20

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I RH1on for Tutlnr, - 26.717(b)(5) Pre-Aceess Testing Reason (optional) Please elaborate (optional)

IPnrAccess !lnltial Authortzation Employ,...nt Type - 26.717(b)(3) Outage Worl<er (optional)?

jComractor1Vaic1or jves Labor Ctter,ory - 26.717(b)(3)

IMaimnr,oe <--' facility)

I* this* Uhour reportable event under 26.719(b)? ~

WH this collect/on refused? - 26.717(b)(7) & 26.75 ~

Tut Results - 26.717(b)(4)

Tes1 Type(s) for Result(s) Reported - 26.717(b)(2) Drug Specimen Tested jDrug Only junne I Tes1 Validity jvalid Was this col/action observed? - 26.717(b)(7) & 26.75 ~

How many substances were confirmed positive for this individual? I~-----~

UsoNRC Initial Confirmatory Limit of Substance - 26.717(b)(2) & (b)(6) Cutoffs? Cutoff Cutoff Detection IMarijuana Subversion Attempt - Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b) ~'- - - N_o _ _ ~

M*nlflemant AC1Jon1 - 26.717(b)(8) & 26.75 Reason for the Action I First drug or alcohol positive Sanction Applied (N RC Minimum or Ucenr,ee Administrated) jNRCMinimum Specific Sanction Applied 114- Day Denial Person(*) RHponlllble for Jnfonnllllon Provided Porwon 1 (required):

LIP_AM_E_LA_~=--c= - -

First Name

- - -J' I BLACK

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I !ACCESS SPECIALIST Position TIiie PASLACK@WCNOC.COM Company Email Address Person 2 (optional):

lsoNYA

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"'a"'m"'ec----J L - -- - .L.ai = t-.N"'ame

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J suPERvtsoR ACCESS SCREENING osition

• SOJONES@WCNoc.coM Company Email Address Flnlll Step (R.equhd}

• NRC will c:onaider ttiia form authentic In accordance with 10 CFR 26.11 only when 1he ...,aJldate & Lock" button 11 clicked and an arrors (hlghH~ted In red) have been corrected. The "Validate & Lock* button wHI dlange to *tocked" after the data vaJidtttion proce11 haa been aucce11fulty completed lndic*ting the form la ready for tubmlnion.

Form Locked On:!Feb 13, 2020 at6:22:19 PM I save to Local PC 11 Print t111, Report I Single Positive Test Fom, (version 1.8.0- April 2018) NRC Fonn 890 (12/2014)