ML20063J228
| 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: |
| 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/'
- 2) EntrlH In some "*'* *u~ulate lntorm.tlon In olhr tlellM
- 3) Moua* ovw fonn ff-'d* to view MtMtlonlll lnfonnetlon
- 4) U.* of Adobe Reeder I or later,. required D
Submission Update D ~~~~~ssion Unique Reference ID (Licensee SUpelied) 104-19 I
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'Woll Creek (50-482]
APPROVED BY 0 MB: CLEARANCE NO. 3150.01'8 EXPIRES: 04/:lll/2021 Estimated burden per response to comply with this collection request It 30 minutes. This form It I voklntllry means of reporting the Information requtred under 10 CFR 26.417(b)(2) 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, 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 of Management and Budget, Washington DC 20503.
If a mean, used to Impose 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.
D-of Col/action I 091 8/2019 I (mm/dd/yyyy)
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RH1on for Tutlnr, - 26. 717(b)(5)
IPnrAccess Pre-Aceess Testing Reason (optional)
Please elaborate (optional)
!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) jDrug Only Drug Specimen Tested 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 ~-----~
Substance - 26. 717(b)(2) & (b)(6)
I Marijuana UsoNRC Cutoffs?
Initial Confirmatory Limit of Cutoff Cutoff Detection Subversion Attempt - Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b) ~' ---N_o _
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M*nlflemant AC1Jon1 - 26.717(b)(8) & 26.75 Reason for the Action I
First drug or alcohol positive Sanction Applied (NRC 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=
- ---J' I BLACK I
!ACCESS SPECIALIST First Name
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Position TIiie Person 2 (optional):
PASLACK@WCNOC.COM Company Email Address lsoNYA I
IJoNEs J suPERvtsoR ACCESS SCREENING SOJONES@WCNoc.coM
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= t-.N"'ame
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osition 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 arr ors (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 Single Positive Test Fom, (version 1.8.0- April 2018)
I save to Local PC 11 Print t111, Report I NRC Fonn 890 (12/2014)