ML20063J240

Single Positive Test Form Collected on 10/28/2019

ML20063J240
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
D5-19, RA 20-0016
Download: ML20063J240 (1)

Text

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• U.S.NRC FFD Program Performance Data Reporting System NRC Form 800 S111gle Pos,trve Test Fo,111 I '

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1) All tlolda,..,ulted ocopl lltoH marl<od 'opllon.r APPROVED BY 0MB: CLEARANCE NO. 3150-014' EXPIRES: 04/30/2021 2J EntriH In *ome ff.,da auto-populate lnfomMllon In other tfalds Estimated burden per response to compty with this collection request 11 30 minutes. This

3) Mouse owr fonn ffelda to view llddtlonlll lnfDmtlldon form it a volunta,y means of reporting the information required under 10 CFR 26.417(b)(2)

4) Use of Adobe Ruder I or lldw I* requlrwd and 26.717. The Information 11 required by NRC to obtain on an annual basis site specific filneas-for-12rty (FFD) program performance data on drug and alcohol programs from 0 Submission D ~~~8!~ssion licensees and other entities. Send comments regarding burden estimate to the FOIA, Update Privacy and lnfOJmation Collection Branch (T5-F53), U.S. Nudear Regu~tory ComffUlion, Washington OC 20555-0001, or by e-mall to lnfocollecta Besource@NBC gov and to the Unl9.ue Rerw.nce ID !Licensee Sueeliedl Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-(1148), Office 10~19 I

of Management and Budget Washington OC 20503.

If a means used to impose information collection does not dl1play a currentty valid 0MB control number, the NRC may not conduct or sponsor, and a person 11 not required to respond to, lhe information Fec/1/ty collection.

IWoH Creek [50-482]

I O.te of Collection 1 10/28/20l Q I (mm/dd/yyyy)

Ruson forTfftlng - 26.717(b)(5)

Pre-Access Testing Reason (optional)

Please elaborate (optional)

IPr&-Access I

I Initial Aulhorization I

I I

Emp/oymMt Type - 26.717(b)(3)

Our.ge Worl<er (optlonaQ?

IContraaor/Vendor I Ives I

Labor Cater,ory - 26.717(b)(3)

IMalntenance(gannl fac:lllty)

I la this a :U.hour n,portab/e e11811t under 28.719(b)? ~

Was this collect/on r11fused? - 26.717(b)(7) & 26.75 ~

Tm Results - 26.717(b)(4)

Test Type(s) for Resutt(s) Reported - 26.717(b)(2)

Drug Specimen Tested 1Drug0nly I lunne I

TestValldlty lva1id I

Was this collect/on observed? - 26. 717(b)(7) & 26.75 ~

How many substances were confirmed positive for this individual? I 1

I Substance-26.717(b)(2) & (b)(6)

UseNRC Initial Confirmatory Limttof Cutoffs?

Cutoff Cutoff Detedion

!Marijuana I

I~

Subversion Attempt - Did this collection involve a subversion attempt?-26.717(b)(7) and 26.75(b) I No I

Management Action* - 26.717(b)(6) & 26. 75 Reason for the Action I First drug or alcohol positive I

Sanction Applied (NRC Minimum or Licensee Administrated)

INRC Minimum I

Specific Sanction Applied j14-Day Denial I

Peraon(*J Responalbl* for lnformlltlon Provided Per.on 1 (re(Jlired):

IPAME.LA lie~

I

!ACCESS SPEctAUST I

PABLACK@WCNOC.COM Fir>tName Last Name Po,ltlonTHle Company Email Address Poraon 2 (optional):

ISONYA I

!JONES I

lsuPERVISOR ACCESS SCREENING SOJONES@ll',CNOC.COM Fir1\\Name Cast Name Position liUe Company Email Address Final SMp{Requlrad)

• NRCwill coneider this form eiuthentic In accordance with 10 CFR 26.11 only when the "Validate & Lock" button Is dicked and 111 errors (highlighted In red) have been c;OfTected. The "Validate & Lock* button will change to *Locked" after the dabt validation proceu has been aucceaafulty completed Indicating the form 1, ready for submiuion.

Form Locked On: !Feb 13, 2020 at 6:25:07 PM I

[ Save to Local PC J I Print this Report I Single Positive Test Form (version 1.8.0 - April 2018)

NRC Form 690 (1212014)