ML20063J247
| ML20063J247 | |
| Person / Time | |
|---|---|
| Site: | Wolf Creek  |
| Issue date: | 02/18/2020 |
| From: | Black P Wolf Creek |
| To: | Office of Nuclear Reactor Regulation, Office of Nuclear Security and Incident Response |
| Shared Package | |
| ML20063J382 | List: |
| References | |
| D3-19, RA 20-0016 | |
| Download: ML20063J247 (1) | |
Text
- ' LJ S N RC '
FFD Program Performance Data Reporting System NRC Forrn 800 S rr1g le I',rt
- Test Form I
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- 1) All field* required except thoH marhd 'optlonal'
- 2) EntrlH In some field* auto-populate Inform.ti on In other field*
- 3) Mouse ov.,. form fl.td* to view additional Information
- 4) Use of Adobe Ruder I or later I* '*luired Unique Reference ID (l.lcenw Supplledl joa-19 I
APPROVED BY 0 MB: CLEARANCE NO. 3150-4141 EXPIRES: 04/30/2021 Estimated burden per response to comply with thia coHection requnt ii 30 minutn. Thia form Is a voluntary means of reporting fie Information ~eel under 10 CFR 26.41 7(b)(2) and 26.717. The infonnation is required by NRC to obtain on an annual bull aite specilc fitness-for-duty (FFD) program performance data on chg and alcohol proe,alM from licensees and other entitiee. Send OOfflffllllS ragardng burden Ntlmate to the FOIA.,
Privacy and Information Collec1lon Brandl (TS-F53}, U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by...,.. to lnfocollects Resource@NRC aov and to the Desk Officer, Office of lnforma11on and Regulatory Affairs. NEOB-1020, (3150-01 48), Office of Management and Budget, WnMngton DC 20503.
If
- meana uaed to lmpOH information collection doea not fiaplay a ourrentty vaUd 0MB control number, the NRC may not conclJet or aponaor, and
- pal'IOl"I ii not required to reapond to, the information collection.
Date of Collect/on 1 12116/2019 I (mm/d<Uyyyy)
Reason for Testing - 26.717(b)(5)
P!.-Aa:au Tuting Reuon (apllanal)
Please e~
(oplionaQ 1~
j1nitia1Authortzatlon Emp/oyff1ent Type -26.717(b)(3) jcoullllCllll>"ff!IIIDI Labor Category - 26.717(b)(3)
Outage Worker (optional) 7 INo ICOMPUTER SERVICES Is this a U-hour reportable event under 26.719(b)7 ~
Was this collect/on refused? - 28.717(b)(7) & 26.75 ~
Test Results - 28.717(b)(4)
Test Type(I) for Reoult(I) Reporllld-26.717(b)(2)
Drug Specimen Tested j0rug 0ny junne I
Test Validity jva11c1 Was this collect/on observed? - 26.717(b)(7) & 28.75 ~
How many substances were confirmed positive far this individual?~' ------
Substance - 28.717(b)(2) & (b)(6)
!o piate: Codeine UseNRC Cutotll?
Initial Conflrmlllory Limit of Cutoff Cutoff Detection Subversion Attempt - Did this collection involve a subversion attempt?. 26.717(b)(7) and 26. 7S(b) ~j ___
N_o __ ~
Management Actions - 26.717(b)(8) & 28.75 Reaon for the Action Sanction Applied (NRC Mlrimurn or l.lcenlN Admlnlatraled) jNRC Minimum j14-Day Denllll Person(s) Responsible for lnformlltlon Provided Person 1 (required):
IPAMELA llaLACK FlmN-LiiiN-J §ss SPECIALIST J PABLACKOVVCNoc.coM
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Company Email Address P.,.on 2 (opllonll):
I-A Fliil Nini II-LiitNiiii I
ISUPERVISOR ACCESS SCREENING I SOJONESQWCNOC.COM
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PoilBon nBi Company Ema,I Address Final Step (R* qulred)
- NRC w4N consider.,.. form authentic in accordance with 10 CFR 29.11 only when the -Validate & Lo<<button II clk:ked and al errcn (highlighted in red) have been corrected. The -Validate & Lock* button will change to *Locked* after the data validation proceu has been aucceaafully completed Indicating the form ts ready for aubmlnion.
Form Locked On:!Feb 18, 2020 at 10:09:13AM I Single Positive TN! Form (version 1.8.0 - April 2018)
I Save to Local PC 11 Pl1nt this Report I NRC Form 890 (12/201 4)