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Category:License-Fitness for Duty (FFD) Performance Report
MONTHYEARML23072A3652023-03-13013 March 2023
Annual Report Form for Drug and Alcohol Tests for 2022
ML23059A4702023-02-28028 February 2023
Annual Fitness for Duty Program Performance Report, and Annual Fatigue Report for 2022
ML22335A4462022-12-0101 December 2022
Annual Fatigue Report Form for 2021 - Supplemental Information
ML22335A4422022-12-0101 December 2022
Annual Fatigue Report Form for 2020
ML22335A4452022-12-0101 December 2022
Annual Fatigue Report Form for 2021
ML22335A4432022-12-0101 December 2022
Annual Fatigue Report Form for 2020 - Supplemental Information
ML22152A2132022-06-0101 June 2022
Single Positive Test Form Collected on 03/12/2021
ML22053A0822022-02-21021 February 2022
Electronic Submittal of Annual Fitness for Duty Program Performance Report and Annual Fatigue Report for 2021
ML22047A2022022-02-16016 February 2022
Annual Report Form for Drug and Alcohol Tests for 2021 - Attachment
ML22047A2072022-02-16016 February 2022
Single Positive Test Form Collected on 03/17/2021
ML22047A2112022-02-16016 February 2022
Single Positive Test Form Collected on 03/11/2021
ML22047A2172022-02-16016 February 2022
Annual Fatigue Report Form for 2021
ML22047A2132022-02-16016 February 2022
Single Positive Test Form Collected on 09/27/2021
ML22047A2042022-02-16016 February 2022
Single Positive Test Form Collected on 04/28/2021
ML22047A2052022-02-16016 February 2022
Single Positive Test Form Collected on 11/29/2021
ML22047A2012022-02-16016 February 2022
Annual Report Form for Drug and Alcohol Tests for 2021
ML22047A2162022-02-16016 February 2022
Single Positive Test Form Collected on 04/19/2021
ML22047A2082022-02-16016 February 2022
Single Positive Test Form Collected on 01/25/2021
ML22047A2062022-02-16016 February 2022
Single Positive Test Form Collected on 11/29/2021
ML22047A2122022-02-16016 February 2022
Single Positive Test Form Collected on 03/12/2021
ML22047A2182022-02-16016 February 2022
Annual Fatigue Report Form for 2021 - Attachment
ML22047A2032022-02-16016 February 2022
Single Positive Test Form Collected on 11/10/2021
ML22047A2142022-02-16016 February 2022
Single Positive Test Form Collected on 03/10/2021
ML22047A2092022-02-16016 February 2022
Single Positive Test Form Collected on 04/05/2021
ML22047A2152022-02-16016 February 2022
Single Positive Test Form Collected on 03/03/2021
ML21056A4572021-02-25025 February 2021
Annual Fatigue Report Form for 2020
ML21056A4592021-02-25025 February 2021
Single Positive Test Form Collected on 09/14/2020
ML21056A4582021-02-25025 February 2021
Annual Report Form for Drug and Alcohol Tests for 2020
ML21056A4602021-02-25025 February 2021
Single Positive Test Form Collected on 06/23/2020
ML21056A4612021-02-25025 February 2021
Single Positive Test Form Collected on 12/18/2019
ML21056A4622021-02-25025 February 2021
Single Positive Test Form Collected on 07/27/2020
ML21056A5602021-02-25025 February 2021
Submittal of Fitness for Duty Program and Fatigue Report for 2020
ML20058H0962020-02-27027 February 2020
Single Positive Test Form Collected on 09/18/2019
ML20058H0832020-02-27027 February 2020
Annual Report Form for Drug and Alcohol Tests for 2019
ML20063J2372020-02-27027 February 2020
Electronic Submittal of Annual Fitness for Duty Program Performance Report and Annual Fatigue Report for 2019
ML20058H0912020-02-27027 February 2020
Single Positive Test Form Collected on 09/23/2019
ML20058H0872020-02-27027 February 2020
Single Positive Test Form Collected on 09/26/2019
ML20058H0992020-02-27027 February 2020
Single Positive Test Form Collected on 10/28/2019
ML20058H1012020-02-27027 February 2020
Annual Fatigue Report Form for 2019
ML20058H0892020-02-27027 February 2020
Single Positive Test Form Collected on 09/18/2019
ML20058H0942020-02-27027 February 2020
Single Positive Test Form Collected on 12/16/2019
ML20063J2342020-02-24024 February 2020
Annual Report Form for Drug and Alcohol Tests for 2019
ML20063J2472020-02-18018 February 2020
Single Positive Test Form Collected on 12/16/2019
ML20063J2522020-02-18018 February 2020
Annual Fatigue Form for 2019
ML20063J2732020-02-13013 February 2020
Single Positive Test Form Collected on 09/26/2019
ML20063J2402020-02-13013 February 2020
Single Positive Test Form Collected on 10/28/2019
ML20063J2322020-02-13013 February 2020
Single Positive Test Form Collected on 09/18/2019
ML20063J2282020-02-13013 February 2020
Single Positive Test Form Collected on 09/18/2019
ML20063J2652020-02-13013 February 2020
Single Positive Test Form Collected on 09/23/2019
ML19064A3642019-03-0505 March 2019
Single Positive Test Form Collected on 12/10/2018
2023-03-13
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Text
- ' LJ S N RC ' FFD Program Performance Data Reporting System
'--' '
- N RC Forrn 800 S rr1 g le I' ,rt
- Test Form I I ,Ill.,,!',;*/, ,111/l/r1 J 11111,11n1
- 1) All field* required except thoH marhd 'optlonal' APPROVED BY 0 MB: CLEARANCE NO. 3150-4141 EXPIRES: 04/30/2021
- 2) EntrlH In some field* auto-populate Inform.ti on In other field* Estimated burden per response to comply with thia coHection requnt ii 30 minutn. Thia
- 3) Mouse ov.,. form fl.td* to view additional Information form Is a voluntary means of reporting fie Information ~eel under 10 CFR 26 .41 7(b)(2)
- 4) Use of Adobe Ruder I or later I* '*luired 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 Unique Reference ID (l.lcenw Supplledl joa-19 I 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 12116/20 19 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) Outage Worker (optional) 7 jcoullllCllll>"ff!IIIDI INo Labor Category - 26.717(b)(3)
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?~'- - - - - -
UseNRC Initial Conflrmlllory Limit of Substance - 28.717(b)(2) & (b)(6)
Cutotll? Cutoff Cutoff Detection
!o piate: Codeine 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 J §ss SPECIALIST J PABLACKOVVCNoc.coM FlmN- ----r===------'~--~Poiltlon---Tiai-----
LiiiN- Company Email Address P.,.on 2 (opllonll):
I-A Fliil Nini II-
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LiitNiiii IISUPERVISOR ACCESS SCREENING PoilBon nBi I SOJONESQWCNOC.COM 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 I Save to Local PC 11 Pl1nt this Report I Single Positive TN! Form (version 1.8.0 - April 2018) NRC Form 890 (12/201 4)
