ML20063J265

Single Positive Test Form Collected on 09/23/2019

ML20063J265
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
D2-19, RA 20-0016
Download: ML20063J265 (1)

Text

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• U.S.NRC FFO Prog ram Performance Data Reporting System NRC Form 800 S11191e Posrtrve Test r'o T I '"'~ !' , t*I, ,011/ 1h, I 11, 11, 1!11' ,

1) All fields required except those marked 'optional' APPROVED BY 0 MB: CLEARANCE NO. 3150.014' EXPIRES: 04/3012021

2) EntrlH In some fields *uto-popula,. Information In othff' fields Estimated burden per responae to compty wtth thil collection ~ 18 30 mlnutee. This

3) MouH ovw fonn fields to view additional Information form is a voluntary means of reporting the i"lfonnation ~ e d under 10 CFR 26.417(b)(2)

4) Use of A doh R..der I or leter I* Aqulred and 26 .717. The information ti fltqlked by NRC to obta6n on an annual basis site specific fitness-for-duty (FFO) program perlormanc. data on drug and alcohol programs from D Submiuion Update o:~~~ssion licensees and oCher enttlfee. Send commentl regarclna burden Ntlmate to fie FotA, Privacy and lnfonnation Conection Brandl (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-()()()1, or by *maU to lnfocollects Resource@NRC aov. and to the Desk Officer, Office of Information and Regulatory Affairs . NEOB* 1020, (3150.0146), Office Unlg_ue Reference ID (UcensN SullPl*ll of Management and Budget, Wahington OC 20503. If

• mean* UHd to Impose jo2-1&

I information collectton don not display a currentty valid 0MB control number, the NRC may not conduct or sponsor, and

• peraon la not req..ilred 1D relPC)l'ld to, the information collection .

Fsclllty 1-c... [50-482]

I Date of Collection (mm/ddlyyyy)

I 09/23/20 19 I Reason for Test/ng - 29.717(b)(5) f'n>.Access Testing Reason (optional) Please elaborate (optional)

,~....

1--

Employment Type - 26.717(b)(3)

Labor Category - 26.717(b)(3)

I I

llnltialAulhorization Outage Worker (options/) 7 IY* I I

I I IMalnllraa<~io I Is this a 24-hour reportable event under 26.719(b)7 ~

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

Test Results - 26.717(b)(4)

Test Type(*) for Reault(a) Reported

• 26.717(b)(2) Drug Spedmen T -

1Drug0nly I junna I Test Validlly jvai<t I Was this collect/on observed? - 26.717(b)(7) & 26.75 ~

How many substances ware confinned positive for this individual? I I

,~

1 UseNRC lnttial Confirmatory Umltof Substance - 26.717(b)(2) & (b)(6)

Cllloffs? Cutoff Cutoff Detection IAmphetamine I

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

Management Act/ons -26.717(b)(8) & 26.75 Reaaon for the Action jForst drug or alcohol positive I Sanction Applied (NRC Minimlffl or lJcensM Adminiltnmd)

INRCMirimum I

Specltlc Sanction ~ed 114- Day Danlaf I

Person(s) Responsible for Information Provided Person 1 {requ ired):

IPAMELA IIBlACK I!ACCESS BPECIAUST I PABUICKIIIIWCNOC.COM FlratNalna LiitName Poiiilon Title Company Email Address Penon 2 (optionol):

lac>>IYA II- ,,SUPERVISOR ACCESS SCREENING I SOJONESCIIWCNOC.COM Flri!Name l.iitName Poilaon tffli Company Ematl Address Final Step (Required)* NRC wlU conaldar thla fonn authentic In accordance Vtfltl 10 CFR 28.11 only \Wien the -Validate & Lock* button II clicked and all .,.ora (hlghUghted In red) have been corrected . The "Validate & Lock" button v114111 change to *Locked" der the data validation procea hH been aucceafully completed indicating the form la ready for aubmlHion.

- Fonn Locked On:!Feb 13, 2020 at8:04:35 PM I I Save ID Local PC 11 Print this Report I Single Positive Teet Fonn (version 1.8.0 - April 2018) NRC Fonn 890 (12/2014)