ML20063J265
| 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: |
| 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 ~ed 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 o:~~~ssion licensees and oCher enttlfee. Send commentl regarclna burden Ntlmate to fie FotA, Update 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 Unlg_ue Reference ID (UcensN SullPl*ll Desk Officer, Office of Information and Regulatory Affairs. NEOB*1020, (3150.0146), Office 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 Fsclllty collection.
1-c... [50-482]
I Date of Collection I 09/23/2019 I (mm/ddlyyyy)
Reason for Test/ng - 29.717(b)(5) f'n>.Access Testing Reason (optional)
Please elaborate (optional) 1--
I llnltialAulhorization I
I I
Employment Type - 26.717(b)(3)
Outage Worker (options/) 7
,~....
I IY*
I Labor Category - 26.717(b)(3)
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 1
I Substance - 26.717(b)(2) & (b)(6)
UseNRC lnttial Confirmatory Umltof Cllloffs?
Cutoff Cutoff Detection I
Amphetamine 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 {required):
IPAMELA IIBlACK I
!ACCESS BPECIAUST I
PABUICKIIIIWCNOC.COM FlratNalna LiitName Poiiilon Title Company Email Address Penon 2 (optionol):
lac>>IYA Flri!Name II-l.iitName
,,SUPERVISOR ACCESS SCREENING Poilaon tffli I
SOJONESCIIWCNOC.COM 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)