|
|---|
Category:License-Fitness for Duty (FFD) Performance Report
MONTHYEARML23058A2912023-02-27027 February 2023
Annual Report Form for Drug and Alcohol Tests for 2022
ML23051A0232023-02-20020 February 2023
Single Positive Test Form Collected on 03/15/2022
ML23051A0302023-02-17017 February 2023
Annual Fatigue Reporting Form for 2022
ML23051A0282023-02-16016 February 2023
Single Positive Test Form Collected on 07/25/2022
ML23051A0252023-02-16016 February 2023
Single Positive Test Form Collected on 05/09/2022
ML23051A0292023-02-16016 February 2023
Annual Reporting Form for Drug and Alcohol Tests for 2022
ML23051A0272023-02-16016 February 2023
Single Positive Test Form Collected on 06/22/2022
ML23051A0212023-02-16016 February 2023
Single Positive Test Form Collected on 01/26/2022
ML23051A0242023-02-16016 February 2023
Single Positive Test Form Collected on 04/28/2022
ML23051A0262023-02-16016 February 2023
Single Positive Test Form Collected on 05/11/2022
ML23051A0202023-02-16016 February 2023
Single Positive Test Form Collected on 01/05/2022
ML23051A0222023-02-16016 February 2023
Single Positive Test Form Collected on 03/07/2022
ML22054A1362022-02-23023 February 2022
Annual Fatigue Form for 2021
ML22054A1342022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A1332022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0832022-02-17017 February 2022
Single Positive Test Form Collected on 03/15/2021
ML22054A0902022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A1272022-02-17017 February 2022
Single Positive Test Form Collected on 03/15/2021
ML22054A0882022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0862022-02-17017 February 2022
Single Positive Test Form Collected on 07/06/2021
ML22054A1282022-02-17017 February 2022
Single Positive Test Form Collected on 03/31/2021
ML22054A0842022-02-17017 February 2022
Single Positive Test Form Collected on 03/31/2021
ML22054A1322022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0852022-02-17017 February 2022
Single Positive Test Form Collected on 04/05/2021
ML22054A0912022-02-17017 February 2022
Single Positive Test Form Collected on 10/07/2021
ML22054A0892022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0872022-02-17017 February 2022
Single Positive Test Form Collected on 07/12/2021
ML22054A1292022-02-17017 February 2022
Single Positive Test Form Collected on 04/05/2021
ML22054A1352022-02-17017 February 2022
Single Positive Test Form Collected on 10/07/2021
ML22054A1312022-02-17017 February 2022
Single Positive Test Form Collected on 07/12/2021
ML22054A1302022-02-17017 February 2022
Single Positive Test Form Collected on 07/06/2021
ML22054A0822022-02-16016 February 2022
Annual Reporting Form for Drug and Alcohol Tests for 2021
ML22054A1262022-02-16016 February 2022
Annual Reporting Form for Drug and Alcohol Tests for 2021
ML21055A7942021-02-24024 February 2021
Annual Report Form for Drug and Alcohol Tests for 2020
ML21055A7932021-02-24024 February 2021
Single Positive Test Form Collected on 12/03/2020
ML21055A7922021-02-24024 February 2021
Single Positive Test Form Collected on 09/21/2020
ML21055A7912021-02-24024 February 2021
Single Positive Test Form Collected on 09/17/2020
ML21055A7902021-02-24024 February 2021
Single Positive Test Form Collected on 09/15/2020
ML21055A7892021-02-24024 February 2021
Single Positive Test Form Collected on 08/30/2020
ML21055A7882021-02-24024 February 2021
Single Positive Test Form Collected on 08/24/2020
ML21055A7872021-02-24024 February 2021
Single Positive Test Form Collected on 08/17/2020
ML21055A7862021-02-24024 February 2021
Single Positive Test Form Collected on 08/10/2020
ML21055A7852021-02-24024 February 2021
Single Positive Test Form Collected on 06/30/2020
ML21054A1582021-02-21021 February 2021
Annual Fatigue Form for 2020
ML21054A1522021-02-11011 February 2021
Single Positive Test Form Collected on 08/24/2020
ML21054A1512021-02-11011 February 2021
Single Positive Test Form Collected on 08/17/2020
ML21054A1542021-02-11011 February 2021
Single Positive Test Form Collected on 09/15/2020
ML21054A1502021-02-11011 February 2021
Single Positive Test Form Collected on 08/10/2020
ML21054A1532021-02-11011 February 2021
Single Positive Test Form Collected on 08/30/2020
ML21054A1552021-02-11011 February 2021
Single Positive Test Form Collected on 09/17/2020
2023-02-27
[Table view] |
Text
- . LJS N f C ' FFD Program Performance Data Reporting System
'~ * ** , \_ NRC Form 890 Single Pos1t1ve Test Fo1m I //11~ I 1 1111 1 , , r ,, ., F.: ' (J '
- 1) All fields required except those marlfed 'optional' APPROVED BY 0MB: CLEARANCE NO. 3150-0146 EXPIRES: 04/30/2021
- 2) Entries in some fields auto-populate lnfonnation In other fields Estimated burden per response to comply with this collection request is 30 minutes. This
- 3) Mouse over fonn fields to view additional infonnatlon form is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2)
- 4) Use of Adobe Reader 8 or later Is required and 26.717. The information Is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFO) program performance data on drug and alcohol programs from licensees and other entities. Send comments regarding burden estimate to the FOIA, Submission Information Services Branch (T6-A1OM), U.S. Nuclear Regulatory Commission, Washington Update Submission DC 20555-0001, or by e-mail to lnfocollects Resource@NRC gqy. and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Uni ue Reference ID Licensee Su lied Management and Budget, Washington DC 20503. If a means used to impose information PAL-2020-03 collection does not display a currenUy valid 0MB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.
Facility
!Palisades [50-255] DateofCol/ectfon (mm/dd/yyyy)
I 0811712020 I I
Reason for Testing - 26. 717(b)(5) Pre-Access Testing Reason (optional) Please elaborate (optional)
Pre-Access jReinstatement (Between 31 and 365 days)
Employment Type -26.717(b)(3) Outage Worker (optional)?
lcontradorNendor Ives I
Labor Catego,y - 26. 717(b)(3)
Facility Support Is this a 24-hour reportable event under 26.719(b)?
Was this collectfon refused?
- 26.717(b)(7) & 26.75 Test Results- 26.717(b)(4)
I Test Type(s) for Result(s) Reported - 26.717(b)(2) Drug Specimen Tested jDrug Only junne Test Validity lva1id Was'~hls collection observed? - 26. 717(b)(7) & 26.75 How many substances were confirmed positive for this individual? Lj_ _ _ _ __ ,
Use NRC Initial Confirmatory Limit of Substance - 26. 717(b)(2) & (b)(6)
Cutoffs? Cutoff Cutoff Detection I Marijuana Subversion Attempt- Did this collection involve a subversion attempt?- 26.717(b)(7) and 26.75(b) LI_ _ _ N_o_ __,
Management Actions - 26.717(b)(8) & 26.75 I
Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated) jucensee Administrated Specific Sanction Applied 13-Year Denial Person(s) Responsible for Information Provided Person 1 (required):
,.tt..__ ~ - - - - - - ~l 1Ls_um_m_**-*-~~~----~' IAA/FFD Superv;sor
'l_s_c9l!,_ J ll,'l.umme1@entergy.com
- Y First Name - Last Name ~ - - - - ,P'"'o.,.s"'1ti.,..on,-T"'i"'Ue
, - - - - - ' lf"'
- If,. '--~C-om-pa_n_y~E~m-a~il~A~dd~re_s_s_ __
Person 2 (optional):
._-=-==_____,I l..___...--==____.I .___I-----=~~ -----=-===--==--===---
First Name Last Name Position Title Company Email Address Final Step (Required)
- NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the "Validate & Lock" button is clicked and all errors (highlighted in red) have been corrected. The "Validate & Lock" button will change to *tocked" after the data validation process has been successfully completed indicating the form is ready for submission.
I Fenn LockedOn:!Feb 11, 2021 at3:29:11 PM I Save to Looal PO j ! Print this Report ]
Single Positive Test Fenn (version 1.9.0 -January 2020) NRC Fenn 890
