ML21054A152

Single Positive Test Form Collected on 08/24/2020

ML21054A152
Person / Time
Site:	Palisades
Issue date:	02/11/2021
From:	Summers S Entergy Nuclear Operations
To:	Document Control Desk, Office of Nuclear Security and Incident Response
Shared Package
ML21054A147	List: ML21054A148 ML21054A149 ML21054A150 ML21054A151 ML21054A152 ML21054A153 ML21054A154 ML21054A155 ML21054A156 ML21054A157 ML21054A158
References
PAL-2020-04
Download: ML21054A152 (1)

Text

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• FFD Program Performance Data Reporting System

'~ J. * * "'\ NRC Form 890 Single Pos 1t1ve Test Fo1m C

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1) All fields required except those marft.ed '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 coUection request Is 30 minutes. This

3) Mouse over fonn fields to view additional infonnatlon form is a votuntary 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 obtaJn on an annual basis site specific fitness~for-duty (FFD) 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-A10M), U.S. Nuclear Regulatory Commission, Washington Update Submission DC 20555-0001, or by e-mail to lnfocoOects Resource@NRC poy. 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-2020-04 collection does not display a currently valid 0MB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

I Facility Palisades [50-255] Date of Collection (mm/dd/yyyy)

I 0812412020 I I I Reason for Testing - 26.717(b)(5) Pre-Access Testing Reason (optional) Please elaborate (optional)

Pre-Access Reinstatement (Between 31 and 365 days)

Employment Type - 26. 717(b)(3) Outage Worker (optlonaQ?

jcontractorNendor jves Labor Category - 26. 717(b)(3)

!Maintenance (general facility)

Is this a 24-hour repottable event under 26.719(b)?

Was this collection 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 lvalid Was this collect/on observed? - 26.717(b)(7) & 26.75 How many substances were confinned positive for this individual? I~-----~

UseNRC Initial Confirmatory Limit of Substance - 26.717(b)(2) & (b)(6)

Cutoffs? Cutoff Cutoff Detedion IMarijuana Subversion Attempt - Did this collection involve a subversion attempt?-26.717(b)(7) and 26.75(b) ~I___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)

!Licensee Administrated Specific Sanction Applied j3-Year Denial Person(s) Responsible for Information Provided

~Is_*_**--=------~' IANFFD I Person 1 (required):

~ls_u_m_m_*r_*_~~~----~I Supervisor ssumm~ ntergy.com

"'iirst Name Last Name '---~P~o-s~iti-on~T,~-u-e_ _ __, "ircompany Email Address Person 2 (optional):

First Name Last Name Position Title Company Email Address Final Step (Required)* NRC 'Nill 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 'Nill change to *Lockedw after the data validation process has been successfully completed indicating the form Is ready for submission.

I Form Locked On:!Feb 11. 2021 at 3:30:42 PM I Save to Local PC !I Pri(lt this Re'/iort I Single Positive Test Form (version 1.9.0-January 2020) NRC Form 890