ML21054A156

Single Positive Test Form Collected on 09/21/2020

ML21054A156
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-2020-08
Download: ML21054A156 (1)

Text

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FFD Program Performance Data Reporting System NRC Form 890 Single Pos1t1ve Test Form I

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1) All ffe/ds required except those marked 'optionar Z) Entries in some fields auto-populate lnfonnatlon In other fields

3) Mouse over form fields to view additional information

4) Use of Adobe Reader B or later Is required Submission Update Submission Unique Reference ID (Licensee Supplied)

IPAL-2020-08 I

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!Palisades [50-255]

APPROVED BY 0MB: CLEARANCE NO. 3150-0146 EXPIRES: 04/30/2021 Estimated burden per response to comply with this collection request is 30 minutes. This form Is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2) 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, Information Services Branch (T6-A10M), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to lnfoconects Besource@NRC goy. and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to Impose information 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.

Date of Collection I 0912112020 I (mm/dd/yyyy)

Reason for Testing

• 26.717(b)(5)

I Pre-Access Pre-Access Testing Reason (optional)

Please elaborate (optional)

!Reinstatement (Between 31 and 365 days)

Employment Type - 26. 717(b)(3) lcontractorNendor Labor Category - 26. 717(b)(3)

I Engineering Outage Worl<er (optlonaQ?

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

Was this collect/on refused? - 26.717(b)(7) & 26.75 Test Results* 26.717(b)(4)

Test Type(s) for Result(s) Reported* 26. 717(b)(2)

Drug Specimen Tested I

Drug Only junne I

Test Validity

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

Substance - 26.717(b)(2) & (b)(6)

)Marijuana UseNRC Cutoffs?

Initial Confirmatory Limit of Cutoff Cutoff Detedion Subversion Attempt-Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b) ~I ___

N_o __

Management Ac11ons - 26.717(b)(8) & 26.75 Reason for the Action I

First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)

I Licensee Administrated Specific Sanction Applied 13-Year Denial Person(s) Responsible for Information Provided Person 1 (required):

lscott I I summers I

IANFFD S4Mrvisor I ssumme1@entergy.com

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Company Email Address Person 2 (optional):

.___~____,l~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 dicked and all errors (highlighted in red) have been corrected. The "Validate & Lock* button will change to *Locked* after the data validation process has been successfully completed indicating the form is ready for submission.

I Form Locked On:!Feb 11, 2021 at3:35:13 PM Single Positive Test Form (version 1.9.0 - January 2020)

I Save t6 Local P.C 11 Prii:it this Report ]

NRC Form 890