ML23051A022

Single Positive Test Form Collected on 03/07/2022

ML23051A022
Person / Time
Site:	Palisades
Issue date:	02/16/2023
From:	Summers S, Hartmann J Entergy Nuclear Operations, Holtec Decommissioning International
To:	Office of Nuclear Security and Incident Response, Document Control Desk
References
PAL-2022-03
Download: ML23051A022 (1)

Text

'1'l U.S.NR C FFD Program Performance Data Reporting System

l 111tul S t llt"~ Sudt"tr R t"f;ULttury Comm1.. ~1on NRC Form 890,Single Positive Test Form

Protectmg People mu/ the r11t'/ro111ue111 (EIE General Submission Portal)

1) All fields required except those marked 'optional' APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 09/30/2024

2) Entries in some fields auto-populate information in other fields Estimated burden per response to comply with this collection request is 30 minutes. This form

3) Mouse over form fields to view additional information is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2) and

4) Use of Adobe Reader 8 or later is required 26.717. The information is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFD) program performance data on drug and alcohol programs from licensees and Submission Delete other entities. Send comments regarding burden estimate to the FOIA, Library, and Information Collections Branch (T-6 A10M), U.S. Nuclear Regulatory Commission, Washington, DC Update Submission 20555-0001, or by e_mail to Infocollects.Resource@NRC.gov, and the OMB reviewer at: OMB Office of Information and Regulatory Affairs, (3150-0146), Attn: Desk Officer for the Nuclear Unique Reference ID (Licensee Supplied) Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e-mail:

PAL-2022-03 oira_submission@omb.eop.gov. The NRC may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the document requesting or requiring the collection displays a currently valid OMB control number.

Facility Palisades [50-255] Date of Collection 03/07/2022 (mm/dd/yyyy)

Reason for Testing - 26.717(b)(5) Please elaborate (optional)

Random

Employment Type - 26.717(b)(3) Outage Worker (optional)?

Licensee Employee No

Labor Category - 26.717(b)(3)

Engineering

Is this a 24-hour reportable event under 26.719(b)? No

Was this collection refused? - 26.717(b)(7) & 26.75 No

Test Results - 26.717(b)(4)

Test Type(s) for Result(s) Reported - 26.717(b)(2) Drug Specimen Tested Drug Only Urine JI Test Validity Valid

Was this collection observed? - 26.717(b)(7) & 26.7517 No

How many substances were confirmed positive for this individual? 1--c--

Substance - 26.717(b)(2) & (b)(6) Use NRC Initial Confirmatory Limit of Cutoffs? Cutoff Cutoff Detection

Marijuana Yes

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

Management Actions - 26.717(b)(8) & 26.75 Reason for the Action First drug or alcohol positive

Sanction Applied (NRC Minimum or Licensee Administrated)

NRC Minimum

Specific Sanction Applied 14-Day Denial

Person(s) Responsible for Information Provided Person 1 (required):

Scott Summers Access Authorization Supervisor s.summers@holtec.com

~ --1~First Name1 --~ ~ --------1 Last Name Position TitleCompany Email Address

Person 2 (optional):

Jean Hartmann Access Authorization Supervisor j.hartmann@holtec.com

~--~~--~l ~First NameLast Name I ----------1 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 Locked after the data validation process has been successfully completed indicating the form is ready for submission.

Locked Form Locked On: Feb 16, 2023 at 3:03:44 PM_____ Save to Local PC Print this Report___.I.__I _ _____.

Single Positive Test Form (version 1.10.0 - October 2021) NRC Form 890