ML23051A024

Single Positive Test Form Collected on 04/28/2022

ML23051A024
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-2022-05
Download: ML23051A024 (1)

Text

Facility Palisades [50-255]

Reason for Testing - 26.717(b)(5)

Pre-Access Pre-Access Testing Reason (optional)

Reinstatement (Between 31 and 365 days)

Please elaborate (optional)

Access was originally terminated due to individual on leave for legal action. Once legal action was cleared, individual was processing as a Pre-Access.

Employment Type - 26.717(b)(3)

Licensee Employee Labor Category - 26.717(b)(3)

Maintenance (safety-significant)

Was this collection refused? - 26.717(b)(7) & 26.75 Test Results - 26.717(b)(4)

Test Validity Valid Test Type(s) for Result(s) Reported - 26.717(b)(2)

Drug Only Drug Specimen Tested Urine Was this collection observed? - 26.717(b)(7) & 26.75 Management Actions - 26.717(b)(8) & 26.75 Specific Sanction Applied Permanent Denial Save to Local PC Print this Report Unique Reference ID (Licensee Supplied)

PAL-2022-05

1) All fields required except those marked 'optional'

2) Entries in some fields auto-populate information in other fields

3) Mouse over form fields to view additional information

4) Use of Adobe Reader 8 or later is required No No 04/28/2022 Submission Update Person(s) Responsible for Information Provided Company Email Address s.summers@holtec.com First Name Scott Position Title Access Authorization Supervisor Position Title Access Authorization Supervisor First Name Jean Last Name Hartmann Last Name Summers Company Email Address j.hartmann@holtec.com Person 1 (required):

Person 2 (optional):

Single Positive Test Form (version 1.10.0 - October 2021)

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 3:22:13 PM Reason for the Action Second drug or alcohol positive Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b)

No Subversion Attempt -

Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Delete Submission FFD Program Performance Data Reporting System APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 09/30/2024 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 (FFD) program performance data on drug and alcohol programs from licensees and 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 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 Regulatory Commission, 725 17th Street NW, Washington, DC 20503; e-mail:

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.

NRC Form 890, Single Positive Test Form (EIE General Submission Portal)

NRC Form 890 Is this a 24-hour reportable event under 26.719(b)?

No No How many substances were confirmed positive for this individual?

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

Use NRC Cutoffs?

Initial Cutoff Confirmatory Cutoff Limit of Detection Marijuana Yes Date of Collection (mm/dd/yyyy)

Outage Worker (optional)?

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