ML23051A028

Single Positive Test Form Collected on 07/25/2022

ML23051A028
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-2022-09
Download: ML23051A028 (1)

Text

'1'l U.S.NRC l 111tul S t llt"~ Sudt"tr Rt"f;ULttury Comm1 ..~1on FFD Program Performance Data Reporting System 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 26.717. The information is required by NRC to obtain on an annual basis site specific fitness-

4) Use of Adobe Reader 8 or later is required 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 Submission Delete 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-2022-09 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 (mm/dd/yyyy) 07/25/2022 Reason for Testing - 26.717(b)(5) Please elaborate (optional)

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

Contractor/Vendor No Labor Category - 26.717(b)(3)

Security 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 17

--c--

Was this collection observed? - 26.717(b)(7) & 26.75 No How many substances were confirmed positive for this individual? 1 Use NRC Initial Confirmatory Limit of Substance - 26.717(b)(2) & (b)(6)

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)

Licensee Administrated Specific Sanction Applied 3-Year Denial Person(s) Responsible for Information Provided Person 1 (required):

~ --1~

Scott First Name Person 2 (optional):

1 Summers

- - ~~

Last Name Access Authorization Supervisor Position Title s.summers@holtec.com Company - - 1 Email Address

~ - - ~ ~ - - ~ l~

Jean First Name Hartmann Last Name IAccess Authorization Supervisor

- - Position - Title - - - - - - - 1 j.hartmann@holtec.com 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 3:38:07 PM _ __

Save _ _PC to Local ___.I .__

I Print

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