ML18060A239

Single Positive Test Form, for Pre-Access, Collected on 02/27/17

ML18060A239
Person / Time
Site:	Indian Point
Issue date:	02/15/2018
From:	Griffin W, Pettus K Entergy Nuclear Northeast
To:	Office of Nuclear Security and Incident Response
References
IPEC 2017-003, NL-18-011
Download: ML18060A239 (1)

Text

, l U.S.NRC \ FFD Program Performance Data Reporting System ' '-' NRC Form 890. Single Pos1t1ve Test Form l, 1, " '" " ,, ' l'r,,lt'I flll}: />c*oplc mu/ tltr I tu ,r""""' 111 1 E.11::_ C,eneral Submission Portal 1 1) All fields required except those marlutd 'optional' APPROVED BY 0MB: CLEAR A NCE NO. 3150-0146 EXPIRES: 11/3 0/2017 2) Entries in some fields auto-populate Information in other fields Estimated burden per response to comply with this collection request is 30 minutes. Th is 3) Mouse over fonn fields to view additional Information form is a voluntary means of reporting the information required under 10 CFR 26.717. The 4) Use of Adobe Reader 8 or l ater Is required information is required b y NRC to obtain on an annual basis site specific fitness-fo r-duty (F FO) program performance d a t a on drug and alcohol programs from licensees a nd other D Submission D ~~~e~~ssion entities. Send comments regarding burden estimate to the FOlA, Privacy and I nformation Update Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission , Washington DC 20555-0001, or by e-mail to l ofocollects R esou r ce@NB C g ov. and to the Desk Officer , Unique Reference ID (License Suoolied)

Office of Information and Regulat ory Affairs , NEOB-1 020 , (3150-01 4 6), O ffi ce of Management and Budget , Washington DC 20503. lf a means used to impose information IIPEC 2017-003 I collection does not display a currently valid 0MB control number , the NRC may not conduct or sponsor , and a pe r so n is not r equired to respond to, the information collectio n. Select Fac/1/ty I Indian Point (50-247; 50-286) I Date of Collec t/on I 02127 1 2017 I (mm/dd/yyyy)

Reason for Testing-26.717(b)(5)

Pre-Access Tes t ing Reason (optiona l) Please elaborate (optional)

I Pre-Access I I Initial Aut h orization I I I Employment Type -26.717(b)(3)

Outage Work e r (optional)?

ICo ntr actorNendor I Jves I Labor Category-26.717(b)(3)

I Maintenance (genera l facili t y) I Is this a 24-hour reporting event? -26. 719(b) Was this coll e ction refused? -26 717(b)(7)

& 26.75 T e st Results -26.717(b)(4) Test Type(s) for Result(s)

Reported -26.717(b)(2)

Drug Specimen Tested I Drug Only I I Urine I Test Validity l valid I Was this coll e ction observed?-26.717(b)(7)

& 26.75 How many substances were confi rm ed positive for this individua l? I 1 I Substance-26.717(b)(2)

& (b)(6) UseNRC Initial Confirmatory lim it of Cutoffs? Cutoff Cutoff Detection

!Marijuana I IGJ Subversion Attempt* Did this collection involve a subversion attempt?-26.717(b)(7) and 26.75(b) I No I Management Actions -26.7 1 7(b)(8) & 26.75 Reason fo r the Action I Fi r st drug or alcohol positive I Sanction App li ed (NRC Min i mum or Licensee Administrated) jLicensee Ad min istrated I Specific Sanction Applied 13-Yea r Denial I P e r s on(s) Responsible for Informat i on Pro vi ded P e r son 1 (required)

I Kelly I !Pettus I lsr. Security Coordinator , Access/FFD I kpettus@entergy.com First Name L as t Name Position Title Com pan y Email Address Person 2 (optiona l): !Wayne I !Griffin I I su p erv isor , Access/FFD I wgriff1@entergy

.com F irst Name Last Name Position Title Company Email Address F i nal Step (R e qu ire d)* NRC will consider this form authentic in accordance with 1 O CFR 26.11 only when the -Validate

& Lock* button is clicked and al1 errors (highlighted in red) have been co rr ected. The "Validate

& L ock" button wilt change t o " Lock ed" after the data validatio n process h as been success fully com pl eted indicati n g the form i s ready for s ubmission. -FormlockedOn:jFeb15

, 2018at10: 11: 37AMI I Save to Loca l PC 1 1 P rint this Report I Single P ositive Test Form (v ersion 1.7.0-December 20 1 6) NRC Form 890 (12/2014)