NL-16-018, Transmittal 2015 Annual Fitness for Duty Program Performance Data Report and Fatigue Management Program Data Report: Difference between revisions

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Washington DC 20555-0001.
Washington DC 20555-0001.
or by e-mail to Infocollecto.Resource@NRC.son, and tc the Desk Officer. Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Offce ot Management and Budget, washington DC 20503. If a means used to imepose information collection does not display a currently nalhd 0MB control number, the NRC may not conduct or sponsor, and a personai not required to respond to, the information collection.
or by e-mail to Infocollecto.Resource@NRC.son, and tc the Desk Officer. Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Offce ot Management and Budget, washington DC 20503. If a means used to imepose information collection does not display a currently nalhd 0MB control number, the NRC may not conduct or sponsor, and a personai not required to respond to, the information collection.
: 1) All fields required unless marked 'optionar" 2) Use of Adobe Reenter 8 or Ilter Is required 3) Mouse over fields for addltional Information Select Facility D-'Submission Update Period of Report J120161 Ilndian Point [5D-247; 50-286]Tfob in tha Year Total Number of Tests Conducted Total Number of Positive, Adulterated, Reason For Testing Licensee Employees ContractorsNendors Substituted, and Refusal to Test Results Random [III 21J 1 " I6 Post-Event Z o I ° [I o Total(Calculated)  
: 1) All fields required unless marked 'optionar" 2) Use of Adobe Reenter 8 or Ilter Is required 3) Mouse over fields for addltional Information Select Facility D-'Submission Update Period of Report J120161 Ilndian Point [5D-247; 50-286]Tfob in tha Year Total Number of Tests Conducted Total Number of Positive, Adulterated, Reason For Testing Licensee Employees ContractorsNendors Substituted, and Refusal to Test Results Random [III 21J 1 " I6 Post-Event Z o I ° [I o Total(Calculated)
[X62 1h61I ZI3I FFD Program Random Testing Population and Rate Average number of Average number of Total size of the random testing pool Annual random testing percentage licensee employees contractors/vendors throughout the period (Calculated) achieved for the testing pool 1 ,°D1 4831 5 '17 3.71 Laboratory Testing Does your program use aI Licensee Testing Facility?
[X62 1h61I ZI3I FFD Program Random Testing Population and Rate Average number of Average number of Total size of the random testing pool Annual random testing percentage licensee employees contractors/vendors throughout the period (Calculated) achieved for the testing pool 1 ,°D1 4831 5 '17 3.71 Laboratory Testing Does your program use aI Licensee Testing Facility?
No (Yes/No)''
No (Yes/No)''
Identity your HHS-Certifled Laboratory(ies)
Identity your HHS-Certifled Laboratory(ies)
QUEST DIAGNOSTIC LABORATORIES Identity your Blind Performance Test Sample supplier(s)  
QUEST DIAGNOSTIC LABORATORIES Identity your Blind Performance Test Sample supplier(s)
[ELSOHLY LABORATORIES, INCORPORATED 1 Substances Tested Did your program only test for NRC-required substances lle Does yoUrinProgram conduct LOD/testing Yes AND at the NRC-specitied minimum cutoff levels? (Yes I No) permitted in26.163(a)(2)? (Yes INo)Substance Use Only NRC Cutoff Initial Confirmatory LOD Testing? Comment Levels? (Yes I No) Cutoff Cutoff (Yes / No) (Optional)
[ELSOHLY LABORATORIES, INCORPORATED 1 Substances Tested Did your program only test for NRC-required substances lle Does yoUrinProgram conduct LOD/testing Yes AND at the NRC-specitied minimum cutoff levels? (Yes I No) permitted in26.163(a)(2)? (Yes INo)Substance Use Only NRC Cutoff Initial Confirmatory LOD Testing? Comment Levels? (Yes I No) Cutoff Cutoff (Yes / No) (Optional)
Alcohol[ ~ I j]Cocaine Yes [e Marijuana Yes [Yes Amphetamines Yes iIIZYes Opiates [Yles__________
Alcohol[ ~ I j]Cocaine Yes [e Marijuana Yes [Yes Amphetamines Yes iIIZYes Opiates [Yles__________
Line 85: Line 85:
Reason for Testing -26.71 7(b)(5)Employment Type -26.71 7(b)(3)?.onracorndor Labor Category -26.71 7(b)(3)Faiity Supot Initial Authorization Outage Worker (optional)?
Reason for Testing -26.71 7(b)(5)Employment Type -26.71 7(b)(3)?.onracorndor Labor Category -26.71 7(b)(3)Faiity Supot Initial Authorization Outage Worker (optional)?
[Yen Dilute Sample-LOD testing required is thits a 24-Hour Reporting Event (Yesdtio)?  
[Yen Dilute Sample-LOD testing required is thits a 24-Hour Reporting Event (Yesdtio)?  
-26.715(b)  
-26.715(b)
[No[Refusal- 26,717(b)(7)  
[No[Refusal- 26,717(b)(7)  
& 26.75 Was this collection refused (Yes I No)? Fi77o7]Teat Results -26.717(b)(4)
& 26.75 Was this collection refused (Yes I No)? Fi77o7]Teat Results -26.717(b)(4)
Line 169: Line 169:
~t Eetelea be some flakla aate-pepudat.
~t Eetelea be some flakla aate-pepudat.
Intonneden In oEarlblde.1) Moos. ever tenon fields to 11rlewaddnlanaIlnfo.ene~on 4)1.1.. of Adobe Reader S Or later in r.qair.d[7J Submission m Delete Update [] Sub mission Select Facility Enanmated burden per response to comply with thin collection request in 30 minutes. This fornm itoa voluntary means of reportina the information raquired under 10 CFR 26.717. The intormchonc in required by NRC to obtain on an annual basis site opecilto fitoess-tor-duty (FFD1 program performance data on drug and alcohol programs from linennees and other entities.
Intonneden In oEarlblde.1) Moos. ever tenon fields to 11rlewaddnlanaIlnfo.ene~on 4)1.1.. of Adobe Reader S Or later in r.qair.d[7J Submission m Delete Update [] Sub mission Select Facility Enanmated burden per response to comply with thin collection request in 30 minutes. This fornm itoa voluntary means of reportina the information raquired under 10 CFR 26.717. The intormchonc in required by NRC to obtain on an annual basis site opecilto fitoess-tor-duty (FFD1 program performance data on drug and alcohol programs from linennees and other entities.
Send commenta regarding borden estimate to the FOIA, Privacy and Intormation Collectimn Branch (TrS-F53), U.S. Nuclear Reeulatory Commission, mashington DC 20555-0001, or by e-mail to Intocotllets Resocrco@NRC nooc end to the Dank Dfinner, Ottice of Informoation and Reaulatory Attairs, NEOB--tO20.  
Send commenta regarding borden estimate to the FOIA, Privacy and Intormation Collectimn Branch (TrS-F53), U.S. Nuclear Reeulatory Commission, mashington DC 20555-0001, or by e-mail to Intocotllets Resocrco@NRC nooc end to the Dank Dfinner, Ottice of Informoation and Reaulatory Attairs, NEOB--tO20.
(3150-Ol4e), Omfie of Manaaemnent and Budget, Washington DC 20003. Itoa means uned to impose inforrration uollection doen not display a currently valid 0MB uonnhol nuomber, the NRC may not conduct or sponsor, anod a person in not required to respond to. the information collection.
(3150-Ol4e), Omfie of Manaaemnent and Budget, Washington DC 20003. Itoa means uned to impose inforrration uollection doen not display a currently valid 0MB uonnhol nuomber, the NRC may not conduct or sponsor, anod a person in not required to respond to. the information collection.
Indian Point [50-247; 50-286](mm/dd/yyyy)D ef~lcin02/23/2015  
Indian Point [50-247; 50-286](mm/dd/yyyy)D ef~lcin02/23/2015  
Line 202: Line 202:
--]Submission L DebISlete IPE-215-005 Select Facility Estimated harden per response to comrply oith this collectioe request is 35 minutes, This form is a volantaty means of reporting the information required under 10 CFR 30.717. The information is required by NRC to obtain on ao annual basis site specitic fithess-for-duty (FF0) program performance dote on drag and alcohol prograns from licensees and other entities.
--]Submission L DebISlete IPE-215-005 Select Facility Estimated harden per response to comrply oith this collectioe request is 35 minutes, This form is a volantaty means of reporting the information required under 10 CFR 30.717. The information is required by NRC to obtain on ao annual basis site specitic fithess-for-duty (FF0) program performance dote on drag and alcohol prograns from licensees and other entities.
Send comments regarding burden estimate to the FOIA, Pdnvacy and Information Collection Branch (TS-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infucolleoto Resoaroae@NRC 000 and to the Desk Officer, Office 01 information and Regulatory Affairs, NEOB-It020, (3150-0146), Office ol Managemert and Budget, hWashington DC 20503. Itoa means used to impone information collection dues nor display a currently ualid 0MB contro number, the NRC may nut conducl or sponsor, and a person is not required to respond to. the information collection.
Send comments regarding burden estimate to the FOIA, Pdnvacy and Information Collection Branch (TS-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infucolleoto Resoaroae@NRC 000 and to the Desk Officer, Office 01 information and Regulatory Affairs, NEOB-It020, (3150-0146), Office ol Managemert and Budget, hWashington DC 20503. Itoa means used to impone information collection dues nor display a currently ualid 0MB contro number, the NRC may nut conducl or sponsor, and a person is not required to respond to. the information collection.
ininPoint  
ininPoint
[027 026 Pro-Access Test ir](mm/d/~yyyy)Da f~lefn02/23/2015 10 Reason (optional)
[027 026 Pro-Access Test ir](mm/d/~yyyy)Da f~lefn02/23/2015 10 Reason (optional)
Please elaborate (optional)
Please elaborate (optional)
Reason for Testing.-
Reason for Testing.-
26.717(b)  
26.717(b)
(5)Employment Type -26.71 7(b)(3)CotacoNendor]
(5)Employment Type -26.71 7(b)(3)CotacoNendor]
Labor Category-26.717(b)(3)
Labor Category-26.717(b)(3)
Line 286: Line 286:
& (b)(6)Marijuanao Additional Substance (as applicable)
& (b)(6)Marijuanao Additional Substance (as applicable)
Please Select Additional Substance (as applicable)
Please Select Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes ( No)?  Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involveta subversion attempt (Yes/No)?  
IPlease Select Use NRC Cutoff (Yes ( No)?  Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involveta subversion attempt (Yes/No)?
[liNo Manaoement Actions -26  
[liNo Manaoement Actions -26  
& 26.75 Reason for the Action Second drug or alcohol posihive Sanction Applied (NRC Minimum or Licensee Administrated)
& 26.75 Reason for the Action Second drug or alcohol posihive Sanction Applied (NRC Minimum or Licensee Administrated)
Line 295: Line 295:
The "Validate  
The "Validate  
& Lonk" batten mill change to "Lonked' afte the data validation process ban been nuccessfolly completed indicating the form in ready for nubminnion.
& Lonk" batten mill change to "Lonked' afte the data validation process ban been nuccessfolly completed indicating the form in ready for nubminnion.
Form Loced on:[Fb2 216st11: :,.7P~ Saet I.c ItthsRI Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)  
Form Loced on:[Fb2 216st11: :,.7P~ Saet I.c ItthsRI Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)
: 3) tne/ o e hed .-auto-pp ./non h, blohrfed Etiroated burden par responso to comrply witth ghis cotention retprest in 30 monutes. Ttis 3) Muse ver ormfle~= toview is a votontary means of reporting the inrformtion required under 10 CFR 28.717. The intormnatio as roqoired by NRC to obtain on an annual boois alto specific  
: 3) tne/ o e hed .-auto-pp ./non h, blohrfed Etiroated burden par responso to comrply witth ghis cotention retprest in 30 monutes. Ttis 3) Muse ver ormfle~= toview is a votontary means of reporting the inrformtion required under 10 CFR 28.717. The intormnatio as roqoired by NRC to obtain on an annual boois alto specific
: 4) Uaa of Adobe Raedw5 8 rltrisnqf~ (FFD) program performanoe data on drag and alcohol programsnrombo lcensees and other[]Sbiso r' Delate entitaes Sand commants regarding burden astirmate to ithe FOIA, Privacy and Intornation Updae I SumisionCatiaccon Branoh (TS-F53), U.S. Nuolear Regulatory Commissioan.
: 4) Uaa of Adobe Raedw5 8 rltrisnqf~ (FFD) program performanoe data on drag and alcohol programsnrombo lcensees and other[]Sbiso r' Delate entitaes Sand commants regarding burden astirmate to ithe FOIA, Privacy and Intornation Updae I SumisionCatiaccon Branoh (TS-F53), U.S. Nuolear Regulatory Commissioan.
Washrington DC Submission05g55000o , or by a-madl to letorolaeto Ranuorrai5NRC ga and to gre Dank Dttrer, Dffioe ot Information and Regulatory Affairs. NEOB-1020, (3150-0146), Dffioe at UnqeRfrneI  
Washrington DC Submission05g55000o , or by a-madl to letorolaeto Ranuorrai5NRC ga and to gre Dank Dttrer, Dffioe ot Information and Regulatory Affairs. NEOB-1020, (3150-0146), Dffioe at UnqeRfrneI  
Line 356: Line 356:
le In eMhr field.3) Moue.. ever ibee field. to sleerwddtdonel linaoms.the
le In eMhr field.3) Moue.. ever ibee field. to sleerwddtdonel linaoms.the
: 4) (Me ot Adobe Reud.5er Is oerIa req.*red[] Submission m-' Delete Update LJ1 Submission iff Select Facility Estimated borden per response to cormply with this collection request is 30 minutes. This boorm le n otuntary meons of reportng the infonmation required uoder 10 CFR 20.717. The ntonnetino is required by NRC to obtain on en anneal basis site seii ios-o-it fFFD) program perfonmnance data no drug end alcohol progranms horomcnesn te nntities.
: 4) (Me ot Adobe Reud.5er Is oerIa req.*red[] Submission m-' Delete Update LJ1 Submission iff Select Facility Estimated borden per response to cormply with this collection request is 30 minutes. This boorm le n otuntary meons of reportng the infonmation required uoder 10 CFR 20.717. The ntonnetino is required by NRC to obtain on en anneal basis site seii ios-o-it fFFD) program perfonmnance data no drug end alcohol progranms horomcnesn te nntities.
Send comments regarding burden estimate to the FOIA, Privnacy and Information Collection Branch (T5-F53), U.S. Nuclear Regolatory Commission, Wenhingtnn DC OO555-000t, or by e-mail to lntfonlaot Ree.~ourgdNRC eon and to the Desk Officer, 310ce 0f Inotmnation end Regulatory Affairs, NEOB-t020.  
Send comments regarding burden estimate to the FOIA, Privnacy and Information Collection Branch (T5-F53), U.S. Nuclear Regolatory Commission, Wenhingtnn DC OO555-000t, or by e-mail to lntfonlaot Ree.~ourgdNRC eon and to the Desk Officer, 310ce 0f Inotmnation end Regulatory Affairs, NEOB-t020.
(3155-0148), Office 01 hlanegament and Budget, Washington DC 25503. Ifta means coed to impose Information collection does not display e currently nalid 0MB control nuomber, the NRC may not condedl or sponsor, anode peosno is net required to respond to. the intormatinon collectnon.
(3155-0148), Office 01 hlanegament and Budget, Washington DC 25503. Ifta means coed to impose Information collection does not display e currently nalid 0MB control nuomber, the NRC may not condedl or sponsor, anode peosno is net required to respond to. the intormatinon collectnon.
Indian Point [50-247; 50-286]Date of Collection  
Indian Point [50-247; 50-286]Date of Collection  
Line 384: Line 384:
h*eas In oeri~ ffld.3) Nosa.en. oter m fiald. ts view .duleln.I lefne~inmfo
h*eas In oeri~ ffld.3) Nosa.en. oter m fiald. ts view .duleln.I lefne~inmfo
: 4) Use oef Adobe Read.5er tS. Ir.erl reqldred'-]Submission r'- Delete U Update L_ Submission UnqeReference ID (Licensee Supplied)IPEC-015-11 Select Facility Eotroatet burden per response to comply wi-th ttos cotiection rerpuest is 30 esnutes. Thur tore is a votontary nmeas of reporting the information rempired ander 10 CFR 26.717. Tha infonnation ie reqoired by NRC to obtain on an annual basis site spocific henna-for-dots (FFD) program performance data Ono drug and alcohol progranms broo lcensees and otee entities, Send comments regarding borden estimate to the FOIA, Privacy anid Information Collection Branch (T5-F53), U.S. Nocdesr Regulatory Commission.
: 4) Use oef Adobe Read.5er tS. Ir.erl reqldred'-]Submission r'- Delete U Update L_ Submission UnqeReference ID (Licensee Supplied)IPEC-015-11 Select Facility Eotroatet burden per response to comply wi-th ttos cotiection rerpuest is 30 esnutes. Thur tore is a votontary nmeas of reporting the information rempired ander 10 CFR 26.717. Tha infonnation ie reqoired by NRC to obtain on an annual basis site spocific henna-for-dots (FFD) program performance data Ono drug and alcohol progranms broo lcensees and otee entities, Send comments regarding borden estimate to the FOIA, Privacy anid Information Collection Branch (T5-F53), U.S. Nocdesr Regulatory Commission.
Washington DC 20555-000t, or by e-rnail to Infocollects Resoorce@NRC gnu, and to the Desk Officer Dfi~ce ot Intornmation and Regolatomy Affairs, NEOB-1020.  
Washington DC 20555-000t, or by e-rnail to Infocollects Resoorce@NRC gnu, and to the Desk Officer Dfi~ce ot Intornmation and Regolatomy Affairs, NEOB-1020.
(3150-0146), Officeo Management and Budget. Washington DC 20503. Itsa means used to inmpose information cllector does not display a corrently natid DMB control nurmber, the NRC masy not condoc or sponsor, and a porson is not reqbired to respond to. the intormation colleciton.
(3150-0146), Officeo Management and Budget. Washington DC 20503. Itsa means used to inmpose information cllector does not display a corrently natid DMB control nurmber, the NRC masy not condoc or sponsor, and a porson is not reqbired to respond to. the intormation colleciton.
lIrdiarn Point [50-247; 50-286]Reason for Testirng.
lIrdiarn Point [50-247; 50-286]Reason for Testirng.
Line 399: Line 399:
-26.717(b)(2)  
-26.717(b)(2)  
& (b)(6) Additional Substance (as applicable)
& (b)(6) Additional Substance (as applicable)
Cocaine ] Please sele]Use NRC Cutoff (Yes / No)?Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?  
Cocaine ] Please sele]Use NRC Cutoff (Yes / No)?Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?
[I j~o Additional Substance (as applicable)
[I j~o Additional Substance (as applicable)
Please. Select Manaoement Actions -26.717(b51181  
Please. Select Manaoement Actions -26.717(b51181  
Line 411: Line 411:
The "Validate  
The "Validate  
& Lock" button mill change to "Locked" atter the data validation process hon bees succnetsouly completed indicating the torm is reerdi tor submission.
& Lock" button mill change to "Locked" atter the data validation process hon bees succnetsouly completed indicating the torm is reerdi tor submission.
Single Positive Test Form (version 1.6.0 -December 19. 2014) NRC Form 890 (12/2014) 0 -I~~*-e. S -L. .I 5 I ~ All 0.14. required esoept ~ flee*.d a~aeaf F~P!ROWO BY 0MB: CLEARANCE NO. 31804146 EXPIRES: ~"-~'!3) rdm01.. in 0.n * .uteld -papuite Iefbnmsaln in elba fields 3) Me.,.. over fans fies to s'aeadlaew  
Single Positive Test Form (version 1.6.0 -December 19. 2014) NRC Form 890 (12/2014) 0 -I~~*-e. S -L. .I 5 I ~ All 0.14. required esoept ~ flee*.d a~aeaf F~P!ROWO BY 0MB: CLEARANCE NO. 31804146 EXPIRES: ~"-~'!3) rdm01.. in 0.n * .uteld -papuite Iefbnmsaln in elba fields 3) Me.,.. over fans fies to s'aeadlaew
: 4) Iteae (Adahe ReaderS or lade, I. requied L SUpdateOf LJ Submissio IPC-015012 Select Facility Estimated burden par respunse to comply with this collection request is 30 minotes. ThiO form is a voluntary means of reporlbng tre intormation required undar 10 CFR 26.717. The information is required by NRC to obtain onl an annual baums adte specoic Itness-for-dutl (FFD) program performance data on drug and alcohol prograns from licensees and ogree entitiea.
: 4) Iteae (Adahe ReaderS or lade, I. requied L SUpdateOf LJ Submissio IPC-015012 Select Facility Estimated burden par respunse to comply with this collection request is 30 minotes. ThiO form is a voluntary means of reporlbng tre intormation required undar 10 CFR 26.717. The information is required by NRC to obtain onl an annual baums adte specoic Itness-for-dutl (FFD) program performance data on drug and alcohol prograns from licensees and ogree entitiea.
Sand cumments regarding burden estimate to gre FOIA, Pdvacy and Informatior Collection Branch (T5-F53).
Sand cumments regarding burden estimate to gre FOIA, Pdvacy and Informatior Collection Branch (T5-F53).
U.S. Nuclear Regulatory Comnisalon, Washington O(20555-0001, Or by e-mail to Intorellects Resource@NRoov n, and to gre Dank Officer Office of information and Regulatory Affairs. NEOB-t020.  
U.S. Nuclear Regulatory Comnisalon, Washington O(20555-0001, Or by e-mail to Intorellects Resource@NRoov n, and to gre Dank Officer Office of information and Regulatory Affairs. NEOB-t020.
(3150-0146), Officeo Managemant and Budget, Washington DC 20503. It a means uoed to impose informatior collection doan not display a corrantly valid 0MB control number. gre NRC may nat candor or sponsor. and a person is not required to respond to. gre intormration collection.
(3150-0146), Officeo Managemant and Budget, Washington DC 20503. It a means uoed to impose informatior collection doan not display a corrantly valid 0MB control number. gre NRC may nat candor or sponsor. and a person is not required to respond to. gre intormration collection.
Indian Point [50-247; 50-286]Reason for Testing -26.71 7(b)(5) p Foloup [Employment Type -26.71 7(b)(3)Licensee Employee I Labor Category -26.71 7(b)(3)_______Date of Collection 0/2/2 15 (mm/dd/yyyy)
Indian Point [50-247; 50-286]Reason for Testing -26.71 7(b)(5) p Foloup [Employment Type -26.71 7(b)(3)Licensee Employee I Labor Category -26.71 7(b)(3)_______Date of Collection 0/2/2 15 (mm/dd/yyyy)
Line 446: Line 446:
Employment Type -26.717(b)(3)
Employment Type -26.717(b)(3)
Outage Worker (optional)?
Outage Worker (optional)?
LicenseEmployeeI  
LicenseEmployeeI
[No]Labor Category-26.717(b)(3)
[No]Labor Category-26.717(b)(3)
Is thils a 24-liour Reporting Event (Yes/No)?-
Is thils a 24-liour Reporting Event (Yes/No)?-
Line 457: Line 457:
-26.71 7(b)(2) & (b:)(6) Additiltonal Substance (as applicable)
-26.71 7(b)(2) & (b:)(6) Additiltonal Substance (as applicable)
Marijuana  
Marijuana  
] Please Select Use NRC Cutoff (Yes / No)? E i Subversion Attempts -26.71 7(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?  
] Please Select Use NRC Cutoff (Yes / No)? E i Subversion Attempts -26.71 7(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?
[NIo ~ i Atditiltonal Substance (aS applicable)
[NIo ~ i Atditiltonal Substance (aS applicable)
IPlease Select]Maneaement Actions -26.71 71b)I8/ & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licenses Administrated)
IPlease Select]Maneaement Actions -26.71 71b)I8/ & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licenses Administrated)
Line 508: Line 508:
Washington DC 20555-0001.
Washington DC 20555-0001.
or by e-mail to Infocollecto.Resource@NRC.son, and tc the Desk Officer. Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Offce ot Management and Budget, washington DC 20503. If a means used to imepose information collection does not display a currently nalhd 0MB control number, the NRC may not conduct or sponsor, and a personai not required to respond to, the information collection.
or by e-mail to Infocollecto.Resource@NRC.son, and tc the Desk Officer. Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Offce ot Management and Budget, washington DC 20503. If a means used to imepose information collection does not display a currently nalhd 0MB control number, the NRC may not conduct or sponsor, and a personai not required to respond to, the information collection.
: 1) All fields required unless marked 'optionar" 2) Use of Adobe Reenter 8 or Ilter Is required 3) Mouse over fields for addltional Information Select Facility D-'Submission Update Period of Report J120161 Ilndian Point [5D-247; 50-286]Tfob in tha Year Total Number of Tests Conducted Total Number of Positive, Adulterated, Reason For Testing Licensee Employees ContractorsNendors Substituted, and Refusal to Test Results Random [III 21J 1 " I6 Post-Event Z o I ° [I o Total(Calculated)  
: 1) All fields required unless marked 'optionar" 2) Use of Adobe Reenter 8 or Ilter Is required 3) Mouse over fields for addltional Information Select Facility D-'Submission Update Period of Report J120161 Ilndian Point [5D-247; 50-286]Tfob in tha Year Total Number of Tests Conducted Total Number of Positive, Adulterated, Reason For Testing Licensee Employees ContractorsNendors Substituted, and Refusal to Test Results Random [III 21J 1 " I6 Post-Event Z o I ° [I o Total(Calculated)
[X62 1h61I ZI3I FFD Program Random Testing Population and Rate Average number of Average number of Total size of the random testing pool Annual random testing percentage licensee employees contractors/vendors throughout the period (Calculated) achieved for the testing pool 1 ,°D1 4831 5 '17 3.71 Laboratory Testing Does your program use aI Licensee Testing Facility?
[X62 1h61I ZI3I FFD Program Random Testing Population and Rate Average number of Average number of Total size of the random testing pool Annual random testing percentage licensee employees contractors/vendors throughout the period (Calculated) achieved for the testing pool 1 ,°D1 4831 5 '17 3.71 Laboratory Testing Does your program use aI Licensee Testing Facility?
No (Yes/No)''
No (Yes/No)''
Identity your HHS-Certifled Laboratory(ies)
Identity your HHS-Certifled Laboratory(ies)
QUEST DIAGNOSTIC LABORATORIES Identity your Blind Performance Test Sample supplier(s)  
QUEST DIAGNOSTIC LABORATORIES Identity your Blind Performance Test Sample supplier(s)
[ELSOHLY LABORATORIES, INCORPORATED 1 Substances Tested Did your program only test for NRC-required substances lle Does yoUrinProgram conduct LOD/testing Yes AND at the NRC-specitied minimum cutoff levels? (Yes I No) permitted in26.163(a)(2)? (Yes INo)Substance Use Only NRC Cutoff Initial Confirmatory LOD Testing? Comment Levels? (Yes I No) Cutoff Cutoff (Yes / No) (Optional)
[ELSOHLY LABORATORIES, INCORPORATED 1 Substances Tested Did your program only test for NRC-required substances lle Does yoUrinProgram conduct LOD/testing Yes AND at the NRC-specitied minimum cutoff levels? (Yes I No) permitted in26.163(a)(2)? (Yes INo)Substance Use Only NRC Cutoff Initial Confirmatory LOD Testing? Comment Levels? (Yes I No) Cutoff Cutoff (Yes / No) (Optional)
Alcohol[ ~ I j]Cocaine Yes [e Marijuana Yes [Yes Amphetamines Yes iIIZYes Opiates [Yles__________
Alcohol[ ~ I j]Cocaine Yes [e Marijuana Yes [Yes Amphetamines Yes iIIZYes Opiates [Yles__________
Line 537: Line 537:
Reason for Testing -26.71 7(b)(5)Employment Type -26.71 7(b)(3)?.onracorndor Labor Category -26.71 7(b)(3)Faiity Supot Initial Authorization Outage Worker (optional)?
Reason for Testing -26.71 7(b)(5)Employment Type -26.71 7(b)(3)?.onracorndor Labor Category -26.71 7(b)(3)Faiity Supot Initial Authorization Outage Worker (optional)?
[Yen Dilute Sample-LOD testing required is thits a 24-Hour Reporting Event (Yesdtio)?  
[Yen Dilute Sample-LOD testing required is thits a 24-Hour Reporting Event (Yesdtio)?  
-26.715(b)  
-26.715(b)
[No[Refusal- 26,717(b)(7)  
[No[Refusal- 26,717(b)(7)  
& 26.75 Was this collection refused (Yes I No)? Fi77o7]Teat Results -26.717(b)(4)
& 26.75 Was this collection refused (Yes I No)? Fi77o7]Teat Results -26.717(b)(4)
Line 621: Line 621:
~t Eetelea be some flakla aate-pepudat.
~t Eetelea be some flakla aate-pepudat.
Intonneden In oEarlblde.1) Moos. ever tenon fields to 11rlewaddnlanaIlnfo.ene~on 4)1.1.. of Adobe Reader S Or later in r.qair.d[7J Submission m Delete Update [] Sub mission Select Facility Enanmated burden per response to comply with thin collection request in 30 minutes. This fornm itoa voluntary means of reportina the information raquired under 10 CFR 26.717. The intormchonc in required by NRC to obtain on an annual basis site opecilto fitoess-tor-duty (FFD1 program performance data on drug and alcohol programs from linennees and other entities.
Intonneden In oEarlblde.1) Moos. ever tenon fields to 11rlewaddnlanaIlnfo.ene~on 4)1.1.. of Adobe Reader S Or later in r.qair.d[7J Submission m Delete Update [] Sub mission Select Facility Enanmated burden per response to comply with thin collection request in 30 minutes. This fornm itoa voluntary means of reportina the information raquired under 10 CFR 26.717. The intormchonc in required by NRC to obtain on an annual basis site opecilto fitoess-tor-duty (FFD1 program performance data on drug and alcohol programs from linennees and other entities.
Send commenta regarding borden estimate to the FOIA, Privacy and Intormation Collectimn Branch (TrS-F53), U.S. Nuclear Reeulatory Commission, mashington DC 20555-0001, or by e-mail to Intocotllets Resocrco@NRC nooc end to the Dank Dfinner, Ottice of Informoation and Reaulatory Attairs, NEOB--tO20.  
Send commenta regarding borden estimate to the FOIA, Privacy and Intormation Collectimn Branch (TrS-F53), U.S. Nuclear Reeulatory Commission, mashington DC 20555-0001, or by e-mail to Intocotllets Resocrco@NRC nooc end to the Dank Dfinner, Ottice of Informoation and Reaulatory Attairs, NEOB--tO20.
(3150-Ol4e), Omfie of Manaaemnent and Budget, Washington DC 20003. Itoa means uned to impose inforrration uollection doen not display a currently valid 0MB uonnhol nuomber, the NRC may not conduct or sponsor, anod a person in not required to respond to. the information collection.
(3150-Ol4e), Omfie of Manaaemnent and Budget, Washington DC 20003. Itoa means uned to impose inforrration uollection doen not display a currently valid 0MB uonnhol nuomber, the NRC may not conduct or sponsor, anod a person in not required to respond to. the information collection.
Indian Point [50-247; 50-286](mm/dd/yyyy)D ef~lcin02/23/2015  
Indian Point [50-247; 50-286](mm/dd/yyyy)D ef~lcin02/23/2015  
Line 654: Line 654:
--]Submission L DebISlete IPE-215-005 Select Facility Estimated harden per response to comrply oith this collectioe request is 35 minutes, This form is a volantaty means of reporting the information required under 10 CFR 30.717. The information is required by NRC to obtain on ao annual basis site specitic fithess-for-duty (FF0) program performance dote on drag and alcohol prograns from licensees and other entities.
--]Submission L DebISlete IPE-215-005 Select Facility Estimated harden per response to comrply oith this collectioe request is 35 minutes, This form is a volantaty means of reporting the information required under 10 CFR 30.717. The information is required by NRC to obtain on ao annual basis site specitic fithess-for-duty (FF0) program performance dote on drag and alcohol prograns from licensees and other entities.
Send comments regarding burden estimate to the FOIA, Pdnvacy and Information Collection Branch (TS-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infucolleoto Resoaroae@NRC 000 and to the Desk Officer, Office 01 information and Regulatory Affairs, NEOB-It020, (3150-0146), Office ol Managemert and Budget, hWashington DC 20503. Itoa means used to impone information collection dues nor display a currently ualid 0MB contro number, the NRC may nut conducl or sponsor, and a person is not required to respond to. the information collection.
Send comments regarding burden estimate to the FOIA, Pdnvacy and Information Collection Branch (TS-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infucolleoto Resoaroae@NRC 000 and to the Desk Officer, Office 01 information and Regulatory Affairs, NEOB-It020, (3150-0146), Office ol Managemert and Budget, hWashington DC 20503. Itoa means used to impone information collection dues nor display a currently ualid 0MB contro number, the NRC may nut conducl or sponsor, and a person is not required to respond to. the information collection.
ininPoint  
ininPoint
[027 026 Pro-Access Test ir](mm/d/~yyyy)Da f~lefn02/23/2015 10 Reason (optional)
[027 026 Pro-Access Test ir](mm/d/~yyyy)Da f~lefn02/23/2015 10 Reason (optional)
Please elaborate (optional)
Please elaborate (optional)
Reason for Testing.-
Reason for Testing.-
26.717(b)  
26.717(b)
(5)Employment Type -26.71 7(b)(3)CotacoNendor]
(5)Employment Type -26.71 7(b)(3)CotacoNendor]
Labor Category-26.717(b)(3)
Labor Category-26.717(b)(3)
Line 738: Line 738:
& (b)(6)Marijuanao Additional Substance (as applicable)
& (b)(6)Marijuanao Additional Substance (as applicable)
Please Select Additional Substance (as applicable)
Please Select Additional Substance (as applicable)
IPlease Select Use NRC Cutoff (Yes ( No)?  Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involveta subversion attempt (Yes/No)?  
IPlease Select Use NRC Cutoff (Yes ( No)?  Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involveta subversion attempt (Yes/No)?
[liNo Manaoement Actions -26  
[liNo Manaoement Actions -26  
& 26.75 Reason for the Action Second drug or alcohol posihive Sanction Applied (NRC Minimum or Licensee Administrated)
& 26.75 Reason for the Action Second drug or alcohol posihive Sanction Applied (NRC Minimum or Licensee Administrated)
Line 747: Line 747:
The "Validate  
The "Validate  
& Lonk" batten mill change to "Lonked' afte the data validation process ban been nuccessfolly completed indicating the form in ready for nubminnion.
& Lonk" batten mill change to "Lonked' afte the data validation process ban been nuccessfolly completed indicating the form in ready for nubminnion.
Form Loced on:[Fb2 216st11: :,.7P~ Saet I.c ItthsRI Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)  
Form Loced on:[Fb2 216st11: :,.7P~ Saet I.c ItthsRI Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)
: 3) tne/ o e hed .-auto-pp ./non h, blohrfed Etiroated burden par responso to comrply witth ghis cotention retprest in 30 monutes. Ttis 3) Muse ver ormfle~= toview is a votontary means of reporting the inrformtion required under 10 CFR 28.717. The intormnatio as roqoired by NRC to obtain on an annual boois alto specific  
: 3) tne/ o e hed .-auto-pp ./non h, blohrfed Etiroated burden par responso to comrply witth ghis cotention retprest in 30 monutes. Ttis 3) Muse ver ormfle~= toview is a votontary means of reporting the inrformtion required under 10 CFR 28.717. The intormnatio as roqoired by NRC to obtain on an annual boois alto specific
: 4) Uaa of Adobe Raedw5 8 rltrisnqf~ (FFD) program performanoe data on drag and alcohol programsnrombo lcensees and other[]Sbiso r' Delate entitaes Sand commants regarding burden astirmate to ithe FOIA, Privacy and Intornation Updae I SumisionCatiaccon Branoh (TS-F53), U.S. Nuolear Regulatory Commissioan.
: 4) Uaa of Adobe Raedw5 8 rltrisnqf~ (FFD) program performanoe data on drag and alcohol programsnrombo lcensees and other[]Sbiso r' Delate entitaes Sand commants regarding burden astirmate to ithe FOIA, Privacy and Intornation Updae I SumisionCatiaccon Branoh (TS-F53), U.S. Nuolear Regulatory Commissioan.
Washrington DC Submission05g55000o , or by a-madl to letorolaeto Ranuorrai5NRC ga and to gre Dank Dttrer, Dffioe ot Information and Regulatory Affairs. NEOB-1020, (3150-0146), Dffioe at UnqeRfrneI  
Washrington DC Submission05g55000o , or by a-madl to letorolaeto Ranuorrai5NRC ga and to gre Dank Dttrer, Dffioe ot Information and Regulatory Affairs. NEOB-1020, (3150-0146), Dffioe at UnqeRfrneI  
Line 808: Line 808:
le In eMhr field.3) Moue.. ever ibee field. to sleerwddtdonel linaoms.the
le In eMhr field.3) Moue.. ever ibee field. to sleerwddtdonel linaoms.the
: 4) (Me ot Adobe Reud.5er Is oerIa req.*red[] Submission m-' Delete Update LJ1 Submission iff Select Facility Estimated borden per response to cormply with this collection request is 30 minutes. This boorm le n otuntary meons of reportng the infonmation required uoder 10 CFR 20.717. The ntonnetino is required by NRC to obtain on en anneal basis site seii ios-o-it fFFD) program perfonmnance data no drug end alcohol progranms horomcnesn te nntities.
: 4) (Me ot Adobe Reud.5er Is oerIa req.*red[] Submission m-' Delete Update LJ1 Submission iff Select Facility Estimated borden per response to cormply with this collection request is 30 minutes. This boorm le n otuntary meons of reportng the infonmation required uoder 10 CFR 20.717. The ntonnetino is required by NRC to obtain on en anneal basis site seii ios-o-it fFFD) program perfonmnance data no drug end alcohol progranms horomcnesn te nntities.
Send comments regarding burden estimate to the FOIA, Privnacy and Information Collection Branch (T5-F53), U.S. Nuclear Regolatory Commission, Wenhingtnn DC OO555-000t, or by e-mail to lntfonlaot Ree.~ourgdNRC eon and to the Desk Officer, 310ce 0f Inotmnation end Regulatory Affairs, NEOB-t020.  
Send comments regarding burden estimate to the FOIA, Privnacy and Information Collection Branch (T5-F53), U.S. Nuclear Regolatory Commission, Wenhingtnn DC OO555-000t, or by e-mail to lntfonlaot Ree.~ourgdNRC eon and to the Desk Officer, 310ce 0f Inotmnation end Regulatory Affairs, NEOB-t020.
(3155-0148), Office 01 hlanegament and Budget, Washington DC 25503. Ifta means coed to impose Information collection does not display e currently nalid 0MB control nuomber, the NRC may not condedl or sponsor, anode peosno is net required to respond to. the intormatinon collectnon.
(3155-0148), Office 01 hlanegament and Budget, Washington DC 25503. Ifta means coed to impose Information collection does not display e currently nalid 0MB control nuomber, the NRC may not condedl or sponsor, anode peosno is net required to respond to. the intormatinon collectnon.
Indian Point [50-247; 50-286]Date of Collection  
Indian Point [50-247; 50-286]Date of Collection  
Line 836: Line 836:
h*eas In oeri~ ffld.3) Nosa.en. oter m fiald. ts view .duleln.I lefne~inmfo
h*eas In oeri~ ffld.3) Nosa.en. oter m fiald. ts view .duleln.I lefne~inmfo
: 4) Use oef Adobe Read.5er tS. Ir.erl reqldred'-]Submission r'- Delete U Update L_ Submission UnqeReference ID (Licensee Supplied)IPEC-015-11 Select Facility Eotroatet burden per response to comply wi-th ttos cotiection rerpuest is 30 esnutes. Thur tore is a votontary nmeas of reporting the information rempired ander 10 CFR 26.717. Tha infonnation ie reqoired by NRC to obtain on an annual basis site spocific henna-for-dots (FFD) program performance data Ono drug and alcohol progranms broo lcensees and otee entities, Send comments regarding borden estimate to the FOIA, Privacy anid Information Collection Branch (T5-F53), U.S. Nocdesr Regulatory Commission.
: 4) Use oef Adobe Read.5er tS. Ir.erl reqldred'-]Submission r'- Delete U Update L_ Submission UnqeReference ID (Licensee Supplied)IPEC-015-11 Select Facility Eotroatet burden per response to comply wi-th ttos cotiection rerpuest is 30 esnutes. Thur tore is a votontary nmeas of reporting the information rempired ander 10 CFR 26.717. Tha infonnation ie reqoired by NRC to obtain on an annual basis site spocific henna-for-dots (FFD) program performance data Ono drug and alcohol progranms broo lcensees and otee entities, Send comments regarding borden estimate to the FOIA, Privacy anid Information Collection Branch (T5-F53), U.S. Nocdesr Regulatory Commission.
Washington DC 20555-000t, or by e-rnail to Infocollects Resoorce@NRC gnu, and to the Desk Officer Dfi~ce ot Intornmation and Regolatomy Affairs, NEOB-1020.  
Washington DC 20555-000t, or by e-rnail to Infocollects Resoorce@NRC gnu, and to the Desk Officer Dfi~ce ot Intornmation and Regolatomy Affairs, NEOB-1020.
(3150-0146), Officeo Management and Budget. Washington DC 20503. Itsa means used to inmpose information cllector does not display a corrently natid DMB control nurmber, the NRC masy not condoc or sponsor, and a porson is not reqbired to respond to. the intormation colleciton.
(3150-0146), Officeo Management and Budget. Washington DC 20503. Itsa means used to inmpose information cllector does not display a corrently natid DMB control nurmber, the NRC masy not condoc or sponsor, and a porson is not reqbired to respond to. the intormation colleciton.
lIrdiarn Point [50-247; 50-286]Reason for Testirng.
lIrdiarn Point [50-247; 50-286]Reason for Testirng.
Line 851: Line 851:
-26.717(b)(2)  
-26.717(b)(2)  
& (b)(6) Additional Substance (as applicable)
& (b)(6) Additional Substance (as applicable)
Cocaine ] Please sele]Use NRC Cutoff (Yes / No)?Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?  
Cocaine ] Please sele]Use NRC Cutoff (Yes / No)?Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?
[I j~o Additional Substance (as applicable)
[I j~o Additional Substance (as applicable)
Please. Select Manaoement Actions -26.717(b51181  
Please. Select Manaoement Actions -26.717(b51181  
Line 863: Line 863:
The "Validate  
The "Validate  
& Lock" button mill change to "Locked" atter the data validation process hon bees succnetsouly completed indicating the torm is reerdi tor submission.
& Lock" button mill change to "Locked" atter the data validation process hon bees succnetsouly completed indicating the torm is reerdi tor submission.
Single Positive Test Form (version 1.6.0 -December 19. 2014) NRC Form 890 (12/2014) 0 -I~~*-e. S -L. .I 5 I ~ All 0.14. required esoept ~ flee*.d a~aeaf F~P!ROWO BY 0MB: CLEARANCE NO. 31804146 EXPIRES: ~"-~'!3) rdm01.. in 0.n * .uteld -papuite Iefbnmsaln in elba fields 3) Me.,.. over fans fies to s'aeadlaew  
Single Positive Test Form (version 1.6.0 -December 19. 2014) NRC Form 890 (12/2014) 0 -I~~*-e. S -L. .I 5 I ~ All 0.14. required esoept ~ flee*.d a~aeaf F~P!ROWO BY 0MB: CLEARANCE NO. 31804146 EXPIRES: ~"-~'!3) rdm01.. in 0.n * .uteld -papuite Iefbnmsaln in elba fields 3) Me.,.. over fans fies to s'aeadlaew
: 4) Iteae (Adahe ReaderS or lade, I. requied L SUpdateOf LJ Submissio IPC-015012 Select Facility Estimated burden par respunse to comply with this collection request is 30 minotes. ThiO form is a voluntary means of reporlbng tre intormation required undar 10 CFR 26.717. The information is required by NRC to obtain onl an annual baums adte specoic Itness-for-dutl (FFD) program performance data on drug and alcohol prograns from licensees and ogree entitiea.
: 4) Iteae (Adahe ReaderS or lade, I. requied L SUpdateOf LJ Submissio IPC-015012 Select Facility Estimated burden par respunse to comply with this collection request is 30 minotes. ThiO form is a voluntary means of reporlbng tre intormation required undar 10 CFR 26.717. The information is required by NRC to obtain onl an annual baums adte specoic Itness-for-dutl (FFD) program performance data on drug and alcohol prograns from licensees and ogree entitiea.
Sand cumments regarding burden estimate to gre FOIA, Pdvacy and Informatior Collection Branch (T5-F53).
Sand cumments regarding burden estimate to gre FOIA, Pdvacy and Informatior Collection Branch (T5-F53).
U.S. Nuclear Regulatory Comnisalon, Washington O(20555-0001, Or by e-mail to Intorellects Resource@NRoov n, and to gre Dank Officer Office of information and Regulatory Affairs. NEOB-t020.  
U.S. Nuclear Regulatory Comnisalon, Washington O(20555-0001, Or by e-mail to Intorellects Resource@NRoov n, and to gre Dank Officer Office of information and Regulatory Affairs. NEOB-t020.
(3150-0146), Officeo Managemant and Budget, Washington DC 20503. It a means uoed to impose informatior collection doan not display a corrantly valid 0MB control number. gre NRC may nat candor or sponsor. and a person is not required to respond to. gre intormration collection.
(3150-0146), Officeo Managemant and Budget, Washington DC 20503. It a means uoed to impose informatior collection doan not display a corrantly valid 0MB control number. gre NRC may nat candor or sponsor. and a person is not required to respond to. gre intormration collection.
Indian Point [50-247; 50-286]Reason for Testing -26.71 7(b)(5) p Foloup [Employment Type -26.71 7(b)(3)Licensee Employee I Labor Category -26.71 7(b)(3)_______Date of Collection 0/2/2 15 (mm/dd/yyyy)
Indian Point [50-247; 50-286]Reason for Testing -26.71 7(b)(5) p Foloup [Employment Type -26.71 7(b)(3)Licensee Employee I Labor Category -26.71 7(b)(3)_______Date of Collection 0/2/2 15 (mm/dd/yyyy)
Line 898: Line 898:
Employment Type -26.717(b)(3)
Employment Type -26.717(b)(3)
Outage Worker (optional)?
Outage Worker (optional)?
LicenseEmployeeI  
LicenseEmployeeI
[No]Labor Category-26.717(b)(3)
[No]Labor Category-26.717(b)(3)
Is thils a 24-liour Reporting Event (Yes/No)?-
Is thils a 24-liour Reporting Event (Yes/No)?-
Line 909: Line 909:
-26.71 7(b)(2) & (b:)(6) Additiltonal Substance (as applicable)
-26.71 7(b)(2) & (b:)(6) Additiltonal Substance (as applicable)
Marijuana  
Marijuana  
] Please Select Use NRC Cutoff (Yes / No)? E i Subversion Attempts -26.71 7(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?  
] Please Select Use NRC Cutoff (Yes / No)? E i Subversion Attempts -26.71 7(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?
[NIo ~ i Atditiltonal Substance (aS applicable)
[NIo ~ i Atditiltonal Substance (aS applicable)
IPlease Select]Maneaement Actions -26.71 71b)I8/ & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licenses Administrated)
IPlease Select]Maneaement Actions -26.71 71b)I8/ & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licenses Administrated)

Revision as of 10:28, 27 April 2019

Transmittal 2015 Annual Fitness for Duty Program Performance Data Report and Fatigue Management Program Data Report
ML16053A236
Person / Time
Site: Indian Point  Entergy icon.png
Issue date: 02/12/2016
From: Coyle L
Entergy Nuclear Northeast
To:
Document Control Desk, Office of Nuclear Reactor Regulation
References
NL-16-018
Download: ML16053A236 (19)


Text

a Entergy Entercav Nuclear Northeast Indian Point Energy Center 450 Broadway, GSB P.O. Box 249 Buchanan, NY 10511-0249 Tel 9142546700 Lawrence Coyle Site Vice President NL-16-018 February 12, 2016 U.S. Nuclear Regulatory Commission Document Control Desk 11545 Rockville Pike, "IWFN-2 F1 Rockville, MD 20852-2738

Subject:

2015 Annual Fitness for Duty Program Performance Data Report and Fatigue Management Program Data Report Indian Point Energy Center Docket Nos. 50-247, 50-286 License Nos. DPR-26, DPR-64

Dear Sir or Madam:

This letter transmits Indian Point Energy Center (IPEC) Fitness for Duty (FFD) Program Performance data for the period January 1, 2015 through December 31, 2015 in accordance with the requirements of 10 CFR 26.717(e).

Included is also the Fatigue Management Program data in accordance with 10 CFR 26.203(e).

There are no new commitments contained in this letter. If you have any questions or require additional information, please contact Mr. Robert Walpole, Regulatory Assurance Manager at (914) 254-6710.Sincerely,

Enclosure:

1. 2015 Annual Fitness for Duty Program Performance Data Report and Fatigue Management Program Data Report 7..-I NL-1 6-018 Docket Nos. 50-247, 50-286 Page 2 of 2 cc: Mr. Daniel H. Dorman, Regional Administrator, NRC Region 1 Mr. Douglas Pickett, Senior Project Manager, NRC NRR DORL IPEC NRC Resident Inspector's Office Mrs. Bridget Frymire, New York State Department of Public Service Mr. John B. Rhodes, President and CEO, NYSERDA Mr. Paul Harris, NRC NSIR DSP SPSB ENCLOSURE 1 TO NL-16-018 2015 Annual Fitness for Duty Program Performance Data Report and Fatigue Management Program Data Report ENTERGY NUCLEAR OPERATIONS, INC.INDIAN POINT NUCLEAR GENERATING UNIT NOS. 2 and 3 DOCKET NOS. 50-247 and 50-286 a 0 .S
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_______ _______ _________________

_______ _______________________________________________________

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Estimated burden per response to comply with this collection request is 114 hours0.00132 days <br />0.0317 hours <br />1.884921e-4 weeks <br />4.3377e-5 months <br />. This form is a voluntary means of reporting the information required under 10 CFR 26.717. The information is required by NRC to obtain 0n an annual basis sode specific fitness-for-duty (FF0) program performance data on drug and alcohol programrs from licensees and other entites. Send comments regarding burden estimaote to the FOIA, privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission.

Washington DC 20555-0001.

or by e-mail to Infocollecto.Resource@NRC.son, and tc the Desk Officer. Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Offce ot Management and Budget, washington DC 20503. If a means used to imepose information collection does not display a currently nalhd 0MB control number, the NRC may not conduct or sponsor, and a personai not required to respond to, the information collection.

1) All fields required unless marked 'optionar" 2) Use of Adobe Reenter 8 or Ilter Is required 3) Mouse over fields for addltional Information Select Facility D-'Submission Update Period of Report J120161 Ilndian Point [5D-247; 50-286]Tfob in tha Year Total Number of Tests Conducted Total Number of Positive, Adulterated, Reason For Testing Licensee Employees ContractorsNendors Substituted, and Refusal to Test Results Random [III 21J 1 " I6 Post-Event Z o I ° [I o Total(Calculated)

[X62 1h61I ZI3I FFD Program Random Testing Population and Rate Average number of Average number of Total size of the random testing pool Annual random testing percentage licensee employees contractors/vendors throughout the period (Calculated) achieved for the testing pool 1 ,°D1 4831 5 '17 3.71 Laboratory Testing Does your program use aI Licensee Testing Facility?

No (Yes/No)

Identity your HHS-Certifled Laboratory(ies)

QUEST DIAGNOSTIC LABORATORIES Identity your Blind Performance Test Sample supplier(s)

[ELSOHLY LABORATORIES, INCORPORATED 1 Substances Tested Did your program only test for NRC-required substances lle Does yoUrinProgram conduct LOD/testing Yes AND at the NRC-specitied minimum cutoff levels? (Yes I No) permitted in26.163(a)(2)? (Yes INo)Substance Use Only NRC Cutoff Initial Confirmatory LOD Testing? Comment Levels? (Yes I No) Cutoff Cutoff (Yes / No) (Optional)

Alcohol[ ~ I j]Cocaine Yes [e Marijuana Yes [Yes Amphetamines Yes iIIZYes Opiates [Yles__________

_____Yes_________

PPYes IYes__Annual Report Form (version 1.6.0 -December 19, 2014) -Page 1 of 2 -NRC Form 891 (12/2014)

Substances Tested -continued Summary of Management Actions -26.71 7(b)(8)Summarize actions implemented to improve FF0 program performance.

As applicable, reference in the topic description audit reports, 30-day reports, and/or corrective action reports. If reporting information on more than three topics, select 'Others" for Topic 3 to report any additional topics.Topic 1 Please Select}Person(s)

Responsible for Information Provided Person 1 (required):

~~IIIIZCoordi11111r kpettus@entergy~com First Name Last Name Position Title Company Email Address Person 2 (optional):

~Im X Z Awgriffl @entergy.com First Name Last Name Position Title Company Email Address Final Step (Required).-

NRC will consider this form authentic in accordance with 26.11 only when the "Validate

& Lock" button has been selected and all errors (iLe., those highlighted in red) have been corrected.

The "Validate

& Lock" button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission.

Form Locked on:l eb22016at1:2O:02 PM L i ] I Annual Report Form (version 1.6.0 -December 19, 2014) -Page 2 of 2 -NRC Form 891 (1212014)

I *-. -S .~- 0 S -S1) A~ll 1114required esc roepflea eeked 'ogtgeno 2l lea son,. fieds aeto-pepaig Irnfmoaeun, In o~ter as~de ,1) Mooae ov, ernet fleld. to vke. .dddnl les~et,.ee,'m~

41 Uxe of AdOtr Reader S or lak, A. required Select Facility Estimated burden per response to comoply with thio collection request is 30 mnruntes.

Thos toerm is a voluntary macno of reporting thre information required uoder t0 CFR 26.717. The informshlon is required by NRC to obtain On an aennul bosi site specilic tlthess-for-rtuf

[FFD) program performance date ott drug and alcohol programis from licensees and otiem entitles.

Send comments regarding burden estimate to tire FOIA, Privacy and Information Collection Biranch (T5-F53), U.S. Noclear Regulatory Commission, Wastrmgtoo DC 20555-0001, or by e-mail to intocotiecls Rcsocrre@NRC coov and to tihe Desk Offcer Oftice of Information cod Reoulatory Affairs, NEOti-1020, (3150-0146).

Office o0 Managiement aod tiudget, Washington DC 20503. lIfe meaos used to impoose otformation colleotion doeo net display a currentgy oalid 0MB control nomber, tire NRC may not 0onducl or sponsor, and a person is not required to respond to, the information collection.

Indian Point [50-247; 50-286}Pre-Access Testi J Dafe of Collecfion[01425 (mm/do/yyyy) ing Reason (optional)

Pleasei elaboratei (optional)

Reason for Testing -26.71 7(b)(5)Employment Type -26.71 7(b)(3)?.onracorndor Labor Category -26.71 7(b)(3)Faiity Supot Initial Authorization Outage Worker (optional)?

[Yen Dilute Sample-LOD testing required is thits a 24-Hour Reporting Event (Yesdtio)?

-26.715(b)

[No[Refusal- 26,717(b)(7)

& 26.75 Was this collection refused (Yes I No)? Fi77o7]Teat Results -26.717(b)(4)

Test Validity Was LOD testing conducted Cr'es ( No) -26,163(a)(2)?

Dilute ] Yeis Test Type(s) for Result(s)

Reported -26.717(b)(2)

Drug Testing Drug Only ]Ifn Was dhis collect ion observed (Yes/No)?

-26.71 7(b)(7( & 26.75 I ]Substance

-26.717(b)(2)

& (b)(6) Additional Substance (as applicable)

Manruan ..] [Please Select Use NRC Cutoff (Yes / No)'? li Subversion Attempts -26.717(b)(7) and 26.75()5 Did this collection involve a subversion attempt (Yes/No)?

]No Additional Substance (as applicable)

IPlease Select Meneoemnent Actions -26.71 71b1181 & 26.75 Roason for the Action IFirst drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Specitic Sanction Applied 2- Year Denial Person(s)

Responsible for Information Provided Person I (required):

Kly PetlsoIed cesScrtyCodiao tikpettos@entergy.com First Name Last Name Position Title Company Email Address Person 2 (optional):

~ ~ mgritit@entergn.com First Name Last Name Position Title Company Email Address Fital Steg, (Required).

NRC mill consider this fo~rm cuthentic in accordance wfth 26,11 only ewhen the "Validate

& Lock" batten is clicked and all errors (highlighted in red) hrane been corrected.

The "Validate

& Lock" button mill change to "Locked" after the data validasion process has been successfully completed indicahlog the form Is ready for submission.

Form Locked on:[~b22016at 12:4941 M] Saet aa C Pri I ext Single Posihtive Test Form (version 1.6.0 -December 195,2014)

NRC Form 690 (12/2014) 0 -~ S -p 1) All asia. rsqr*ssi eee.pt files. ,eae~ ~ APPROVED BY 0MB: CLEARANCE NO. 3150-0148 EXPIRES: 1113012017 2)Enele in aser filds aaa.eedas ,nafonsn o,, abfeld.3) Maoase ovar fa,,m 051*d to vhJe adtltlaesj inisn,,a~sn

4) tUse ot Adoh ReadrS a rlatar 1. rsq.*red r-] Submission rm Delete L Update L_ Sub mission Select Facility Indian Point [50-247; 50-2861 Estlmated burden per response to comply With thlis totlection request in 30 ninutes. This form is a voluntary means of reporting the infonmation reqoired under 10 CFR 26,7t7, The intonmation is required by NRC to obtain On an annual basis site speific fitness-for-duty (FFD 0) prognrm performance data on drua end alcohol progeras barnm lcensees end other enhties. Send comments regsrding borden estiorste to the FOIA, Privacy and Informration Coilevo~on Branch (Tt-F53), U.S. Noclear Regulatory Cornmission.

Washgtoono DC 25055-0OS1, Or by e-mail to infeoooltct Reswocree@NPC eon, end to the Desk Officer, Office ot Information and Regulatory Affairs, NEOE-1020, (3150-0146).

Office of Management and Budget, Whashington DC 25503. Ifs ormeas uoed to impose information collection does not display a currently valid DMB control number, the NRC may not condoct or sponsor, endsa pemson is not required to respond to, the information collection.(mmldd/yyyy)Oe[of~leji~n0120205 j Reason for Test ing -2671 7(b)(5) Please elaborate (optional)

Rand I Employment Type -26.71 7(b)(3) Outage Worker (optional)

?CotatrNendor I No Labor Category -26.717(b)(3)

Faiity Supot Is this a 24-Hour Reporting Event (YeseJro)?

-26.719(b)

No Refusal- 26.717(b)(7)

& 26.75 Was thls collection refused (Yes I No)? ' [~II Test Results -26.71 7(b)(4)Test Validity Toot Type(s) for Result(s)

Reported -20.717(b)(2)

Drug Tooting Drug Only] dn Was this collection observed (Yes/No)?

-26.71 7(b)(7) & 26.75 [ L i Substance

-26,717(b)(2)

& (b)(6) Additional Substance (as applicable)

Marijun .. Please Select Use NRC Cutoff (Yes / No)?Ye Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection inoolve a subversion attempt (Yes/No)?

Eioi l ]Additional Substance (as applicable)

[Please Select]Manasoement Actions -26.7171b1181

& 26.75 Reason for the Action Frtdrug or alcohol positive Sanction Applied (NRC Minimum or Ucensee Administrated)

Licensee Administrated Specific Sanction Applied 3- Year Denial Person(s)

Responsible for Information Provided Ferson 1 (required)l:

First Name Last Name Positioo Title Company Email Address emaon 2 (optional):

I~aye GrffinSupervisor, Aceess/Fithess for Dory mawgiffl @entergy.com First Name Last Name Position Tite Company Email Address Final Step (Reqsdrsd. -NRC mill consider this form authentic in accordance with 26.1: only whren the "ValIdate

& Lock" button is clicked and all errors (highlighted in red) have been corrected.

The "Vatidate

& Loch" botton mill change to "Locked" alter the dats validation process boo been successiully compfeted indicating the foes Is ready for submisaion.

Form Locked on:[~ebj201 2o j50: PM $] O Ia C ItI W It Single Positiv Test Form (version 1.6.0 -De;emnber 19, 2014) NRC Form 890 (12/2014) 2)Entedes inote .eld a =tut~ pua lc Ino" e Estimatad borden par response to comply with this cotiection request in 30 minutes, This d)Mu e 7oe5fo m .fed fo tne noffm form is a volunfary means of reportng the information required under 10 CFR 26.717. The 3) Maaeinformanon in required by NRC to obtain on an annoal basis site specdioi fithess-for-duty

4) U a lAdeh.e ReaderS 8 rae l (FFD) program performance data on drug and alcohol programs from licensees and othar J]Submission Deoeentitee.

Sand comments regarding borden estimate to the FOIA, Privacy and information rDelete Collection Branch (T5-F53).

U.S. Nuclear Regulatory Commission.

Washington DC Li pdta t.J Sumsin20555-0001, Or by e-mail fo Infovollects ResouorcetiNRC noov and to the Desk Officer, Office of information and Regulatory Affairs, INEOB-I(020, (3150-0140), Office 01 Uini ue Reference ID (Licensee Supplied)

Management and Budget, Washington DC 20503. ifta means used to impose information SIPEC-2015-003 collection does not display a currently valid 0MB control number, the NRC may not condoci I or sponsor, and a person is net required to resprmd to, the information collection.

Select Facility Dt fCleto ~Indian Point (50-247; 50-286]DtofCleto(mm/dd/yyyy) 02/25 n cnal) Please elaborate (optional)

Reason fot' Testing -26.717(b)(5)

Employment Type -26.717(b)(3)

Contract~orenmor Labor Categoty -26.71 7(b)(3)Maintenance (general facility)Pre-Access Testing Reason (optio Reinstatement (Between 31 and 365 days)Outage Worker (optional)?

JYes Is tihis a 24-Hour Reporting Event (Yeais/Na)?

-26.719(b)

N Refusal- 26.717(b)(7)

& 26.75 Was this collection ref used (Yes I No)? ~ iiI Test Results -26,717)b)(4)

Test Validity Test Type(s) for Result(s)

Reported -26.717(b)(2)

Dwug Testing Drug Only [1 I iIIIe Was this collection observed (Yes/No)?

-26.717(b)(7)

& 26.75[ iI]Substance

-26.717(b)(2)

& (b)(6) Additional Substance (as applicable)

Marijuana

] Please Select Use NRC Cutoff (Yes / No)? ~ I Subversion Attempts -26.71 7(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

E~o ]Additional Substance (as applicable)

IPlease Select Manaoement Actions -26.717(b1181

& 26.75 Reason for the Action First drug or alcohol positive Sancton Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Specific Sanction Applied J3- Year Denial Person 1 (required).

JKelly F~ I~ IIIIIIIJ~

~ Jed hpettus~entergy .c..First Name Last Name Position Titie Company Email Address Pemson 2 (optional):

Wayn Grffi Sprvisor, Access/Fcithess fortDuly wrl ffl m tt@entergy.com First Name Last Name Position Title Company Email Address Final Step (Requied).-NRC mill consider this form authentic in accordance mith 20.11 only when the 'Validate

& Lock' button is clicked and all erroms (highlighted in red) sane been corrected.

The =Validate

& Lank' hutton mill change to 'Locked' after the data validation process hon been suocessfully completed indicasing the form is ready for submission.

Form Locked On:[geb2,216 at 122:31 PM J ~ Q~~I PCfhqtr Single Poesitve Test Form (version 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)

~t Eetelea be some flakla aate-pepudat.

Intonneden In oEarlblde.1) Moos. ever tenon fields to 11rlewaddnlanaIlnfo.ene~on 4)1.1.. of Adobe Reader S Or later in r.qair.d[7J Submission m Delete Update [] Sub mission Select Facility Enanmated burden per response to comply with thin collection request in 30 minutes. This fornm itoa voluntary means of reportina the information raquired under 10 CFR 26.717. The intormchonc in required by NRC to obtain on an annual basis site opecilto fitoess-tor-duty (FFD1 program performance data on drug and alcohol programs from linennees and other entities.

Send commenta regarding borden estimate to the FOIA, Privacy and Intormation Collectimn Branch (TrS-F53), U.S. Nuclear Reeulatory Commission, mashington DC 20555-0001, or by e-mail to Intocotllets Resocrco@NRC nooc end to the Dank Dfinner, Ottice of Informoation and Reaulatory Attairs, NEOB--tO20.

(3150-Ol4e), Omfie of Manaaemnent and Budget, Washington DC 20003. Itoa means uned to impose inforrration uollection doen not display a currently valid 0MB uonnhol nuomber, the NRC may not conduct or sponsor, anod a person in not required to respond to. the information collection.

Indian Point [50-247; 50-286](mm/dd/yyyy)D ef~lcin02/23/2015

]onall Please elaborate (optional)

Reason for Testing -26.71 7(b)(5)Employment Type -26,71 7(b)(3)Labor Category -26.71 7(b)(3)IMaintenance (general facility)Pro-Access Testing Reason (ootio iupdate Authorization Outage Worker (optional)?

IYes Is this a 24-Hour Reporting Event (Yena/o)?

-26.719(b)

N Refusal- 26.717(b)(7)

& 26.75 Wals this collection refused (Yes / No)? [Test Results -26.717(b)(4)

Test Validity Test Type(s) for Result(s)

Reported -26.717(b)(2)

Drug Testing Drug Only ] Urine Was this collection observed (Yes/No)?

-26.717(b)(7)

& 26.75 i I Substance

-26. 71 7(b)(2) & (b:)(6) Additional Substance (as applicable)

Marijuana

] Please Select Use NRC Ocutoff (Yes / No)? EI~Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

I~ ~IoI Additional Substance (as applicable)

IPlease Select Manaoement Actions -26.7171b1181

& 26.75 Reason for the Action IFirst drug or alcohtol positive Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Specific Sanction Applied 3- Year Denial Peran~s)Resonsile fr Iformt~onProide Person 1 (required):

Kelly I efs)ed A~essencudW Coordminao Z kpe~us@entergy

....First Name Last Name Position Title Compeny Email Address Person 2 (optional):

First Name Last Name Position Titie Company Email Address Final Step (Requied).

NRC will consider thus fony authentic in accordance with 26,11 only when the "Velidate

& Look" bucone mo clicked and all erroms (highlighted in red) have been corrected.

The "Validate

& Lock" sctore will chenge to "Locked" atier the data validation process has bees successfully completed indicating the form in ready tor nubminnion.

Foro Locked on:le2 ~2o16Nt2:S3:PM SWI f GS P ~ R p~Single Positive Test Forrm (version 1.6.0 -December 19, 2014) NRC Form 8980(12/2014) 1)i All field. required except those. narked "oadiorr APPROVED BY 0MB: CLEARANCE NO. 3165-0146 EXPIRES- 1113012017

3) Eared., in soe.a aeto-popoiaf.

iftn.Uonar in ofir fel~d.3) Mose. ovear ten, hieds to view addtlonalbd onnfa 4) U.. of Adobe R..der l or-lI. isqrd.-.de

--]Submission L DebISlete IPE-215-005 Select Facility Estimated harden per response to comrply oith this collectioe request is 35 minutes, This form is a volantaty means of reporting the information required under 10 CFR 30.717. The information is required by NRC to obtain on ao annual basis site specitic fithess-for-duty (FF0) program performance dote on drag and alcohol prograns from licensees and other entities.

Send comments regarding burden estimate to the FOIA, Pdnvacy and Information Collection Branch (TS-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infucolleoto Resoaroae@NRC 000 and to the Desk Officer, Office 01 information and Regulatory Affairs, NEOB-It020, (3150-0146), Office ol Managemert and Budget, hWashington DC 20503. Itoa means used to impone information collection dues nor display a currently ualid 0MB contro number, the NRC may nut conducl or sponsor, and a person is not required to respond to. the information collection.

ininPoint

[027 026 Pro-Access Test ir](mm/d/~yyyy)Da f~lefn02/23/2015 10 Reason (optional)

Please elaborate (optional)

Reason for Testing.-

26.717(b)

(5)Employment Type -26.71 7(b)(3)CotacoNendor]

Labor Category-26.717(b)(3)

Maintenance (general facility)Inilial Authorization Outage Worker (optional)?

Y~es ]Is this a 24-Hour Reporting Event (Yes/No)?

-26.719(b)

No Refusal- 26.71 7(b)(7) & 26.75 Was this collection refused (Yes / No)? Test Results -26.717(b)(4)

Test Validity Test Type(s) for Result(s)

Reported -26 717(b)(2)

Drag Testing Drug Only un Was this collection observerd (Yes /No)? -26 717(b)(7)

& 26.75 [Zi Substance

-26.71 7(b)(2) & (b)(6) Additional Substance (as applicable)

Marilun ..] Pleese Select Use NRC Cubtof (Yes ( No)? EI Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collechion inyolye a sub version attempt (Yes/No)?

Eiliol Additional Substance (as applicable) 1Please Select Manaoement Actions -26.717(b11t81

& 26.75 Reason for the Action First drug or alcohol positilye Sanction Applied (NRC Minimum or Licensee Administrated)

Licenses Administrated]

Specitic Sanction Applied 3- Year Deniali Persn~s)Resonsile or iformtio Proide person 1 (required):

ely Pettus Led cesScrt oriao kpettus@entergy~corn First Name Last Name Position Title Company Email Address Person 2 loptional):

First Name Last Name Position Titie Company Email Address Final Step (Requtred) -NRC wdil consider this form authentic in eccordance with 26, ft only when the "Validate

& Lock" button is clicked and all errors (highlighted in red) hone been rorrected.

The "Validate

& Loch" button mill change to =Locked" offer the data validation process hos been surcessfolly completed indicating the form is ready for submission.

Form Locked On:[Feb 2, 2016 at 12:55.12 PM ]a to ocI P Pt!R~g t Single Positive Test Forms (version 1.6.0 -December 19, 2014) NRC Fotnm 800 (12/2014)

Affff-alda eaqu/ved esap /Mba. gefd 'opfftptr ArrP vtUVP. U MB:

NV.

P3.Pces: 1llgo-tal, 2) in a... #eisi eastopopuabit .in. o6,e -Estiniated burden per response to compty with this collection request Is 30 nrdnotas.

This 3J6I..oae ovaver fon~ita1fed=t I.o eo trm wsanvcluntary means of reportlng the informationt re qoired under 10 CF R 26.717. Th.nforat~n i reuird b NR toobtain no an annoal basis sit, specific ftoleos-for-ttut3

4) Uae d4Adobe. 8 orae/ retl (FFD) progianh performance data on ding and alcohoi progranms trots tlcesees and ottel r" umsin Delet en~tits., Send commnents regarding borden estinate to the FOIA, privacy and Infonmation

[] i~*~ 6 oflection B.anch (TS-F53), U.S. Nuclear Regulatory Conmislsion, Washington DC L.Upae J Submission 20555-0051.

on by e-mail to Infouoilects aov, and tO the Dash Officer Office ot Intonnation and RegulatOry Affairs, NEOB-1020, (3150-0148), Office o UniueRe fereDnce I/ieseeSuppiedL Management and Budget, Washington DC 20503. If a means used to impose information IPEC-2015-006 I collecton does not display a corrently valid OMB control nomber, the NRC may not conduc" I or sponsor, and a parson is not required to respond to, the information collection.

Select Facility Dt fCleto lndian Point [50-247; 50-286](mmldd/yy)

I°2 °1 Pro-Access Testing Reason (optional)

Please elaborate (optional)

Reason for Testing -26.717(b)(5)

Pr-Acss]Employment Type -26.717(b)(3)

Labor Category -20.71 7(b)(3)Mainenance(gerlfclit)

Initial Authordzation DOtage Worker (optional)?

IYes is this a 24-Hour Reporting Event (Yes/No)?

-26.71 9(b) N Refusal- 26.71 7(b)(7) & 26.75 Was this collection refused (Yes / No)? j j Teat Results -26.717(b)(4)

Test Validity Test Type(s) fur Result(s)

Reported -26.717(b)(2)

Drug Testing Drug Only ]Irn Was this collection observed (Yes/No)?

-26.717(b)(7)

& 26.75[ Il Substance

-26.717(b)(2)

& (b)(6)( Additional Substance (as applicable)

Marijuana I Please Select]Use NRC Cutoff (Yes / No)?Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

I~ j~oj Additional Substance (as applicable)

IPlease Select]Manaoement Actions -26.7171b1181

& 20.75 Reason for the Action IFtrst drug or alcohol positive Sancton Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated]

Specific Sanction Applied 3- Year Denial Person(s)

Responsible fur Information Provided Person 1 (required):

Kel I IIIy I [Pettso]Ied ces tecort borint r Iketts@entergyi.c..

First Name Last Name Position Title Company Email Address Person 2 (optional):

Wayne [Gfi IsprioAcs/~s mo ut griffi @entergy.com First Name Last Name Position Title Company Email Address Final Step (Required)

-NRC mril consider this form authentic in accordance with 26.11 only when thre "Validate

& Lock" botton is clicked and all errors (highlighted in red) base been corrected.

The "Validate

& Loch" botton mitl change to "Locked' offer the data oalidatinn process has been successfolly completed indicating the form is ready for submission.

FormLocke OnJle , 16 s 2~:d:4PM SI A gIP lh R f Single Posibive Test Foro (versionl 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)

I1) AMl 1154 requared except tho. se mrked IAPPROVE BY OMB: CLEARANCE NO. 3110-0146 EXPIRES. 1113012017 EmresI soearv,. fonf nds o .ot-eata In ew ie 3) M~eoo.. as, on Cold CerV. odtsuleoelIdoee LI Submmsson elete Select Facility lndian Point [50-247; 50-286]Estiromted borden per response to comply ise thies cotiectionl request i. 30 minutes. Thin form in a voluntary means of reportin tire informration reqoired onder itt CFR 26.717. The intormraton is reqoired by NRC to obtain on an annual basin ted specrfic tibress-for-duty (FF0) program performance data on drog and alcohol prograrns fronm licensees ond other enttities.

Send comrrents regarding burden estimate to tihe FOIA, Privacy and lnfornmationr Cotiection Branch (TS-F53), U.S. Nuclear Regolatoty Comnmissionn Washington DC 205555-0001, or by e-nrint to Infcocttct Rnsoorco46NRC goy. and to tire Desk Officer.Office of Intnrnation and Regulatnry Affairs. NEOti-t020, (3150-0146t).

Office of Management and Budget, Washington DC 20503. Itoa means osed to impnse information collection does not display a currenlty valid OMti control nomber, the NRC may not conduct or sponsor, and a person in not reqoired to respond to, tire information colleobon.

Date of Collection o1?25mldyy)

Reason for Testing -26.717(b)(5)

Employment Type -26.717(b)(3)

Labor Category-26,717(b)(3)

Pro-Access Testing Reasont (optionral)

I'nitial Authlorizabion Outage Workrer (optional)?

Yes Please elaborate (optional)

Observed collection-applicant returming to indostry from positive test in 2008 Is this a 24-Hour Reporting Event (Yes/No)?-

26.7198(b)

N Refusal- 26.717(b)(7)

& 26.75 Was this collechion refused (Yes /No)? EiI Test Results -26 717(b)(4)Test Validityj Test Type(s) for Result(s)

Reported -26.717(b)(2)

Drug Testing IDrug Only I [Urine Was tils collection observed (Yes /No)?- 26.717()(7))

& 26.75 [II Substance-26.717(b)(2)

& (b)(6)Marijuanao Additional Substance (as applicable)

Please Select Additional Substance (as applicable)

IPlease Select Use NRC Cutoff (Yes ( No)? Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involveta subversion attempt (Yes/No)?

[liNo Manaoement Actions -26

& 26.75 Reason for the Action Second drug or alcohol posihive Sanction Applied (NRC Minimum or Licensee Administrated)

SLicensee Administrated Specific Sanction Applied Perm..anet Denial Person(s)

Responsible fur Information Pro vided Person 1 (required):

Iey Pettun [La.Acs eut orieo kpettusl~entergy c..m First Name Last Name Position Titte Company Email Address Person 2 (option al): Wayne ]Griffin Supervisor, Access/Fitoess for Duty m grittt@entergyp.com First Name Last Name Position Title Company Email Address Fliraf Step (Reqcrlrerft .NRC mill consider this form aothestic in acoordance with 20.11 only when the "Validate

& Lock" botton in clicked and all errors (highlighted in red) have been corrected.

The "Validate

& Lonk" batten mill change to "Lonked' afte the data validation process ban been nuccessfolly completed indicating the form in ready for nubminnion.

Form Loced on:[Fb2 216st11: :,.7P~ Saet I.c ItthsRI Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)

3) tne/ o e hed .-auto-pp ./non h, blohrfed Etiroated burden par responso to comrply witth ghis cotention retprest in 30 monutes. Ttis 3) Muse ver ormfle~= toview is a votontary means of reporting the inrformtion required under 10 CFR 28.717. The intormnatio as roqoired by NRC to obtain on an annual boois alto specific
4) Uaa of Adobe Raedw5 8 rltrisnqf~ (FFD) program performanoe data on drag and alcohol programsnrombo lcensees and other[]Sbiso r' Delate entitaes Sand commants regarding burden astirmate to ithe FOIA, Privacy and Intornation Updae I SumisionCatiaccon Branoh (TS-F53), U.S. Nuolear Regulatory Commissioan.

Washrington DC Submission05g55000o , or by a-madl to letorolaeto Ranuorrai5NRC ga and to gre Dank Dttrer, Dffioe ot Information and Regulatory Affairs. NEOB-1020, (3150-0146), Dffioe at UnqeRfrneI

~cne upid Monagoment and Budget. Washington DC 20503. Itoa meant used to impono informalton IIPEC-21 -2008 5 8cotaecton daes not disploy a currantly nalid DM2 control numbter. tra NRC map rot conduct or sponsor, and a person lb not raquired to raspond to, uhe intormation collaction.

Select Faciliy Indian Point [50-247; 50-286]Date of Collection Fo31021(mdyy)

Reason for Testinrg-26.717(b)(5) p Employment Type -26.717(b)(3)

C Labor -26.71 7(b)(3)elaborate (optional)

Ourtage Worker (optional)?

Is it/isea 24-Hour Reporting Event (Vesfido)?

-26.719(b)

N Refusal- 26.717(b)(7)

& 26.75 Was this collection refused (Yes / No)? E II Test Results -26.717(b:)(4)

Test Validity Test Type(s) fot Result(s)

Reported -26.717(b)(2)

Drug Testing Drug only ] l I~no I]Was ft/is collection observed (Yes / No.)? -26.71 7(b)(7) & 26.75 [ II Substance

-26.717(b)(2)

& (b)(6) Addi/tiona/

Substance (as app//cable)

Marijuana

] Please SelectI Additional Substance (as applicable)

[Please Select Use NRC Cutoff (Yes I No)?Sube-ers/on Attempts -26.71 7(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

o Manaoement Actions.-

26.7171b118)

& 26.75 Reason for the Action First drug or alcohol positive I Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated]

Specttlc Sanction Applied 3- Year Denial Person(s)

Responsible for Information Provided Parson t (required):

Kel ZIyI I] IPatton ] ~a.Acs eut oriao h pettusgentergy

....First Name Last Name Position Title Company Email Address Parson 2 (optional):

First Name Last Name Position Ttite Company Email Address Float $tap tRaquelre.

NRC milh consider this form authoenti In accordanr cengrt 26 11t only whmen the "Valdate & Lock" boston as chocked and all errors (highilghted in redl have bean corrected, Tho "Validate

& Loch" button will change to "Locked" altar the data validation process has boon succestoully completed indicating the term ia ready far submission.

Single Positive Teat Form (version 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)

P 3U*00 --P ~*-.. S -S I tiM ff.at. ,50t*Sd aweapt us... resotrad olaeone IA~~D BY 0MB: CLEARANCE NO. 31504148 EXPIRES: 1113012011 2)Enarles isn seen. fil~ds .ada-paplat tarsrnneton In o~ers fieds 3) MOS o o'.r formn fields to viassrsdditionallrdInmrnUonr 4)11U. of Adobe Reedsr D or tldr Is reqaal'redSubmiss ion [r1 Delete LiUpdate 1-i Submission UnqeRfrneI

~cne upid SelEC-2015-I1t9 Etiemated burden per response to comply wdtr this collection request is 30 mirnutes.

This torm is a voluntary mreans of reporting tre intormalton required under 10 CFR 26.717. The intormnation is required by NRC to obtaun on an annual basis site specilic ftloess-for-doty (FF0) program pertornmance date onr drug and alcohol programs frem licensees end other entlies. Send comnments regardong burden estimate to the FOiA, Pdivaey and Intermatiun Coilection Branch 1T5-F53), U.S. Nuciear Reguistory Conorsosien, Washington DC 20555-S0S1, or by e-rmadl to Infoculollctsesnoureo@NRC non. anid to the Desli Otffier, 0010e of etnformaton end Reguiatory Affairs, NEOB-t020, (3150-014e), Ofmen ot Mlanagenrant and Budeet, Washington DC 20503. if e mer.s coed to impose interormton ceiiectacn dues riot dispiay a corrently vailid 0MB controi number, the NRC may not conduct or sponsor, aod e person in cot required to respond to, the inforrmatoe cotlnotion.

Indian Point [50-247; 50-286]Dale of Collection (mm/dd/ I°1°yy)Reason for Testing -26.71 7(b)(5)Please elaborate (optional)

Employment Type- 28.71 7(b)(3) Outage Worker (optional)?

Licensee Employee I [leaeSaleti]

Labor Category-28.71 7(b)(3) Please elaborate Supervsor J Maintenance supervisor Irorking nighte for tire outage) mas nuitfed at Ore FPEC SOCA access facility, which is outside the I pr'otected ore,, to report to the Access facidity ton a randem Fitness-Fvc-Outy (FFD) test. A toot ter aicohol resulted in a confirmed Is this a 24-Hour Reporting Event (Yeaftrfo)?

-26.719(b)

Ys Reactor Rlant Ecent Notifucalton Wolrticheet EN # 50879 won completed to docomant nofification.

Refusal- 26.717(b)(7)

& 28.75 Was this collection refused (Yes I No)? o Test Results -26.71 7(b)(4)Test Validity No Aplicbe ]Test Type(s) for Result(s)

Reported -26,717(b)(2)

Alcohol Only]Alcohol Testing Substance-26.717(b)(2)

& (b)(6)Alcohol]What 28.103 BAC level mao exceeded?0.04 or greaterJ Subversion Attempts -26.717(b)(7) and 28.75(b)Did ltins collection involve a subversion attempt (Yes/No)?

o Manaaement Actions -26.71 71b118' & 28.75 Reason for the Action IFirst drug or alcohol positive Sanction Applied (NRC Minimum or Liceesee Administrated)

NRC Minimum]Specific Sanction Applied 14- Day Denial Person(s)

Responsible for Information Provided parson 1 {required):

First Name Last Name Posdtion Title Company Email Address Person 2 (optionall:

First Narse Lost Name Position Title Company Email Address Flnal Slep NRC wetl consider this term authentbc in accordance mrlt 24 11t only when the "Valotate

& Lock" button is clickled end all enrors Ihighldighted sinred) have beer corrected.

The "Validate

& Lock" button will change to "Locked" alter the data validation process huo been successfully completed indicticong thle tonrm is ready for submission.

Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 8t90 11212014)

D S.. ~0 -~ * -k. a -I 1) AM field. req~d excafit lAb,. mwte.d ~apemaf IAPPR(2~~W BY OM9~ CLEARANCE NO. 31000146 EXPIRESI 1113012017

2) Ermeesa In some flalda auel.pepalat.

le In eMhr field.3) Moue.. ever ibee field. to sleerwddtdonel linaoms.the

4) (Me ot Adobe Reud.5er Is oerIa req.*red[] Submission m-' Delete Update LJ1 Submission iff Select Facility Estimated borden per response to cormply with this collection request is 30 minutes. This boorm le n otuntary meons of reportng the infonmation required uoder 10 CFR 20.717. The ntonnetino is required by NRC to obtain on en anneal basis site seii ios-o-it fFFD) program perfonmnance data no drug end alcohol progranms horomcnesn te nntities.

Send comments regarding burden estimate to the FOIA, Privnacy and Information Collection Branch (T5-F53), U.S. Nuclear Regolatory Commission, Wenhingtnn DC OO555-000t, or by e-mail to lntfonlaot Ree.~ourgdNRC eon and to the Desk Officer, 310ce 0f Inotmnation end Regulatory Affairs, NEOB-t020.

(3155-0148), Office 01 hlanegament and Budget, Washington DC 25503. Ifta means coed to impose Information collection does not display e currently nalid 0MB control nuomber, the NRC may not condedl or sponsor, anode peosno is net required to respond to. the intormatinon collectnon.

Indian Point [50-247; 50-286]Date of Collection

-(nmm/ddlyyyy) Please elaborate (optional)

Reason for Testing -26.717(b)(5)

Employment Type -26,71 7(b)(3)Licensee Employee Labor Category-26.717(b)(3)

For Cause Testing Reason IPhysical Condition/Smell of Alcohol Outage Worker (optional)?

INo Is this a 24-Hour Reporting Event (Yes/Ndo)?

-26.719(b)

N Refusal- 26717(b)(7)

& 26.75 Was this collection refused (Yes / No)? 1 7 Test Results -26.71 7(b)(4)Test Validity Not Applicable Test Type(s) for Restilt(s)

Reported.-

26.717(b)(2)

Alcohol Testing Alcohol Only I ~i iiIth]Substance

-26.717(b)(2)

& (b)(6)IAlcohol SWat 26.103 BAC level was exceeded?0.04 or greeter ]Subversion Attempts -26.71 7(b))7) and 26.75(b)Did this collection innolve a subversion attempt (Yes/No)?

o Manaoement Actions -26.71 71b1168 & 26.75 Reason for the Action Frtdrug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)

NRC Minimum Specific Sanction Applied 14- Day Denial Person(s)

Responsible for Information Pro vided Person 1 Iroeuired):

Kelly ll 1I I [Pettus ] ~aAcs eurt oriao kpettos@eotergy .com First Name Last Name Position Title Company Email Address Person 2 loptionall:

Wye X I II I Z J [Gi E up rvior ccess/i1toess tor Duty mgrifft @entorgy.com First Name Lest Name Position Titie Company Email Addrtiss Final Step Iltequltecl)

NRC mill consider this term authentic in accordance woth 26 It only when the "Validate

& LOnik" button is duicked and all errors (highllighted in red) haoe bees corrected.

The "Validate

& Lock" hotton mill change te "Locked" offer the date validation process has been successfully completed indicating the torm is ready tor submission.

Form Locked On: Feb 2, 2016 at 1:54 MSw1 oa C PbttI p~Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 6901(1212014) 3 mU S --S -3~ -*~SS 0 -I i~ AM 0.11. re sIred exeaet thea. mw*eal 'eatleaaj APPRO~~~ BY OMBr CLEARANCE NO. 3180.0144 EXPIRESI 1113012017 Zt Ern~sto, nsame Bald. aute-popail.

h*eas In oeri~ ffld.3) Nosa.en. oter m fiald. ts view .duleln.I lefne~inmfo

4) Use oef Adobe Read.5er tS. Ir.erl reqldred'-]Submission r'- Delete U Update L_ Submission UnqeReference ID (Licensee Supplied)IPEC-015-11 Select Facility Eotroatet burden per response to comply wi-th ttos cotiection rerpuest is 30 esnutes. Thur tore is a votontary nmeas of reporting the information rempired ander 10 CFR 26.717. Tha infonnation ie reqoired by NRC to obtain on an annual basis site spocific henna-for-dots (FFD) program performance data Ono drug and alcohol progranms broo lcensees and otee entities, Send comments regarding borden estimate to the FOIA, Privacy anid Information Collection Branch (T5-F53), U.S. Nocdesr Regulatory Commission.

Washington DC 20555-000t, or by e-rnail to Infocollects Resoorce@NRC gnu, and to the Desk Officer Dfi~ce ot Intornmation and Regolatomy Affairs, NEOB-1020.

(3150-0146), Officeo Management and Budget. Washington DC 20503. Itsa means used to inmpose information cllector does not display a corrently natid DMB control nurmber, the NRC masy not condoc or sponsor, and a porson is not reqbired to respond to. the intormation colleciton.

lIrdiarn Point [50-247; 50-286]Reason for Testirng.

26.71 7(b)(5) Please elaborate (ophionail)

Employment Type -26.71 7(b)(3) Outage Worker (optional)

?Licenses Employee [SINO I Labor Category-26.71 7(b)(3)Is thIs a 24-Hour Reporting Enent (Yes/No)?

-26.71 9(b) No Refusal- 26.717(b)(7)

& 26.75 Was this collection refused (Yes I No)? EI~oI]Date of Collection 4/125(mdyy)

Test Results -26.71 7(b)(4)Tent Validity Test Type(s) for Resuit(s)

Reported -26.717(b)(2)

Drug Testing IDrug Only [I I Idne Waatitis collection observed (Yee/No)?

-26.717(b)(7)

& 26.75 No Substance

-26.717(b)(2)

& (b)(6) Additional Substance (as applicable)

Cocaine ] Please sele]Use NRC Cutoff (Yes / No)?Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

[I j~o Additional Substance (as applicable)

Please. Select Manaoement Actions -26.717(b51181

& 26.75 Reason for the Action First drug or alcohol positiveJ Sanction Applied (NRC Mirnimum or Uicensee Administrated)

INRc Minimum I Specitic Sanction Applied 114- Day Denial Person(s)

Responsible fur Information Provided Person 1 (required):

First Name Last Name Positon Title Company Email Address Person 2 (opuonal):

WaynmeI I~rfi Superor, Accesol/Ftiess for Duty]wntnteaco First Name Last Name Position Titie Company Email Address Final Step (Rempoimed)

NRC will consider this tore authenhic in accordance rat 26.11 only wdhen the "Vanidate

& Lock" button is sticked and all errors (highdlghted in red) have bees corrected.

The "Validate

& Lock" button mill change to "Locked" atter the data validation process hon bees succnetsouly completed indicating the torm is reerdi tor submission.

Single Positive Test Form (version 1.6.0 -December 19. 2014) NRC Form 890 (12/2014) 0 -I~~*-e. S -L. .I 5 I ~ All 0.14. required esoept ~ flee*.d a~aeaf F~P!ROWO BY 0MB: CLEARANCE NO. 31804146 EXPIRES: ~"-~'!3) rdm01.. in 0.n * .uteld -papuite Iefbnmsaln in elba fields 3) Me.,.. over fans fies to s'aeadlaew

4) Iteae (Adahe ReaderS or lade, I. requied L SUpdateOf LJ Submissio IPC-015012 Select Facility Estimated burden par respunse to comply with this collection request is 30 minotes. ThiO form is a voluntary means of reporlbng tre intormation required undar 10 CFR 26.717. The information is required by NRC to obtain onl an annual baums adte specoic Itness-for-dutl (FFD) program performance data on drug and alcohol prograns from licensees and ogree entitiea.

Sand cumments regarding burden estimate to gre FOIA, Pdvacy and Informatior Collection Branch (T5-F53).

U.S. Nuclear Regulatory Comnisalon, Washington O(20555-0001, Or by e-mail to Intorellects Resource@NRoov n, and to gre Dank Officer Office of information and Regulatory Affairs. NEOB-t020.

(3150-0146), Officeo Managemant and Budget, Washington DC 20503. It a means uoed to impose informatior collection doan not display a corrantly valid 0MB control number. gre NRC may nat candor or sponsor. and a person is not required to respond to. gre intormration collection.

Indian Point [50-247; 50-286]Reason for Testing -26.71 7(b)(5) p Foloup [Employment Type -26.71 7(b)(3)Licensee Employee I Labor Category -26.71 7(b)(3)_______Date of Collection 0/2/2 15 (mm/dd/yyyy)

Please elaborate on the reason for tooting (optional)

Outage Worker (optional)?

is this a 24-Hour Reporting Event (Yes/No) ? -26.719(b)

N Refusal- 26.717(bi)(7)

& 26.75 Was grin collection refused (Yes I No)? [Teat Resuits -26.717(b)(4)

Test Validity Was LOD testing conducted (Yes / No) -26.163(a)(2)?

Dilue ] le Test Type(s) for Result~s)

Repotted -26.717(b)(2)

Drug Tooting Drug Only ] Iri IIe I Was this coiiection observed (Yes /No)? -26.717(b)(7)

& 26.75 I I I Substance

-26.717(ti)(2)

& (b)(6) Additional Substance (as applicabie)

Cocaine ] Please Select Use NRC Cutoff (Yes I No)?Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

I~Io Additional Substance (as appilicable)

Iplease Select Manaoement Actions -26.717lbll8l

& 26.75 Reason for the Action Second drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Speobic Sanction Applied Permanent DenialJ Person(s)

Responsible for Information Provided Person I (required):

First Name Last Name Position Title Company Email Address Person 2 (optional):

Wan rfi Suerisr AccessiFitnass for Duty orgrifft @antergy.com First Name Last Name Position Titie Company Email Address Final Steop (Required).

NRC will consider this form autrantic in accordance withi 20.It only when gre "Validate

& Locti hutton as clicked and all errors (hightighted in red) have been corrected.

The "Vairdate

& Loch" button will change to 'Locked" alter gre data validation process has been successfully completed indicating the form is ready for submission.

Formo Locied On:[Feb2, 2016 at 1:00:23 PM S]~OLc C ~OtSO~Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 690 (1212014) 1j Flea ne qim ensapi ene. maxau opw 2) BEnat. hi sxeni filde au opopuiai leinaeo In oerl dfele 3) Moo.se ver Ia.,, fied.s to w s eds'di~lbon aadie 4) IP~ a Adobe Roeder# a, tr laer I reqetrad-]Submission i- Delete Select Facility Etmimated bnurden per response tn comply with this cotienhnun request is 30 minutes. This torm is 8 voluntary means of reporting the infornmaion required under 10 CFR 26.717. The informartion is required hy NRC to obtitin en on annual basise site specific fitess-tor-dudy (FF0) pruogrm pertormance dot. on drug end olcohol pregrams from licensees and nther entites. Send cnmments megardng burden estimote to the FOIA, Privocy end Intormotion COtetion Branch (TS-F53).

U.S. Nuctear Regulotory Comnussinon Washington DC 20555-0001 Om by n-mael to InftooclctoOs ResoacNRC cco, ond to the Desk Othcer, Office ut Intormation and Regulatory Affoirs, NEOe-1020, t3t50-0146), Offie ot Managtement and Budget, Washington DC 20503. Itoa means used to impose inforination colleotlon dues not display a currently oalid 0MB control number, the NRC moy net conduct mr sponsor, and a person is not required to respond to, the information collec~on.

Indian Point [50-247; 50-286]Date of CollectiOnmmeyyy 11/3/05I Reason for Tasting -26.71 7(b)(5) Please elaborate (optional)

Employment Type -26.717(b)(3)

Outage Worker (optional)?

LicenseEmployeeI

[No]Labor Category-26.717(b)(3)

Is thils a 24-liour Reporting Event (Yes/No)?-

26.715(b)

N Refusal- 26.717(b)(7)

& 26.75 Was this collection refused (Yes I No)? E ii Test Results -26.71 7(b)(4)Test Validity Test Typo(s) for Result(s)

Reported -26.717(bi)(2)

Drug Testinrg IDrug Only [ Iu i na Was this collection observeti (Yes/No)?

-26.71 7(b)(7) & 26.75 I I]Substance

-26.71 7(b)(2) & (b:)(6) Additiltonal Substance (as applicable)

Marijuana

] Please Select Use NRC Cutoff (Yes / No)? E i Subversion Attempts -26.71 7(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

[NIo ~ i Atditiltonal Substance (aS applicable)

IPlease Select]Maneaement Actions -26.71 71b)I8/ & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licenses Administrated)

NRC Minimum Specific Sanction Applied 14- Day Denial Person(s)

Responsible fur Information Provideti Person 1 trequired):

First Name Last Name Position Title Company Email Address Person 2 (op t ionll): Wayn GrifinSupervisor.

Acceos/Fitness ler Duty wgrlffl@entergy.com First Name Last Name Position Bite Company Email Address Final Stop (Raquirsd)

-NRC sill consider this leon authentic in eccordenco with 26 t11 only when the "Validate

& Lock" button is clicked ond all errors (highlighted In red) have been corrected.

The "Validate

& Lock" button will change to "Locked" alter the data volidaiton process has boon successfully compyleted indicating the forin is ready for submission.

Form Locked On:[Feb 2, 2016 at 1:12:43 PM S] o 1a Single Positive Test Fors (version 1.6.0 -December 19, 2014) NRC Form 890 (1212014) a Entergy Entercav Nuclear Northeast Indian Point Energy Center 450 Broadway, GSB P.O. Box 249 Buchanan, NY 10511-0249 Tel 9142546700 Lawrence Coyle Site Vice President NL-16-018 February 12, 2016 U.S. Nuclear Regulatory Commission Document Control Desk 11545 Rockville Pike, "IWFN-2 F1 Rockville, MD 20852-2738

Subject:

2015 Annual Fitness for Duty Program Performance Data Report and Fatigue Management Program Data Report Indian Point Energy Center Docket Nos. 50-247, 50-286 License Nos. DPR-26, DPR-64

Dear Sir or Madam:

This letter transmits Indian Point Energy Center (IPEC) Fitness for Duty (FFD) Program Performance data for the period January 1, 2015 through December 31, 2015 in accordance with the requirements of 10 CFR 26.717(e).

Included is also the Fatigue Management Program data in accordance with 10 CFR 26.203(e).

There are no new commitments contained in this letter. If you have any questions or require additional information, please contact Mr. Robert Walpole, Regulatory Assurance Manager at (914) 254-6710.Sincerely,

Enclosure:

1. 2015 Annual Fitness for Duty Program Performance Data Report and Fatigue Management Program Data Report 7..-I NL-1 6-018 Docket Nos. 50-247, 50-286 Page 2 of 2 cc: Mr. Daniel H. Dorman, Regional Administrator, NRC Region 1 Mr. Douglas Pickett, Senior Project Manager, NRC NRR DORL IPEC NRC Resident Inspector's Office Mrs. Bridget Frymire, New York State Department of Public Service Mr. John B. Rhodes, President and CEO, NYSERDA Mr. Paul Harris, NRC NSIR DSP SPSB ENCLOSURE 1 TO NL-16-018 2015 Annual Fitness for Duty Program Performance Data Report and Fatigue Management Program Data Report ENTERGY NUCLEAR OPERATIONS, INC.INDIAN POINT NUCLEAR GENERATING UNIT NOS. 2 and 3 DOCKET NOS. 50-247 and 50-286 a 0 .S
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_______ _______ _________________

_______ _______________________________________________________

I 1500615 4050551IIS605A 610 )l,55)IC1..fl.,.1015 Gosorot Coormonts (optIonal)LOS

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Estimated burden per response to comply with this collection request is 114 hours0.00132 days <br />0.0317 hours <br />1.884921e-4 weeks <br />4.3377e-5 months <br />. This form is a voluntary means of reporting the information required under 10 CFR 26.717. The information is required by NRC to obtain 0n an annual basis sode specific fitness-for-duty (FF0) program performance data on drug and alcohol programrs from licensees and other entites. Send comments regarding burden estimaote to the FOIA, privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission.

Washington DC 20555-0001.

or by e-mail to Infocollecto.Resource@NRC.son, and tc the Desk Officer. Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Offce ot Management and Budget, washington DC 20503. If a means used to imepose information collection does not display a currently nalhd 0MB control number, the NRC may not conduct or sponsor, and a personai not required to respond to, the information collection.

1) All fields required unless marked 'optionar" 2) Use of Adobe Reenter 8 or Ilter Is required 3) Mouse over fields for addltional Information Select Facility D-'Submission Update Period of Report J120161 Ilndian Point [5D-247; 50-286]Tfob in tha Year Total Number of Tests Conducted Total Number of Positive, Adulterated, Reason For Testing Licensee Employees ContractorsNendors Substituted, and Refusal to Test Results Random [III 21J 1 " I6 Post-Event Z o I ° [I o Total(Calculated)

[X62 1h61I ZI3I FFD Program Random Testing Population and Rate Average number of Average number of Total size of the random testing pool Annual random testing percentage licensee employees contractors/vendors throughout the period (Calculated) achieved for the testing pool 1 ,°D1 4831 5 '17 3.71 Laboratory Testing Does your program use aI Licensee Testing Facility?

No (Yes/No)

Identity your HHS-Certifled Laboratory(ies)

QUEST DIAGNOSTIC LABORATORIES Identity your Blind Performance Test Sample supplier(s)

[ELSOHLY LABORATORIES, INCORPORATED 1 Substances Tested Did your program only test for NRC-required substances lle Does yoUrinProgram conduct LOD/testing Yes AND at the NRC-specitied minimum cutoff levels? (Yes I No) permitted in26.163(a)(2)? (Yes INo)Substance Use Only NRC Cutoff Initial Confirmatory LOD Testing? Comment Levels? (Yes I No) Cutoff Cutoff (Yes / No) (Optional)

Alcohol[ ~ I j]Cocaine Yes [e Marijuana Yes [Yes Amphetamines Yes iIIZYes Opiates [Yles__________

_____Yes_________

PPYes IYes__Annual Report Form (version 1.6.0 -December 19, 2014) -Page 1 of 2 -NRC Form 891 (12/2014)

Substances Tested -continued Summary of Management Actions -26.71 7(b)(8)Summarize actions implemented to improve FF0 program performance.

As applicable, reference in the topic description audit reports, 30-day reports, and/or corrective action reports. If reporting information on more than three topics, select 'Others" for Topic 3 to report any additional topics.Topic 1 Please Select}Person(s)

Responsible for Information Provided Person 1 (required):

~~IIIIZCoordi11111r kpettus@entergy~com First Name Last Name Position Title Company Email Address Person 2 (optional):

~Im X Z Awgriffl @entergy.com First Name Last Name Position Title Company Email Address Final Step (Required).-

NRC will consider this form authentic in accordance with 26.11 only when the "Validate

& Lock" button has been selected and all errors (iLe., those highlighted in red) have been corrected.

The "Validate

& Lock" button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission.

Form Locked on:l eb22016at1:2O:02 PM L i ] I Annual Report Form (version 1.6.0 -December 19, 2014) -Page 2 of 2 -NRC Form 891 (1212014)

I *-. -S .~- 0 S -S1) A~ll 1114required esc roepflea eeked 'ogtgeno 2l lea son,. fieds aeto-pepaig Irnfmoaeun, In o~ter as~de ,1) Mooae ov, ernet fleld. to vke. .dddnl les~et,.ee,'m~

41 Uxe of AdOtr Reader S or lak, A. required Select Facility Estimated burden per response to comoply with thio collection request is 30 mnruntes.

Thos toerm is a voluntary macno of reporting thre information required uoder t0 CFR 26.717. The informshlon is required by NRC to obtain On an aennul bosi site specilic tlthess-for-rtuf

[FFD) program performance date ott drug and alcohol programis from licensees and otiem entitles.

Send comments regarding burden estimate to tire FOIA, Privacy and Information Collection Biranch (T5-F53), U.S. Noclear Regulatory Commission, Wastrmgtoo DC 20555-0001, or by e-mail to intocotiecls Rcsocrre@NRC coov and to tihe Desk Offcer Oftice of Information cod Reoulatory Affairs, NEOti-1020, (3150-0146).

Office o0 Managiement aod tiudget, Washington DC 20503. lIfe meaos used to impoose otformation colleotion doeo net display a currentgy oalid 0MB control nomber, tire NRC may not 0onducl or sponsor, and a person is not required to respond to, the information collection.

Indian Point [50-247; 50-286}Pre-Access Testi J Dafe of Collecfion[01425 (mm/do/yyyy) ing Reason (optional)

Pleasei elaboratei (optional)

Reason for Testing -26.71 7(b)(5)Employment Type -26.71 7(b)(3)?.onracorndor Labor Category -26.71 7(b)(3)Faiity Supot Initial Authorization Outage Worker (optional)?

[Yen Dilute Sample-LOD testing required is thits a 24-Hour Reporting Event (Yesdtio)?

-26.715(b)

[No[Refusal- 26,717(b)(7)

& 26.75 Was this collection refused (Yes I No)? Fi77o7]Teat Results -26.717(b)(4)

Test Validity Was LOD testing conducted Cr'es ( No) -26,163(a)(2)?

Dilute ] Yeis Test Type(s) for Result(s)

Reported -26.717(b)(2)

Drug Testing Drug Only ]Ifn Was dhis collect ion observed (Yes/No)?

-26.71 7(b)(7( & 26.75 I ]Substance

-26.717(b)(2)

& (b)(6) Additional Substance (as applicable)

Manruan ..] [Please Select Use NRC Cutoff (Yes / No)'? li Subversion Attempts -26.717(b)(7) and 26.75()5 Did this collection involve a subversion attempt (Yes/No)?

]No Additional Substance (as applicable)

IPlease Select Meneoemnent Actions -26.71 71b1181 & 26.75 Roason for the Action IFirst drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Specitic Sanction Applied 2- Year Denial Person(s)

Responsible for Information Provided Person I (required):

Kly PetlsoIed cesScrtyCodiao tikpettos@entergy.com First Name Last Name Position Title Company Email Address Person 2 (optional):

~ ~ mgritit@entergn.com First Name Last Name Position Title Company Email Address Fital Steg, (Required).

NRC mill consider this fo~rm cuthentic in accordance wfth 26,11 only ewhen the "Validate

& Lock" batten is clicked and all errors (highlighted in red) hrane been corrected.

The "Validate

& Lock" button mill change to "Locked" after the data validasion process has been successfully completed indicahlog the form Is ready for submission.

Form Locked on:[~b22016at 12:4941 M] Saet aa C Pri I ext Single Posihtive Test Form (version 1.6.0 -December 195,2014)

NRC Form 690 (12/2014) 0 -~ S -p 1) All asia. rsqr*ssi eee.pt files. ,eae~ ~ APPROVED BY 0MB: CLEARANCE NO. 3150-0148 EXPIRES: 1113012017 2)Enele in aser filds aaa.eedas ,nafonsn o,, abfeld.3) Maoase ovar fa,,m 051*d to vhJe adtltlaesj inisn,,a~sn

4) tUse ot Adoh ReadrS a rlatar 1. rsq.*red r-] Submission rm Delete L Update L_ Sub mission Select Facility Indian Point [50-247; 50-2861 Estlmated burden per response to comply With thlis totlection request in 30 ninutes. This form is a voluntary means of reporting the infonmation reqoired under 10 CFR 26,7t7, The intonmation is required by NRC to obtain On an annual basis site speific fitness-for-duty (FFD 0) prognrm performance data on drua end alcohol progeras barnm lcensees end other enhties. Send comments regsrding borden estiorste to the FOIA, Privacy and Informration Coilevo~on Branch (Tt-F53), U.S. Noclear Regulatory Cornmission.

Washgtoono DC 25055-0OS1, Or by e-mail to infeoooltct Reswocree@NPC eon, end to the Desk Officer, Office ot Information and Regulatory Affairs, NEOE-1020, (3150-0146).

Office of Management and Budget, Whashington DC 25503. Ifs ormeas uoed to impose information collection does not display a currently valid DMB control number, the NRC may not condoct or sponsor, endsa pemson is not required to respond to, the information collection.(mmldd/yyyy)Oe[of~leji~n0120205 j Reason for Test ing -2671 7(b)(5) Please elaborate (optional)

Rand I Employment Type -26.71 7(b)(3) Outage Worker (optional)

?CotatrNendor I No Labor Category -26.717(b)(3)

Faiity Supot Is this a 24-Hour Reporting Event (YeseJro)?

-26.719(b)

No Refusal- 26.717(b)(7)

& 26.75 Was thls collection refused (Yes I No)? ' [~II Test Results -26.71 7(b)(4)Test Validity Toot Type(s) for Result(s)

Reported -20.717(b)(2)

Drug Tooting Drug Only] dn Was this collection observed (Yes/No)?

-26.71 7(b)(7) & 26.75 [ L i Substance

-26,717(b)(2)

& (b)(6) Additional Substance (as applicable)

Marijun .. Please Select Use NRC Cutoff (Yes / No)?Ye Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection inoolve a subversion attempt (Yes/No)?

Eioi l ]Additional Substance (as applicable)

[Please Select]Manasoement Actions -26.7171b1181

& 26.75 Reason for the Action Frtdrug or alcohol positive Sanction Applied (NRC Minimum or Ucensee Administrated)

Licensee Administrated Specific Sanction Applied 3- Year Denial Person(s)

Responsible for Information Provided Ferson 1 (required)l:

First Name Last Name Positioo Title Company Email Address emaon 2 (optional):

I~aye GrffinSupervisor, Aceess/Fithess for Dory mawgiffl @entergy.com First Name Last Name Position Tite Company Email Address Final Step (Reqsdrsd. -NRC mill consider this form authentic in accordance with 26.1: only whren the "ValIdate

& Lock" button is clicked and all errors (highlighted in red) have been corrected.

The "Vatidate

& Loch" botton mill change to "Locked" alter the dats validation process boo been successiully compfeted indicating the foes Is ready for submisaion.

Form Locked on:[~ebj201 2o j50: PM $] O Ia C ItI W It Single Positiv Test Form (version 1.6.0 -De;emnber 19, 2014) NRC Form 890 (12/2014) 2)Entedes inote .eld a =tut~ pua lc Ino" e Estimatad borden par response to comply with this cotiection request in 30 minutes, This d)Mu e 7oe5fo m .fed fo tne noffm form is a volunfary means of reportng the information required under 10 CFR 26.717. The 3) Maaeinformanon in required by NRC to obtain on an annoal basis site specdioi fithess-for-duty

4) U a lAdeh.e ReaderS 8 rae l (FFD) program performance data on drug and alcohol programs from licensees and othar J]Submission Deoeentitee.

Sand comments regarding borden estimate to the FOIA, Privacy and information rDelete Collection Branch (T5-F53).

U.S. Nuclear Regulatory Commission.

Washington DC Li pdta t.J Sumsin20555-0001, Or by e-mail fo Infovollects ResouorcetiNRC noov and to the Desk Officer, Office of information and Regulatory Affairs, INEOB-I(020, (3150-0140), Office 01 Uini ue Reference ID (Licensee Supplied)

Management and Budget, Washington DC 20503. ifta means used to impose information SIPEC-2015-003 collection does not display a currently valid 0MB control number, the NRC may not condoci I or sponsor, and a person is net required to resprmd to, the information collection.

Select Facility Dt fCleto ~Indian Point (50-247; 50-286]DtofCleto(mm/dd/yyyy) 02/25 n cnal) Please elaborate (optional)

Reason fot' Testing -26.717(b)(5)

Employment Type -26.717(b)(3)

Contract~orenmor Labor Categoty -26.71 7(b)(3)Maintenance (general facility)Pre-Access Testing Reason (optio Reinstatement (Between 31 and 365 days)Outage Worker (optional)?

JYes Is tihis a 24-Hour Reporting Event (Yeais/Na)?

-26.719(b)

N Refusal- 26.717(b)(7)

& 26.75 Was this collection ref used (Yes I No)? ~ iiI Test Results -26,717)b)(4)

Test Validity Test Type(s) for Result(s)

Reported -26.717(b)(2)

Dwug Testing Drug Only [1 I iIIIe Was this collection observed (Yes/No)?

-26.717(b)(7)

& 26.75[ iI]Substance

-26.717(b)(2)

& (b)(6) Additional Substance (as applicable)

Marijuana

] Please Select Use NRC Cutoff (Yes / No)? ~ I Subversion Attempts -26.71 7(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

E~o ]Additional Substance (as applicable)

IPlease Select Manaoement Actions -26.717(b1181

& 26.75 Reason for the Action First drug or alcohol positive Sancton Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Specific Sanction Applied J3- Year Denial Person 1 (required).

JKelly F~ I~ IIIIIIIJ~

~ Jed hpettus~entergy .c..First Name Last Name Position Titie Company Email Address Pemson 2 (optional):

Wayn Grffi Sprvisor, Access/Fcithess fortDuly wrl ffl m tt@entergy.com First Name Last Name Position Title Company Email Address Final Step (Requied).-NRC mill consider this form authentic in accordance mith 20.11 only when the 'Validate

& Lock' button is clicked and all erroms (highlighted in red) sane been corrected.

The =Validate

& Lank' hutton mill change to 'Locked' after the data validation process hon been suocessfully completed indicasing the form is ready for submission.

Form Locked On:[geb2,216 at 122:31 PM J ~ Q~~I PCfhqtr Single Poesitve Test Form (version 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)

~t Eetelea be some flakla aate-pepudat.

Intonneden In oEarlblde.1) Moos. ever tenon fields to 11rlewaddnlanaIlnfo.ene~on 4)1.1.. of Adobe Reader S Or later in r.qair.d[7J Submission m Delete Update [] Sub mission Select Facility Enanmated burden per response to comply with thin collection request in 30 minutes. This fornm itoa voluntary means of reportina the information raquired under 10 CFR 26.717. The intormchonc in required by NRC to obtain on an annual basis site opecilto fitoess-tor-duty (FFD1 program performance data on drug and alcohol programs from linennees and other entities.

Send commenta regarding borden estimate to the FOIA, Privacy and Intormation Collectimn Branch (TrS-F53), U.S. Nuclear Reeulatory Commission, mashington DC 20555-0001, or by e-mail to Intocotllets Resocrco@NRC nooc end to the Dank Dfinner, Ottice of Informoation and Reaulatory Attairs, NEOB--tO20.

(3150-Ol4e), Omfie of Manaaemnent and Budget, Washington DC 20003. Itoa means uned to impose inforrration uollection doen not display a currently valid 0MB uonnhol nuomber, the NRC may not conduct or sponsor, anod a person in not required to respond to. the information collection.

Indian Point [50-247; 50-286](mm/dd/yyyy)D ef~lcin02/23/2015

]onall Please elaborate (optional)

Reason for Testing -26.71 7(b)(5)Employment Type -26,71 7(b)(3)Labor Category -26.71 7(b)(3)IMaintenance (general facility)Pro-Access Testing Reason (ootio iupdate Authorization Outage Worker (optional)?

IYes Is this a 24-Hour Reporting Event (Yena/o)?

-26.719(b)

N Refusal- 26.717(b)(7)

& 26.75 Wals this collection refused (Yes / No)? [Test Results -26.717(b)(4)

Test Validity Test Type(s) for Result(s)

Reported -26.717(b)(2)

Drug Testing Drug Only ] Urine Was this collection observed (Yes/No)?

-26.717(b)(7)

& 26.75 i I Substance

-26. 71 7(b)(2) & (b:)(6) Additional Substance (as applicable)

Marijuana

] Please Select Use NRC Ocutoff (Yes / No)? EI~Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

I~ ~IoI Additional Substance (as applicable)

IPlease Select Manaoement Actions -26.7171b1181

& 26.75 Reason for the Action IFirst drug or alcohtol positive Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Specific Sanction Applied 3- Year Denial Peran~s)Resonsile fr Iformt~onProide Person 1 (required):

Kelly I efs)ed A~essencudW Coordminao Z kpe~us@entergy

....First Name Last Name Position Title Compeny Email Address Person 2 (optional):

First Name Last Name Position Titie Company Email Address Final Step (Requied).

NRC will consider thus fony authentic in accordance with 26,11 only when the "Velidate

& Look" bucone mo clicked and all erroms (highlighted in red) have been corrected.

The "Validate

& Lock" sctore will chenge to "Locked" atier the data validation process has bees successfully completed indicating the form in ready tor nubminnion.

Foro Locked on:le2 ~2o16Nt2:S3:PM SWI f GS P ~ R p~Single Positive Test Forrm (version 1.6.0 -December 19, 2014) NRC Form 8980(12/2014) 1)i All field. required except those. narked "oadiorr APPROVED BY 0MB: CLEARANCE NO. 3165-0146 EXPIRES- 1113012017

3) Eared., in soe.a aeto-popoiaf.

iftn.Uonar in ofir fel~d.3) Mose. ovear ten, hieds to view addtlonalbd onnfa 4) U.. of Adobe R..der l or-lI. isqrd.-.de

--]Submission L DebISlete IPE-215-005 Select Facility Estimated harden per response to comrply oith this collectioe request is 35 minutes, This form is a volantaty means of reporting the information required under 10 CFR 30.717. The information is required by NRC to obtain on ao annual basis site specitic fithess-for-duty (FF0) program performance dote on drag and alcohol prograns from licensees and other entities.

Send comments regarding burden estimate to the FOIA, Pdnvacy and Information Collection Branch (TS-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infucolleoto Resoaroae@NRC 000 and to the Desk Officer, Office 01 information and Regulatory Affairs, NEOB-It020, (3150-0146), Office ol Managemert and Budget, hWashington DC 20503. Itoa means used to impone information collection dues nor display a currently ualid 0MB contro number, the NRC may nut conducl or sponsor, and a person is not required to respond to. the information collection.

ininPoint

[027 026 Pro-Access Test ir](mm/d/~yyyy)Da f~lefn02/23/2015 10 Reason (optional)

Please elaborate (optional)

Reason for Testing.-

26.717(b)

(5)Employment Type -26.71 7(b)(3)CotacoNendor]

Labor Category-26.717(b)(3)

Maintenance (general facility)Inilial Authorization Outage Worker (optional)?

Y~es ]Is this a 24-Hour Reporting Event (Yes/No)?

-26.719(b)

No Refusal- 26.71 7(b)(7) & 26.75 Was this collection refused (Yes / No)? Test Results -26.717(b)(4)

Test Validity Test Type(s) for Result(s)

Reported -26 717(b)(2)

Drag Testing Drug Only un Was this collection observerd (Yes /No)? -26 717(b)(7)

& 26.75 [Zi Substance

-26.71 7(b)(2) & (b)(6) Additional Substance (as applicable)

Marilun ..] Pleese Select Use NRC Cubtof (Yes ( No)? EI Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collechion inyolye a sub version attempt (Yes/No)?

Eiliol Additional Substance (as applicable) 1Please Select Manaoement Actions -26.717(b11t81

& 26.75 Reason for the Action First drug or alcohol positilye Sanction Applied (NRC Minimum or Licensee Administrated)

Licenses Administrated]

Specitic Sanction Applied 3- Year Deniali Persn~s)Resonsile or iformtio Proide person 1 (required):

ely Pettus Led cesScrt oriao kpettus@entergy~corn First Name Last Name Position Title Company Email Address Person 2 loptional):

First Name Last Name Position Titie Company Email Address Final Step (Requtred) -NRC wdil consider this form authentic in eccordance with 26, ft only when the "Validate

& Lock" button is clicked and all errors (highlighted in red) hone been rorrected.

The "Validate

& Loch" button mill change to =Locked" offer the data validation process hos been surcessfolly completed indicating the form is ready for submission.

Form Locked On:[Feb 2, 2016 at 12:55.12 PM ]a to ocI P Pt!R~g t Single Positive Test Forms (version 1.6.0 -December 19, 2014) NRC Fotnm 800 (12/2014)

Affff-alda eaqu/ved esap /Mba. gefd 'opfftptr ArrP vtUVP. U MB:

NV.

P3.Pces: 1llgo-tal, 2) in a... #eisi eastopopuabit .in. o6,e -Estiniated burden per response to compty with this collection request Is 30 nrdnotas.

This 3J6I..oae ovaver fon~ita1fed=t I.o eo trm wsanvcluntary means of reportlng the informationt re qoired under 10 CF R 26.717. Th.nforat~n i reuird b NR toobtain no an annoal basis sit, specific ftoleos-for-ttut3

4) Uae d4Adobe. 8 orae/ retl (FFD) progianh performance data on ding and alcohoi progranms trots tlcesees and ottel r" umsin Delet en~tits., Send commnents regarding borden estinate to the FOIA, privacy and Infonmation

[] i~*~ 6 oflection B.anch (TS-F53), U.S. Nuclear Regulatory Conmislsion, Washington DC L.Upae J Submission 20555-0051.

on by e-mail to Infouoilects aov, and tO the Dash Officer Office ot Intonnation and RegulatOry Affairs, NEOB-1020, (3150-0148), Office o UniueRe fereDnce I/ieseeSuppiedL Management and Budget, Washington DC 20503. If a means used to impose information IPEC-2015-006 I collecton does not display a corrently valid OMB control nomber, the NRC may not conduc" I or sponsor, and a parson is not required to respond to, the information collection.

Select Facility Dt fCleto lndian Point [50-247; 50-286](mmldd/yy)

I°2 °1 Pro-Access Testing Reason (optional)

Please elaborate (optional)

Reason for Testing -26.717(b)(5)

Pr-Acss]Employment Type -26.717(b)(3)

Labor Category -20.71 7(b)(3)Mainenance(gerlfclit)

Initial Authordzation DOtage Worker (optional)?

IYes is this a 24-Hour Reporting Event (Yes/No)?

-26.71 9(b) N Refusal- 26.71 7(b)(7) & 26.75 Was this collection refused (Yes / No)? j j Teat Results -26.717(b)(4)

Test Validity Test Type(s) fur Result(s)

Reported -26.717(b)(2)

Drug Testing Drug Only ]Irn Was this collection observed (Yes/No)?

-26.717(b)(7)

& 26.75[ Il Substance

-26.717(b)(2)

& (b)(6)( Additional Substance (as applicable)

Marijuana I Please Select]Use NRC Cutoff (Yes / No)?Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

I~ j~oj Additional Substance (as applicable)

IPlease Select]Manaoement Actions -26.7171b1181

& 20.75 Reason for the Action IFtrst drug or alcohol positive Sancton Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated]

Specific Sanction Applied 3- Year Denial Person(s)

Responsible fur Information Provided Person 1 (required):

Kel I IIIy I [Pettso]Ied ces tecort borint r Iketts@entergyi.c..

First Name Last Name Position Title Company Email Address Person 2 (optional):

Wayne [Gfi IsprioAcs/~s mo ut griffi @entergy.com First Name Last Name Position Title Company Email Address Final Step (Required)

-NRC mril consider this form authentic in accordance with 26.11 only when thre "Validate

& Lock" botton is clicked and all errors (highlighted in red) base been corrected.

The "Validate

& Loch" botton mitl change to "Locked' offer the data oalidatinn process has been successfolly completed indicating the form is ready for submission.

FormLocke OnJle , 16 s 2~:d:4PM SI A gIP lh R f Single Posibive Test Foro (versionl 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)

I1) AMl 1154 requared except tho. se mrked IAPPROVE BY OMB: CLEARANCE NO. 3110-0146 EXPIRES. 1113012017 EmresI soearv,. fonf nds o .ot-eata In ew ie 3) M~eoo.. as, on Cold CerV. odtsuleoelIdoee LI Submmsson elete Select Facility lndian Point [50-247; 50-286]Estiromted borden per response to comply ise thies cotiectionl request i. 30 minutes. Thin form in a voluntary means of reportin tire informration reqoired onder itt CFR 26.717. The intormraton is reqoired by NRC to obtain on an annual basin ted specrfic tibress-for-duty (FF0) program performance data on drog and alcohol prograrns fronm licensees ond other enttities.

Send comrrents regarding burden estimate to tihe FOIA, Privacy and lnfornmationr Cotiection Branch (TS-F53), U.S. Nuclear Regolatoty Comnmissionn Washington DC 205555-0001, or by e-nrint to Infcocttct Rnsoorco46NRC goy. and to tire Desk Officer.Office of Intnrnation and Regulatnry Affairs. NEOti-t020, (3150-0146t).

Office of Management and Budget, Washington DC 20503. Itoa means osed to impnse information collection does not display a currenlty valid OMti control nomber, the NRC may not conduct or sponsor, and a person in not reqoired to respond to, tire information colleobon.

Date of Collection o1?25mldyy)

Reason for Testing -26.717(b)(5)

Employment Type -26.717(b)(3)

Labor Category-26,717(b)(3)

Pro-Access Testing Reasont (optionral)

I'nitial Authlorizabion Outage Workrer (optional)?

Yes Please elaborate (optional)

Observed collection-applicant returming to indostry from positive test in 2008 Is this a 24-Hour Reporting Event (Yes/No)?-

26.7198(b)

N Refusal- 26.717(b)(7)

& 26.75 Was this collechion refused (Yes /No)? EiI Test Results -26 717(b)(4)Test Validityj Test Type(s) for Result(s)

Reported -26.717(b)(2)

Drug Testing IDrug Only I [Urine Was tils collection observed (Yes /No)?- 26.717()(7))

& 26.75 [II Substance-26.717(b)(2)

& (b)(6)Marijuanao Additional Substance (as applicable)

Please Select Additional Substance (as applicable)

IPlease Select Use NRC Cutoff (Yes ( No)? Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involveta subversion attempt (Yes/No)?

[liNo Manaoement Actions -26

& 26.75 Reason for the Action Second drug or alcohol posihive Sanction Applied (NRC Minimum or Licensee Administrated)

SLicensee Administrated Specific Sanction Applied Perm..anet Denial Person(s)

Responsible fur Information Pro vided Person 1 (required):

Iey Pettun [La.Acs eut orieo kpettusl~entergy c..m First Name Last Name Position Titte Company Email Address Person 2 (option al): Wayne ]Griffin Supervisor, Access/Fitoess for Duty m grittt@entergyp.com First Name Last Name Position Title Company Email Address Fliraf Step (Reqcrlrerft .NRC mill consider this form aothestic in acoordance with 20.11 only when the "Validate

& Lock" botton in clicked and all errors (highlighted in red) have been corrected.

The "Validate

& Lonk" batten mill change to "Lonked' afte the data validation process ban been nuccessfolly completed indicating the form in ready for nubminnion.

Form Loced on:[Fb2 216st11: :,.7P~ Saet I.c ItthsRI Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)

3) tne/ o e hed .-auto-pp ./non h, blohrfed Etiroated burden par responso to comrply witth ghis cotention retprest in 30 monutes. Ttis 3) Muse ver ormfle~= toview is a votontary means of reporting the inrformtion required under 10 CFR 28.717. The intormnatio as roqoired by NRC to obtain on an annual boois alto specific
4) Uaa of Adobe Raedw5 8 rltrisnqf~ (FFD) program performanoe data on drag and alcohol programsnrombo lcensees and other[]Sbiso r' Delate entitaes Sand commants regarding burden astirmate to ithe FOIA, Privacy and Intornation Updae I SumisionCatiaccon Branoh (TS-F53), U.S. Nuolear Regulatory Commissioan.

Washrington DC Submission05g55000o , or by a-madl to letorolaeto Ranuorrai5NRC ga and to gre Dank Dttrer, Dffioe ot Information and Regulatory Affairs. NEOB-1020, (3150-0146), Dffioe at UnqeRfrneI

~cne upid Monagoment and Budget. Washington DC 20503. Itoa meant used to impono informalton IIPEC-21 -2008 5 8cotaecton daes not disploy a currantly nalid DM2 control numbter. tra NRC map rot conduct or sponsor, and a person lb not raquired to raspond to, uhe intormation collaction.

Select Faciliy Indian Point [50-247; 50-286]Date of Collection Fo31021(mdyy)

Reason for Testinrg-26.717(b)(5) p Employment Type -26.717(b)(3)

C Labor -26.71 7(b)(3)elaborate (optional)

Ourtage Worker (optional)?

Is it/isea 24-Hour Reporting Event (Vesfido)?

-26.719(b)

N Refusal- 26.717(b)(7)

& 26.75 Was this collection refused (Yes / No)? E II Test Results -26.717(b:)(4)

Test Validity Test Type(s) fot Result(s)

Reported -26.717(b)(2)

Drug Testing Drug only ] l I~no I]Was ft/is collection observed (Yes / No.)? -26.71 7(b)(7) & 26.75 [ II Substance

-26.717(b)(2)

& (b)(6) Addi/tiona/

Substance (as app//cable)

Marijuana

] Please SelectI Additional Substance (as applicable)

[Please Select Use NRC Cutoff (Yes I No)?Sube-ers/on Attempts -26.71 7(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

o Manaoement Actions.-

26.7171b118)

& 26.75 Reason for the Action First drug or alcohol positive I Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated]

Specttlc Sanction Applied 3- Year Denial Person(s)

Responsible for Information Provided Parson t (required):

Kel ZIyI I] IPatton ] ~a.Acs eut oriao h pettusgentergy

....First Name Last Name Position Title Company Email Address Parson 2 (optional):

First Name Last Name Position Ttite Company Email Address Float $tap tRaquelre.

NRC milh consider this form authoenti In accordanr cengrt 26 11t only whmen the "Valdate & Lock" boston as chocked and all errors (highilghted in redl have bean corrected, Tho "Validate

& Loch" button will change to "Locked" altar the data validation process has boon succestoully completed indicating the term ia ready far submission.

Single Positive Teat Form (version 1.6.0 -December 19, 2014) NRC Form 890 (12/2014)

P 3U*00 --P ~*-.. S -S I tiM ff.at. ,50t*Sd aweapt us... resotrad olaeone IA~~D BY 0MB: CLEARANCE NO. 31504148 EXPIRES: 1113012011 2)Enarles isn seen. fil~ds .ada-paplat tarsrnneton In o~ers fieds 3) MOS o o'.r formn fields to viassrsdditionallrdInmrnUonr 4)11U. of Adobe Reedsr D or tldr Is reqaal'redSubmiss ion [r1 Delete LiUpdate 1-i Submission UnqeRfrneI

~cne upid SelEC-2015-I1t9 Etiemated burden per response to comply wdtr this collection request is 30 mirnutes.

This torm is a voluntary mreans of reporting tre intormalton required under 10 CFR 26.717. The intormnation is required by NRC to obtaun on an annual basis site specilic ftloess-for-doty (FF0) program pertornmance date onr drug and alcohol programs frem licensees end other entlies. Send comnments regardong burden estimate to the FOiA, Pdivaey and Intermatiun Coilection Branch 1T5-F53), U.S. Nuciear Reguistory Conorsosien, Washington DC 20555-S0S1, or by e-rmadl to Infoculollctsesnoureo@NRC non. anid to the Desli Otffier, 0010e of etnformaton end Reguiatory Affairs, NEOB-t020, (3150-014e), Ofmen ot Mlanagenrant and Budeet, Washington DC 20503. if e mer.s coed to impose interormton ceiiectacn dues riot dispiay a corrently vailid 0MB controi number, the NRC may not conduct or sponsor, aod e person in cot required to respond to, the inforrmatoe cotlnotion.

Indian Point [50-247; 50-286]Dale of Collection (mm/dd/ I°1°yy)Reason for Testing -26.71 7(b)(5)Please elaborate (optional)

Employment Type- 28.71 7(b)(3) Outage Worker (optional)?

Licensee Employee I [leaeSaleti]

Labor Category-28.71 7(b)(3) Please elaborate Supervsor J Maintenance supervisor Irorking nighte for tire outage) mas nuitfed at Ore FPEC SOCA access facility, which is outside the I pr'otected ore,, to report to the Access facidity ton a randem Fitness-Fvc-Outy (FFD) test. A toot ter aicohol resulted in a confirmed Is this a 24-Hour Reporting Event (Yeaftrfo)?

-26.719(b)

Ys Reactor Rlant Ecent Notifucalton Wolrticheet EN # 50879 won completed to docomant nofification.

Refusal- 26.717(b)(7)

& 28.75 Was this collection refused (Yes I No)? o Test Results -26.71 7(b)(4)Test Validity No Aplicbe ]Test Type(s) for Result(s)

Reported -26,717(b)(2)

Alcohol Only]Alcohol Testing Substance-26.717(b)(2)

& (b)(6)Alcohol]What 28.103 BAC level mao exceeded?0.04 or greaterJ Subversion Attempts -26.717(b)(7) and 28.75(b)Did ltins collection involve a subversion attempt (Yes/No)?

o Manaaement Actions -26.71 71b118' & 28.75 Reason for the Action IFirst drug or alcohol positive Sanction Applied (NRC Minimum or Liceesee Administrated)

NRC Minimum]Specific Sanction Applied 14- Day Denial Person(s)

Responsible for Information Provided parson 1 {required):

First Name Last Name Posdtion Title Company Email Address Person 2 (optionall:

First Narse Lost Name Position Title Company Email Address Flnal Slep NRC wetl consider this term authentbc in accordance mrlt 24 11t only when the "Valotate

& Lock" button is clickled end all enrors Ihighldighted sinred) have beer corrected.

The "Validate

& Lock" button will change to "Locked" alter the data validation process huo been successfully completed indicticong thle tonrm is ready for submission.

Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 8t90 11212014)

D S.. ~0 -~ * -k. a -I 1) AM field. req~d excafit lAb,. mwte.d ~apemaf IAPPR(2~~W BY OM9~ CLEARANCE NO. 31000146 EXPIRESI 1113012017

2) Ermeesa In some flalda auel.pepalat.

le In eMhr field.3) Moue.. ever ibee field. to sleerwddtdonel linaoms.the

4) (Me ot Adobe Reud.5er Is oerIa req.*red[] Submission m-' Delete Update LJ1 Submission iff Select Facility Estimated borden per response to cormply with this collection request is 30 minutes. This boorm le n otuntary meons of reportng the infonmation required uoder 10 CFR 20.717. The ntonnetino is required by NRC to obtain on en anneal basis site seii ios-o-it fFFD) program perfonmnance data no drug end alcohol progranms horomcnesn te nntities.

Send comments regarding burden estimate to the FOIA, Privnacy and Information Collection Branch (T5-F53), U.S. Nuclear Regolatory Commission, Wenhingtnn DC OO555-000t, or by e-mail to lntfonlaot Ree.~ourgdNRC eon and to the Desk Officer, 310ce 0f Inotmnation end Regulatory Affairs, NEOB-t020.

(3155-0148), Office 01 hlanegament and Budget, Washington DC 25503. Ifta means coed to impose Information collection does not display e currently nalid 0MB control nuomber, the NRC may not condedl or sponsor, anode peosno is net required to respond to. the intormatinon collectnon.

Indian Point [50-247; 50-286]Date of Collection

-(nmm/ddlyyyy) Please elaborate (optional)

Reason for Testing -26.717(b)(5)

Employment Type -26,71 7(b)(3)Licensee Employee Labor Category-26.717(b)(3)

For Cause Testing Reason IPhysical Condition/Smell of Alcohol Outage Worker (optional)?

INo Is this a 24-Hour Reporting Event (Yes/Ndo)?

-26.719(b)

N Refusal- 26717(b)(7)

& 26.75 Was this collection refused (Yes / No)? 1 7 Test Results -26.71 7(b)(4)Test Validity Not Applicable Test Type(s) for Restilt(s)

Reported.-

26.717(b)(2)

Alcohol Testing Alcohol Only I ~i iiIth]Substance

-26.717(b)(2)

& (b)(6)IAlcohol SWat 26.103 BAC level was exceeded?0.04 or greeter ]Subversion Attempts -26.71 7(b))7) and 26.75(b)Did this collection innolve a subversion attempt (Yes/No)?

o Manaoement Actions -26.71 71b1168 & 26.75 Reason for the Action Frtdrug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)

NRC Minimum Specific Sanction Applied 14- Day Denial Person(s)

Responsible for Information Pro vided Person 1 Iroeuired):

Kelly ll 1I I [Pettus ] ~aAcs eurt oriao kpettos@eotergy .com First Name Last Name Position Title Company Email Address Person 2 loptionall:

Wye X I II I Z J [Gi E up rvior ccess/i1toess tor Duty mgrifft @entorgy.com First Name Lest Name Position Titie Company Email Addrtiss Final Step Iltequltecl)

NRC mill consider this term authentic in accordance woth 26 It only when the "Validate

& LOnik" button is duicked and all errors (highllighted in red) haoe bees corrected.

The "Validate

& Lock" hotton mill change te "Locked" offer the date validation process has been successfully completed indicating the torm is ready tor submission.

Form Locked On: Feb 2, 2016 at 1:54 MSw1 oa C PbttI p~Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 6901(1212014) 3 mU S --S -3~ -*~SS 0 -I i~ AM 0.11. re sIred exeaet thea. mw*eal 'eatleaaj APPRO~~~ BY OMBr CLEARANCE NO. 3180.0144 EXPIRESI 1113012017 Zt Ern~sto, nsame Bald. aute-popail.

h*eas In oeri~ ffld.3) Nosa.en. oter m fiald. ts view .duleln.I lefne~inmfo

4) Use oef Adobe Read.5er tS. Ir.erl reqldred'-]Submission r'- Delete U Update L_ Submission UnqeReference ID (Licensee Supplied)IPEC-015-11 Select Facility Eotroatet burden per response to comply wi-th ttos cotiection rerpuest is 30 esnutes. Thur tore is a votontary nmeas of reporting the information rempired ander 10 CFR 26.717. Tha infonnation ie reqoired by NRC to obtain on an annual basis site spocific henna-for-dots (FFD) program performance data Ono drug and alcohol progranms broo lcensees and otee entities, Send comments regarding borden estimate to the FOIA, Privacy anid Information Collection Branch (T5-F53), U.S. Nocdesr Regulatory Commission.

Washington DC 20555-000t, or by e-rnail to Infocollects Resoorce@NRC gnu, and to the Desk Officer Dfi~ce ot Intornmation and Regolatomy Affairs, NEOB-1020.

(3150-0146), Officeo Management and Budget. Washington DC 20503. Itsa means used to inmpose information cllector does not display a corrently natid DMB control nurmber, the NRC masy not condoc or sponsor, and a porson is not reqbired to respond to. the intormation colleciton.

lIrdiarn Point [50-247; 50-286]Reason for Testirng.

26.71 7(b)(5) Please elaborate (ophionail)

Employment Type -26.71 7(b)(3) Outage Worker (optional)

?Licenses Employee [SINO I Labor Category-26.71 7(b)(3)Is thIs a 24-Hour Reporting Enent (Yes/No)?

-26.71 9(b) No Refusal- 26.717(b)(7)

& 26.75 Was this collection refused (Yes I No)? EI~oI]Date of Collection 4/125(mdyy)

Test Results -26.71 7(b)(4)Tent Validity Test Type(s) for Resuit(s)

Reported -26.717(b)(2)

Drug Testing IDrug Only [I I Idne Waatitis collection observed (Yee/No)?

-26.717(b)(7)

& 26.75 No Substance

-26.717(b)(2)

& (b)(6) Additional Substance (as applicable)

Cocaine ] Please sele]Use NRC Cutoff (Yes / No)?Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

[I j~o Additional Substance (as applicable)

Please. Select Manaoement Actions -26.717(b51181

& 26.75 Reason for the Action First drug or alcohol positiveJ Sanction Applied (NRC Mirnimum or Uicensee Administrated)

INRc Minimum I Specitic Sanction Applied 114- Day Denial Person(s)

Responsible fur Information Provided Person 1 (required):

First Name Last Name Positon Title Company Email Address Person 2 (opuonal):

WaynmeI I~rfi Superor, Accesol/Ftiess for Duty]wntnteaco First Name Last Name Position Titie Company Email Address Final Step (Rempoimed)

NRC will consider this tore authenhic in accordance rat 26.11 only wdhen the "Vanidate

& Lock" button is sticked and all errors (highdlghted in red) have bees corrected.

The "Validate

& Lock" button mill change to "Locked" atter the data validation process hon bees succnetsouly completed indicating the torm is reerdi tor submission.

Single Positive Test Form (version 1.6.0 -December 19. 2014) NRC Form 890 (12/2014) 0 -I~~*-e. S -L. .I 5 I ~ All 0.14. required esoept ~ flee*.d a~aeaf F~P!ROWO BY 0MB: CLEARANCE NO. 31804146 EXPIRES: ~"-~'!3) rdm01.. in 0.n * .uteld -papuite Iefbnmsaln in elba fields 3) Me.,.. over fans fies to s'aeadlaew

4) Iteae (Adahe ReaderS or lade, I. requied L SUpdateOf LJ Submissio IPC-015012 Select Facility Estimated burden par respunse to comply with this collection request is 30 minotes. ThiO form is a voluntary means of reporlbng tre intormation required undar 10 CFR 26.717. The information is required by NRC to obtain onl an annual baums adte specoic Itness-for-dutl (FFD) program performance data on drug and alcohol prograns from licensees and ogree entitiea.

Sand cumments regarding burden estimate to gre FOIA, Pdvacy and Informatior Collection Branch (T5-F53).

U.S. Nuclear Regulatory Comnisalon, Washington O(20555-0001, Or by e-mail to Intorellects Resource@NRoov n, and to gre Dank Officer Office of information and Regulatory Affairs. NEOB-t020.

(3150-0146), Officeo Managemant and Budget, Washington DC 20503. It a means uoed to impose informatior collection doan not display a corrantly valid 0MB control number. gre NRC may nat candor or sponsor. and a person is not required to respond to. gre intormration collection.

Indian Point [50-247; 50-286]Reason for Testing -26.71 7(b)(5) p Foloup [Employment Type -26.71 7(b)(3)Licensee Employee I Labor Category -26.71 7(b)(3)_______Date of Collection 0/2/2 15 (mm/dd/yyyy)

Please elaborate on the reason for tooting (optional)

Outage Worker (optional)?

is this a 24-Hour Reporting Event (Yes/No) ? -26.719(b)

N Refusal- 26.717(bi)(7)

& 26.75 Was grin collection refused (Yes I No)? [Teat Resuits -26.717(b)(4)

Test Validity Was LOD testing conducted (Yes / No) -26.163(a)(2)?

Dilue ] le Test Type(s) for Result~s)

Repotted -26.717(b)(2)

Drug Tooting Drug Only ] Iri IIe I Was this coiiection observed (Yes /No)? -26.717(b)(7)

& 26.75 I I I Substance

-26.717(ti)(2)

& (b)(6) Additional Substance (as applicabie)

Cocaine ] Please Select Use NRC Cutoff (Yes I No)?Subversion Attempts -26.717(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

I~Io Additional Substance (as appilicable)

Iplease Select Manaoement Actions -26.717lbll8l

& 26.75 Reason for the Action Second drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Speobic Sanction Applied Permanent DenialJ Person(s)

Responsible for Information Provided Person I (required):

First Name Last Name Position Title Company Email Address Person 2 (optional):

Wan rfi Suerisr AccessiFitnass for Duty orgrifft @antergy.com First Name Last Name Position Titie Company Email Address Final Steop (Required).

NRC will consider this form autrantic in accordance withi 20.It only when gre "Validate

& Locti hutton as clicked and all errors (hightighted in red) have been corrected.

The "Vairdate

& Loch" button will change to 'Locked" alter gre data validation process has been successfully completed indicating the form is ready for submission.

Formo Locied On:[Feb2, 2016 at 1:00:23 PM S]~OLc C ~OtSO~Single Positive Test Form (version 1.6.0 -December 19, 2014) NRC Form 690 (1212014) 1j Flea ne qim ensapi ene. maxau opw 2) BEnat. hi sxeni filde au opopuiai leinaeo In oerl dfele 3) Moo.se ver Ia.,, fied.s to w s eds'di~lbon aadie 4) IP~ a Adobe Roeder# a, tr laer I reqetrad-]Submission i- Delete Select Facility Etmimated bnurden per response tn comply with this cotienhnun request is 30 minutes. This torm is 8 voluntary means of reporting the infornmaion required under 10 CFR 26.717. The informartion is required hy NRC to obtitin en on annual basise site specific fitess-tor-dudy (FF0) pruogrm pertormance dot. on drug end olcohol pregrams from licensees and nther entites. Send cnmments megardng burden estimote to the FOIA, Privocy end Intormotion COtetion Branch (TS-F53).

U.S. Nuctear Regulotory Comnussinon Washington DC 20555-0001 Om by n-mael to InftooclctoOs ResoacNRC cco, ond to the Desk Othcer, Office ut Intormation and Regulatory Affoirs, NEOe-1020, t3t50-0146), Offie ot Managtement and Budget, Washington DC 20503. Itoa means used to impose inforination colleotlon dues not display a currently oalid 0MB control number, the NRC moy net conduct mr sponsor, and a person is not required to respond to, the information collec~on.

Indian Point [50-247; 50-286]Date of CollectiOnmmeyyy 11/3/05I Reason for Tasting -26.71 7(b)(5) Please elaborate (optional)

Employment Type -26.717(b)(3)

Outage Worker (optional)?

LicenseEmployeeI

[No]Labor Category-26.717(b)(3)

Is thils a 24-liour Reporting Event (Yes/No)?-

26.715(b)

N Refusal- 26.717(b)(7)

& 26.75 Was this collection refused (Yes I No)? E ii Test Results -26.71 7(b)(4)Test Validity Test Typo(s) for Result(s)

Reported -26.717(bi)(2)

Drug Testinrg IDrug Only [ Iu i na Was this collection observeti (Yes/No)?

-26.71 7(b)(7) & 26.75 I I]Substance

-26.71 7(b)(2) & (b:)(6) Additiltonal Substance (as applicable)

Marijuana

] Please Select Use NRC Cutoff (Yes / No)? E i Subversion Attempts -26.71 7(b)(7) and 26.75(b)Did this collection involve a subversion attempt (Yes/No)?

[NIo ~ i Atditiltonal Substance (aS applicable)

IPlease Select]Maneaement Actions -26.71 71b)I8/ & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licenses Administrated)

NRC Minimum Specific Sanction Applied 14- Day Denial Person(s)

Responsible fur Information Provideti Person 1 trequired):

First Name Last Name Position Title Company Email Address Person 2 (op t ionll): Wayn GrifinSupervisor.

Acceos/Fitness ler Duty wgrlffl@entergy.com First Name Last Name Position Bite Company Email Address Final Stop (Raquirsd)

-NRC sill consider this leon authentic in eccordenco with 26 t11 only when the "Validate

& Lock" button is clicked ond all errors (highlighted In red) have been corrected.

The "Validate

& Lock" button will change to "Locked" alter the data volidaiton process has boon successfully compyleted indicating the forin is ready for submission.

Form Locked On:[Feb 2, 2016 at 1:12:43 PM S] o 1a Single Positive Test Fors (version 1.6.0 -December 19, 2014) NRC Form 890 (1212014)