ML14162A321

Single Positive Test Form Collected on 03/12/2014

ML14162A321
Person / Time
Site:	Seabrook
Issue date:	06/11/2014
From:	NextEra Energy Seabrook
To:	Document Control Desk, Office of Nuclear Security and Incident Response
Paul Harris - 287-9294
References
Download: ML14162A321 (1)

Text

FFD Program Performance Data Reporting System Single Positive Test Form (EIE General Submission Portal)

Note:

Submission Delete 1) All fields are required except those marked 'optional'.

Update Submission 2) Entries in some form fields may result in information being auto-populated into other form fields.

Unique Reference Number (Licensee Supplied)

3) Use Adobe Reader 8 or later for this form to work properly.

196722F 4) Hold your mouse over a form field to view additional information.

Select Facility Seabrook [50-443] Date of Collection (mm/dd/yyyy) 03/12/2014 Reason for Testing - 26.717(b)(5) Pre-Access Testing Reason (optional) Please elaborate (optional)

Pre-Access Initial Authorization Employment Type - 26.717(b)(3)

Contractor/Vendor Labor Category - 26.717(b)(3)

Maintenance (Craft)

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

Test Validity Valid 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 No Substance - 26.717(b)(2) & (b)(6) Additional Substance (as applicable) Additional Substance (as applicable)

Marijuana Please Select Please Select Use NRC Cutoff (Yes / No)? Yes Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) No Subversion Attempts - 26.717(b)(7) and 26.75(b)

Did this collection involve a subversion attempt (Yes/No)? No Management Actions - 26.717(b)(8) & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Specific Sanction Applied 5- Year Denial Person(s) Responsible for Information Provided Person 1 (required):

Stella Dumais Site Access/FFD Supervisor stella.dumais@fpl.com First Name Last Name Position Title Company Email Address Person 2 (optional):

David Bonthron AA/FFD Program Manager david.bonthron@fpl.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 (i.e., 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.

Locked Form Locked On: Jun 10, 2014 at 3:55:04 PM Save to Local PC Print this Report Single Positive Test Form (version 1.5.0 - January 1, 2014)