ML14118A417

Single Positive Test Form Collected on 01/15/2013

ML14118A417
Person / Time
Site:	Quad Cities
Issue date:	04/28/2014
From:	Exelon Generation Co
To:	Document Control Desk, Office of Nuclear Security and Incident Response
Paul Harris - 287-9294
References
Download: ML14118A417 (1)

Text

NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Please explain the change(s) to the form Note:

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

2) Entries in some form fields may result in information being auto-Unique Reference Number (Licensee Supplied) populated into other form fields.

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

2013-QAD-1 4) Hold your mouse over a form field to view additional information.

Select Facility Quad Cities [50-254; 50-265] Date of Collection (mm/dd/yyyy) 01/15/2013 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)? Yes Test Results - 26.717(b)(4)

Test Validity Test Type(s) for Result(s) Reported - 26.717(b)(2) Alcohol Testing Drug Testing Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.75 Substance - 26.717(b)(2) & (b)(6) Additional Substance (as applicable) Additional Substance (as applicable)

Use NRC Cutoff (Yes / No)? Use NRC Cutoff (Yes / No)? Use NRC Cutoff (Yes / No)?

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)? Please elaborate on the choice(s) selected:

Yes Temperature was 103.8 on initial test. Declared a subversion.

Refused to provide initial specimen Specimen characteristics (e.g., color, odor, precipitant)

Refused to provide second specimen Invalid test result (initial specimen collected) - 26.185(f)

Specimen temperature (out of range) Refused to follow directions Specimen paraphernalia identified Other Management Actions - 26.717(b)(8) & 26.75 Reason for the Action Subversion attempt Sanction Applied (NRC Minimum or Licensee Administrated)

NRC Minimum Specific Sanction Applied Permanent Denial Person(s) Responsible for Information Provided Person 1 (required):

Vicki Farbo FFD Analyst-West vicki.farbo@exeloncorp.com First Name Last Name Position Title Company Email Address Person 2 (optional):

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: Apr 28, 2014 at 11:35:12 AM Save to Local PC Print this Report Single Positive Test Form version 1.4.0 - Oct 31, 2012