ML14162A322: Difference between revisions
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{{#Wiki_filter:Select Facility Seabrook [50-443] | {{#Wiki_filter:FFD Program Performance Data Reporting System Single Positive Test Form (EIE General Submission Portal) | ||
Reason for Testing - 26.717(b)(5) | Note: | ||
Submission Delete 1) All fields are required except those marked 'optional'. | |||
Employment Type - 26.717(b)(3) | 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. | |||
162272F 4) Hold your mouse over a form field to view additional information. | |||
Select Facility Seabrook [50-443] Date of Collection (mm/dd/yyyy) 03/06/2014 Reason for Testing - 26.717(b)(5) Please elaborate (optional) | |||
Random Employment Type - 26.717(b)(3) | |||
Contractor/Vendor Labor Category - 26.717(b)(3) | Contractor/Vendor Labor Category - 26.717(b)(3) | ||
Maintenance (Craft) | Maintenance (Craft) | ||
Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)? | Refusal - 26.717(b)(7) & 26.75 Was this collection refused (Yes / No)? No Test Results - 26.717(b)(4) | ||
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) | ||
Test Validity Valid Test Type(s) for Result(s) Reported - 26.717(b)(2) | Cocaine 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) | ||
Drug Only | 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) | ||
Please Select Please Select Use NRC Cutoff (Yes / No)? | Licensee Administrated Specific Sanction Applied 5- Year Denial Person(s) Responsible for Information Provided Person 1 (required): | ||
Yes | 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 3:53:27 PM Save to Local PC Print this Report Single Positive Test Form (version 1.5.0 - January 1, 2014)}} | |||
Person 2 (optional): | |||
Final Step (Required) - | |||
NRC will consider this form authentic in accordance with 26.11 only when the | |||
Latest revision as of 04:32, 4 November 2019
ML14162A322 | |
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: ML14162A322 (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.
162272F 4) Hold your mouse over a form field to view additional information.
Select Facility Seabrook [50-443] Date of Collection (mm/dd/yyyy) 03/06/2014 Reason for Testing - 26.717(b)(5) Please elaborate (optional)
Random 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)
Cocaine 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 3:53:27 PM Save to Local PC Print this Report Single Positive Test Form (version 1.5.0 - January 1, 2014)