ML18060A239

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

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

Text

,l U.S.NRC \ FFD Program Performance Data Reporting System ' '-' NRC Form 890. Single Pos1t1ve Test Form l, 1, " '" " ,, ' l'r,,lt'I flll}: />c*oplc mu/ tltr I tu ,r""""' 111 1 E.11::_ C,eneral Submission Portal 1 1) All fields required except those marlutd 'optional' APPROVED BY 0MB: CLEARANCE NO. 3150-0146 EXPIRES: 11/30/2017 2) Entries in some fields auto-populate Information in other fields Estimated burden per response to comply with this collection request is 30 minutes. This 3) Mouse over fonn fields to view additional Information form is a voluntary means of reporting the information required under 10 CFR 26.717. The 4) Use of Adobe Reader 8 or later Is required information is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFO) program performance data on drug and alcohol programs from licensees and other D Submission D ~~~e~~ssion entities. Send comments regarding burden estimate to the FOlA, Privacy and Information Update Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to lofocollects Resource@NBC gov. and to the Desk Officer, Unique Reference ID (License Suoolied) Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. lf a means used to impose information IIPEC 2017-003 I collection does not display a currently valid 0MB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection. Select Fac/1/ty I Indian Point (50-247; 50-286) I Date of Collect/on I 0212712017 I (mm/dd/yyyy) Reason for Testing-26.717(b)(5) Pre-Access Testing Reason (optional) Please elaborate (optional) I Pre-Access I I Initial Authorization I I I Employment Type -26.717(b)(3) Outage Worker (optional)? IContractorNendor I Jves I Labor Category-26.717(b)(3) I Maintenance (general facility) I Is this a 24-hour reporting event? -26. 719(b) Was this collection refused? -26 717(b)(7) & 26.75 Test Results -26.717(b)(4) Test Type(s) for Result(s) Reported -26.717(b)(2) Drug Specimen Tested I Drug Only I IUrine I Test Validity lvalid I Was this collection observed?-26.717(b)(7) & 26.75 How many substances were confirmed positive for this individual? I 1 I Substance-26.717(b)(2) & (b)(6) UseNRC Initial Confirmatory limit of Cutoffs? Cutoff Cutoff Detection !Marijuana I IGJ Subversion Attempt* Did this collection involve a subversion attempt?-26.717(b)(7) and 26.75(b) I No I Management Actions -26.717(b)(8) & 26.75 Reason for the Action I First drug or alcohol positive I Sanction Applied (NRC Minimum or Licensee Administrated) jLicensee Administrated I Specific Sanction Applied 13-Year Denial I Person(s) Responsible for Information Provided Person 1 (required): I Kelly I !Pettus I lsr. Security Coordinator, Access/FFD I kpettus@entergy.com First Name Last Name Position Title Company Email Address Person 2 (optional): !Wayne I !Griffin I I supervisor, Access/FFD I wgriff1@entergy.com First Name Last Name Position Title Company Email Address Final Step (Required)* NRC will consider this form authentic in accordance with 1 O CFR 26.11 only when the -Validate & Lock* button is clicked and al1 errors (highlighted in red) have been corrected. The "Validate & Lock" button wilt change to "Locked" after the data validation process has been successfully completed indicating the form is ready for submission. -FormlockedOn:jFeb15,2018at10:11:37AMI I Save to Local PC 11 Print this Report I Single Positive Test Form (version 1.7.0-December 2016) NRC Form 890 (12/2014)