ML18058A909: Difference between revisions

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{{#Wiki_filter:Select FacilityPalisades [50-255]Reason for Testing - 26.717(b)(5)Pre-AccessPre-Access Testing Reason (optional)Initial AuthorizationPlease elaborate (optional)Employment Type - 26.717(b)(3)Contractor/VendorLabor Category - 26.717(b)(3)OtherWas this collection refused? - 26.717(b)(7) & 26.75Test Results - 26.717(b)(4)Test ValidityValidTest Type(s) for Result(s) Reported - 26.717(b)(2)Drug OnlyDrug Specimen TestedUrineWas this collection observed? - 26.717(b)(7) & 26.75Management Actions - 26.717(b)(8) & 26.75   Specific Sanction Applied3- Year DenialSave to Local PCPrint this ReportUnique Reference ID (License Supplied)2017-PAL-003Please elaborate on the Labor Category selectedCooling Tower Replacement1) All fields required except those marked 'optional' 2) Entries in some fields auto-populate information in other fields  
{{#Wiki_filter:Select Facility Palisades [50-255]
Reason for Testing  
- 26.717(b)(5)
Pre-Access Pre-Access Testing Reason (optional)
Initial Authorization Please elaborate (optional)
Employment Type
- 26.717(b)(3)
Contractor/Vendor Labor Category
- 26.717(b)(3)
OtherWas this collection refused?  
- 26.717(b)(7) & 26.75 Test Results  
- 26.717(b)(4)
Test Validity ValidTest Type(s) for Result(s) Reported - 26.717(b)(2)
Drug Only Drug Specimen Tested UrineWas this collection observed?
- 26.717(b)(7) & 26.75 Management Actions
- 26.717(b)(8) & 26.75 Specific Sanction Applied 3- Year Denial Save to Local PC Print this Report Unique Reference ID (License Supplied) 2017-PAL-003 Please elaborate on the Labor Category selected Cooling Tower Replacement
: 1) All fields required except those marked 'optional'  
: 2) Entries in some fields auto-populate information in other fields  
: 3) Mouse over form fields to view additional information  
: 3) Mouse over form fields to view additional information  
: 4) Use of Adobe Reader 8 or later is requiredNoNo03/13/2017Submission UpdatePerson(s) Responsible for Information Provided Company Email Addressbrabide@entergy.comFirst NameBrianPosition TitleSupervisor Access Authorization/FFDPosition TitleLicensing SpecialistFirst NameBarbLast NameDotsonLast Name RabideauCompany Email Addressbdotson@entergy.comPerson 1 (required):Person 2 (optional):Single Positive Test Form (version 1.7.0 - December 2016)Final Step (Required) - NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the "Validate & Lock" button is clicked and all errors (highlighted in red) have been corrected. The "Validate & Lock" button will change to "Locked" after the data validation process has been successfully completed indicating the form is ready for submission. LockedForm Locked On:May 23, 2017 at 2:11:10 PMReason for the ActionFirst drug or alcohol positiveDid this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b)NoSubversion Attempt - Sanction Applied (NRC Minimum or Licensee Administrated)Licensee AdministratedDelete SubmissionFFD Program Performance Data Reporting SystemAPPROVED BY OMB: CLEARANCE NO. 3150-0146                    EXPIRES: 11/30/2017 Estimated burden per response to comply with this collection request is 30 minutes. This form is a voluntary means of reporting the information required under 10 CFR 26.717. The information is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFD) program performance data on drug and alcohol programs from licensees and other entities. Send comments regarding burden estimate to the FOIA, Privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.NRC Form 890, Single Positive Test Form(EIE General Submission Portal)NRC Form 890 (12/2014)Is this a 24-hour reporting event? - 26.719(b)NoNoHow many substances were confirmed positive for this individual?1Substance - 26.717(b)(2) & (b)(6)Use NRC Cutoffs?Initial CutoffConfirmatory CutoffLimit of DetectionAmphetamineYesDate of Collection (mm/dd/yyyy)Outage Worker (optional)?}}
: 4) Use of Adobe Reader 8 or later is required NoNo03/13/2017 Submission UpdatePerson(s) Responsible for Information Provided Company Email Address brabide@entergy.com First Name BrianPosition Title Supervisor Access Authorization/FFD Position Title Licensing Specialist First Name BarbLast Name DotsonLast Name RabideauCompany Email Address bdotson@entergy.com Person 1 (required):
Person 2 (optional):
Single Positive Test Form (version 1.7.0 - December 2016)
Final Step (Required) -
NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the "Validate & Lock" button is clicked and all errors (highlighted in red) have been corrected. The "Validate & Lock" button will change to "Locked" after the data validation process has been successfully co mpleted indicating the form is ready for submission.
LockedForm Locked On:Ma y 23, 2017 at 2:11:10 PM Reason for the Action First drug or alcohol positiveDid this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b)No Subversion Attempt -
Sanction Applied (NRC Minimum or Licensee Administrated)
Licensee Administrated Delete Submission FFD Program Performance Data Reporting System APPROVED BY OMB: CLEARANCE NO. 3150-0146                    EXPIRES: 11/30/2017 Estimated burden per response to comply with this collection request is 30 minutes. This form is a voluntary means of reporting the information required under 10 CFR 26.717. The  
 
information is required by NRC to obtain on an annual basis site specific fitness-for-duty  
 
(FFD) program performance data on drug and alcohol programs from licensees and other entities. Send comments regarding burden estimate to the FOIA, Privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov
, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct  
 
or sponsor, and a person is not required to respond to, the information collection.
NRC Form 890, Single Positive Test Form (EIE General Submission Portal)
NRC Form 890 (12/2014)
Is this a 24-hour reporting event?  
- 26.719(b)No NoHow many substances were confirmed positive for this individual?
1Substance  
- 26.717(b)(2) & (b)(6)
Use NRC Cutoffs?Initial CutoffConfirmatory CutoffLimit of Detection Amphetamine YesDate of Collection (mm/dd/yyyy)
Outage Worker (optional)?}}

Revision as of 01:29, 29 June 2018

Palisades, Single Positive Test Form, for Pre-Access, Collected on 03/13/17
ML18058A909
Person / Time
Site: Palisades Entergy icon.png
Issue date: 05/23/2017
From: Dotson B, Rabideau B
Entergy Nuclear Operations
To:
Document Control Desk, Office of Nuclear Security and Incident Response
Shared Package
ML18058A902 List:
References
2017-PAL-003
Download: ML18058A909 (1)


Text

Select Facility Palisades [50-255]

Reason for Testing

- 26.717(b)(5)

Pre-Access Pre-Access Testing Reason (optional)

Initial Authorization Please elaborate (optional)

Employment Type

- 26.717(b)(3)

Contractor/Vendor Labor Category

- 26.717(b)(3)

OtherWas this collection refused?

- 26.717(b)(7) & 26.75 Test Results

- 26.717(b)(4)

Test Validity ValidTest Type(s) for Result(s) Reported - 26.717(b)(2)

Drug Only Drug Specimen Tested UrineWas this collection observed?

- 26.717(b)(7) & 26.75 Management Actions

- 26.717(b)(8) & 26.75 Specific Sanction Applied 3- Year Denial Save to Local PC Print this Report Unique Reference ID (License Supplied) 2017-PAL-003 Please elaborate on the Labor Category selected Cooling Tower Replacement

1) All fields required except those marked 'optional'
2) Entries in some fields auto-populate information in other fields
3) Mouse over form fields to view additional information
4) Use of Adobe Reader 8 or later is required NoNo03/13/2017 Submission UpdatePerson(s) Responsible for Information Provided Company Email Address brabide@entergy.com First Name BrianPosition Title Supervisor Access Authorization/FFD Position Title Licensing Specialist First Name BarbLast Name DotsonLast Name RabideauCompany Email Address bdotson@entergy.com Person 1 (required):

Person 2 (optional):

Single Positive Test Form (version 1.7.0 - December 2016)

Final Step (Required) -

NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the "Validate & Lock" button is clicked and all errors (highlighted in red) have been corrected. The "Validate & Lock" button will change to "Locked" after the data validation process has been successfully co mpleted indicating the form is ready for submission.

LockedForm Locked On:Ma y 23, 2017 at 2:11:10 PM Reason for the Action First drug or alcohol positiveDid this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b)No Subversion Attempt -

Sanction Applied (NRC Minimum or Licensee Administrated)

Licensee Administrated Delete Submission FFD Program Performance Data Reporting System APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 11/30/2017 Estimated burden per response to comply with this collection request is 30 minutes. This form is a voluntary means of reporting the information required under 10 CFR 26.717. The

information is required by NRC to obtain on an annual basis site specific fitness-for-duty

(FFD) program performance data on drug and alcohol programs from licensees and other entities. Send comments regarding burden estimate to the FOIA, Privacy and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov

, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct

or sponsor, and a person is not required to respond to, the information collection.

NRC Form 890, Single Positive Test Form (EIE General Submission Portal)

NRC Form 890 (12/2014)

Is this a 24-hour reporting event?

- 26.719(b)No NoHow many substances were confirmed positive for this individual?

1Substance

- 26.717(b)(2) & (b)(6)

Use NRC Cutoffs?Initial CutoffConfirmatory CutoffLimit of Detection Amphetamine YesDate of Collection (mm/dd/yyyy)

Outage Worker (optional)?