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

Please elaborate on the choice(s) selected:

Temperature was 103.8 on initial test. Declared a subversion.

NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Select Facility Quad Cities [50-254; 50-265]

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)

Maintenance (Craft)

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

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)?

Management Actions

- 26.717(b)(8) & 26.75 Specific Sanction Applied Permanent Denial Save to Local PC Print this Report Unique Reference Number (Licensee Supplied) 2013-QAD-1 Note: 1) All fields are required except those marked 'optional'.

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

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

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

Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b)No Yes Date of Collection (mm/dd/yyyy) 01/15/2013 Submission Update Person(s) Responsible for Information Provided Company Email Address vicki.farbo@exeloncorp.com First Name Vicki Position Title FFD Analyst-West Position Title First Name Last Name Last Name Farbo Company Email Address Person 1 (required):

Person 2 (optional):

Single Positive Test Form version 1.4.0 - Oct 31, 2012 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 valid ation process has been successfully completed and the form is ready for submission.

Locked Form Locked On:

Ap r 28, 2014 at 11:35:12 AM Please explain the change(s) to the form correction required Reason for the Action Subversion attempt Refused to provide initial specimen Refused to provide second specimen Specimen characteristics (e.g., color, odor, precipitant)

Specimen temperature (out of range)

Invalid test result (initial specimen collected) - 26.185(f)

Specimen paraphernalia identified Did this collection involve a subversion attempt (Yes/No)?

Yes Subversion Attempts

- 26.717(b)(7) and 26.75(b)

Refused to follow directions Other Sanction Applied (NRC Minimum or Licensee Administrated)

NRC Minimum