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Category:License-Fitness for Duty (FFD) Performance Report
MONTHYEARML24052A2992024-02-21021 February 2024
Annual Fatigue Form for 2023
ML24052A3012024-02-20020 February 2024
Single Positive Test Form Collected on 05/17/2023
ML24052A3022024-02-20020 February 2024
Single Positive Test Form Collected on 10/18/2023
ML24052A3002024-02-20020 February 2024
Single Positive Test Form Collected on 02/14/2023
ML24052A2972024-02-20020 February 2024
Annual Reporting Form for Drug and Alcohol Tests for 2023
ML24052A3042024-02-20020 February 2024
Single Positive Test Form Collected on 12/06/2023
ML24052A3032024-02-20020 February 2024
Single Positive Test Form Collected on 11/28/2023
ML23058A2912023-02-27027 February 2023
Annual Report Form for Drug and Alcohol Tests for 2022
ML23051A0232023-02-20020 February 2023
Single Positive Test Form Collected on 03/15/2022
ML23051A0302023-02-17017 February 2023
Annual Fatigue Reporting Form for 2022
ML23051A0262023-02-16016 February 2023
Single Positive Test Form Collected on 05/11/2022
ML23051A0282023-02-16016 February 2023
Single Positive Test Form Collected on 07/25/2022
ML23051A0242023-02-16016 February 2023
Single Positive Test Form Collected on 04/28/2022
ML23051A0212023-02-16016 February 2023
Single Positive Test Form Collected on 01/26/2022
ML23051A0272023-02-16016 February 2023
Single Positive Test Form Collected on 06/22/2022
ML23051A0292023-02-16016 February 2023
Annual Reporting Form for Drug and Alcohol Tests for 2022
ML23051A0252023-02-16016 February 2023
Single Positive Test Form Collected on 05/09/2022
ML23051A0222023-02-16016 February 2023
Single Positive Test Form Collected on 03/07/2022
ML23051A0202023-02-16016 February 2023
Single Positive Test Form Collected on 01/05/2022
ML22054A1362022-02-23023 February 2022
Annual Fatigue Form for 2021
ML22054A1312022-02-17017 February 2022
Single Positive Test Form Collected on 07/12/2021
ML22054A0872022-02-17017 February 2022
Single Positive Test Form Collected on 07/12/2021
ML22054A1322022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0892022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0912022-02-17017 February 2022
Single Positive Test Form Collected on 10/07/2021
ML22054A0852022-02-17017 February 2022
Single Positive Test Form Collected on 04/05/2021
ML22054A0842022-02-17017 February 2022
Single Positive Test Form Collected on 03/31/2021
ML22054A0862022-02-17017 February 2022
Single Positive Test Form Collected on 07/06/2021
ML22054A0882022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0902022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A0832022-02-17017 February 2022
Single Positive Test Form Collected on 03/15/2021
ML22054A1332022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A1352022-02-17017 February 2022
Single Positive Test Form Collected on 10/07/2021
ML22054A1292022-02-17017 February 2022
Single Positive Test Form Collected on 04/05/2021
ML22054A1282022-02-17017 February 2022
Single Positive Test Form Collected on 03/31/2021
ML22054A1272022-02-17017 February 2022
Single Positive Test Form Collected on 03/15/2021
ML22054A1302022-02-17017 February 2022
Single Positive Test Form Collected on 07/06/2021
ML22054A1342022-02-17017 February 2022
Single Positive Test Form Collected on 09/13/2021
ML22054A1262022-02-16016 February 2022
Annual Reporting Form for Drug and Alcohol Tests for 2021
ML22054A0822022-02-16016 February 2022
Annual Reporting Form for Drug and Alcohol Tests for 2021
ML21055A7892021-02-24024 February 2021
Single Positive Test Form Collected on 08/30/2020
ML21055A7852021-02-24024 February 2021
Single Positive Test Form Collected on 06/30/2020
ML21055A7862021-02-24024 February 2021
Single Positive Test Form Collected on 08/10/2020
ML21055A7872021-02-24024 February 2021
Single Positive Test Form Collected on 08/17/2020
ML21055A7882021-02-24024 February 2021
Single Positive Test Form Collected on 08/24/2020
ML21055A7902021-02-24024 February 2021
Single Positive Test Form Collected on 09/15/2020
ML21055A7912021-02-24024 February 2021
Single Positive Test Form Collected on 09/17/2020
ML21055A7922021-02-24024 February 2021
Single Positive Test Form Collected on 09/21/2020
ML21055A7932021-02-24024 February 2021
Single Positive Test Form Collected on 12/03/2020
ML21055A7942021-02-24024 February 2021
Annual Report Form for Drug and Alcohol Tests for 2020
2024-02-21
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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
- 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)?
