ML19058A545

Single Positive Test Form Collected on 03/21/2018

ML19058A545
Person / Time
Site:	Wolf Creek
Issue date:	02/19/2019
From:	Black P, Tate M Wolf Creek
To:	Office of Nuclear Security and Incident Response
Shared Package
ML19058A542	List: ML19058A539 ML19058A540 ML19058A541 ML19058A543 ML19058A544 ML19058A545 ML19058A546 ML19058A547 ML19058A548 ML19058A549 ML19058A550 ML19058A551
References
D3-18, RA 19-0030
Download: ML19058A545 (1)

Text

• "--- U.S.NRC

' ' I /~ f' /' o/1/lf/r, / /II I/

1) All fltid* required except those marlced 'optlonal'

\ l FFO Program Performance Data Reporting System NRC Fc11n 2,r,, S,ng*e P o~1t1,.-c T,~st APPROVED BY 0MB: CLEARANCE NO. 3150-0141

~ 01111 EXPIRES: 04/30/2021

2) EntrlH In some field* auto-populate Information In othw tr*lds Estimated burden per response to compty with this collection request Is 30 minutes . This

3) MouH over form ff.Jd* to view addltlonal Information fo<m Is a voluntary means of reporting the informatfon required under 10 CFR 26 .417(b)(2)

.f) U.a of Adobe RNdw I or later I* ~ulred and 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 D Submission Update D ~~~e!~ssion licensees and other entities. Send comme nts 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 lofocoflocta Be1ouccc @ N RC goy and to the Desk Officer, Office of Information and Regulatory Affairs , NEOB-1020 , (3150-0146} , Office Unlaue Reference ID (Licensee Suooliedl of Management and Budget, Washington DC 20503 . If a means used to impose ID3-18 information collection does not display a currentty valid 0MB control number, the NRC may I

not conduct or sponsor, and a person is not required to respond to, the Information Facility collection .

IWolf Creek (50-482)

I Date of Collect/on (mm/dd/yyyy)

I 0312112018 I

Reason for Tutlng . 28.717(b)(5) Pre-Access Testing Reason (optional) Please elaborate (optional)

IPre-Access I lrnitial Authorization I

Employment Type . 26.717(b)(3) Outllge Worl<er (optional)?

IContraclorNendor I jves I I i Labor Category . 26.717(b)(3)

I Maintenance (general facility)

I Is this a U.hour reportable event under 28.719(b)? ~

Was this collect/on refused?

• 28.717(b)(7) & 26.75 ~

Test Result$ . 28.717(b)(4)

Test Type(s) fo, Result(s) Reported* 26.717(b)(2) Drug Specimen Tested I Drug Only I junne I Test Validity

!valid I

Was this collect/on observed?

• 28.717(b) (7) & 26.75 ~

How many substances were confirmed positive for this individual? J 1 I

UseNRC Initial Confirmatory Limttof Substance - 26.717(b)(2) & (b)(6)

Cutoffs? Cutoff Cutoff Detection IMarijuana I I~

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 F irst drug o r a lcoh ol positive I

Sanction Applied (NRC Minimum or Licensee Administrated)

INRC Minimum I

Specific Sanction Applied 114- Day Denial I

Person(s) Responsible for lnformlttion Provided Person 1 (requhd) :

IPamefa First Name I la1ack Last N ame I !Access Specialist Position T itle I pabfack@wcnoc.com Company Email Address Person 2 (optional):

!Michael (Kenn) )ITate 11Superintendent Security I mitate@wcnoc.com First Name Last Name Pos1t1on Title Company Email Address Final St*p (Re quired)

• NRC wHI consider this form authentic in accordance with 10 CFR 26 .11 only 'When the 'Validate & lock* button la dicked and all errors (highlighted in red) have been corrected . The "Validate & Lock* button will change to

• Locked* after the data validation process has been success fully completed indicating the form is ready for submission .

- Form Locked On:!Feb 19, 2019 at 1:41 :09 PM I I Save to Local PC 11 Print this Report I Single Positive Test Form (version 1.6.0 . April 2018) NRC Form 890 (12/201 4)