ML12066A094

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Annual Reporting Form for Drug and Alcohol Tests, for Period Ending 2011
ML12066A094
Person / Time
Site: Pilgrim
Issue date: 12/31/2011
From: Denise Wilson
Entergy Nuclear Operations
To:
Office of Nuclear Reactor Regulation, Document Control Desk
References
PNP-2011-001, PNP-2011-002, PNP-2011-003, PNP-2011-004, PNP-2011-005, PNP-2011-006, PNP-2011-007, PNP-2011-008, PNP-2011-009, PNP-2011-010, PNP-2011-011, PNP-2011-012, PNP-2011-013, PNP-2011-014, PNP-2011-015, PNP-2011-016, PNP-2011-017
Download: ML12066A094 (20)
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Text

{{#Wiki_filter:.- \It \I USN ..... . R C A Pro(,', (11Ig Proplr <1l1d ti,,* /-.""I*i",,"/IIOI( I . , ' I , ( ~ Electronic Inform.ClJion Exchange NRC FFD Program Performance Data Reporting System Annual Reporting Form for Drug and Alcohol Tests for the EIE General Submission Portal Please explain the change(s) to the form NPIe: 1'\71 Submission Did not submit original report using correct format. Notice sent back 1) All fields required except those marked *optional'. IC>J Update from NRC requesting re-submittal 2) Use Adobe Reader 8 or later for this form 10 work properly.

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

Select Facilily Period of Report Ipilgrim [50-293] 2011 Tests Conducted in the Calendar Year Total Number of Tests Conducted Total Number of Positive, Adulterated, Reason For Testing Licensee Employees ContractorsNendors SUbstituted, and Refusal to Test Results Pre-Access I 591 I 6941 I 14 1 Random I 4201 87 1 I 21 For Cause I 31 01 I 11 Post-Event I 41 11 I 01 Fonowup I 171 161 I 01 Total (Calculated) I 5031 7981 I 17 1 FFD Program Random Testing Population and Rate Average number of Average number of Total size of the random testing pool Annual random testing percentage licensee employees contractors/vendors throughout the period (Calculated) achieved for the testing pool 697 261 958 I 1 I 1 I 1 Laboratory Testing Does your program use a Licensee Testing Facility? No I (Yes / No) .--------' Identify your HHS-Certified Laboratory(ies) IQuest Diagnostics: PA L----.===================================== Identify your Blind Performance Test Sample supplier(s) ILE_1So_h_IY_L_a_bs_._ln_c_ 

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Substances Tested Did your program only test for NRC-required substances illiQ at the NRC-specified minimum cutoff levels? (Yes / No) . Ives Does your program conduct LOD testing permitted in 26.163(a)(2)? (Yes / No) Ives 

                                                                                                                                                               .                  ..J Use Only NRC Cutoff            Initial                Confirmatory                      LOO Testing?                         Comment Substance Levels? (Yes / No)           Cutoff                      Cutoff                           (Yes/ No)                       (Optional)

Alcohol Ives INot Applicable Cocaine Ives Ives Marijuana Ives Ives Amphetamines Ives Ives Opiates Ives !ves PCP Ives Ives Annual Report Form (version 1.3.0* Nov 8, 2011)

  • Page 1 of 2-

Substances Tested* continued Summary of Management Actions - 26.717(b)(8) Summarize actions implemented to improve FFD program performance. As applicable. reference in the topic description audit reports. 30-day reports. and/or corrective action reports. If reporting information on more than three topics. select "Others" for Topic 3to report any additional topics. Topic 1 Topic 1 Description Fitness for Duty/Access Authorization (including PADS) audit conducted between July 11 and August Iprogram and System Management 31.2011. Quality Assurance Audit Report QA-01-2011-HQN-1 Rev. 1 The audit concluded that these programs at each of the Entergy Sites continue to be effectively implemented and meet the requirements of 10CFR Parts 26. 73.58 and 73.57 o Add an additional Topic Person(s) Responsible for Information Provided Person 1 (required): I.. D_ia_nn_e_ _ =,.,.,=:-:- First Name IIV'Alson Last Name II Security Coordinator Position Tille dwilso3@entergy.com Company Email Address Person 2 (optional): I'------",,=:-;=::c::-----' First Name 

                                          ....---.,-;;;:TM=;------"'-----O;:;=:::Tr.:;:::------'                       ---~==-r=::;;-;c:T:'r:=---1 Company Email Address Fina/ Step (Required) - NRC will consider this form authentic in accordance with 26.11 only when the "Validate & Lock" bullon has been selected and all errors (i.e.. those highlighted in red) have been corrected. The "Validate & Lock" bullon will change to "Locked" after the data vatidation process has been successfully completed and the form is ready for submission.

Annual Report Form (version 1.3.0 - Nov 8.2011) 

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        ,    ~ Electronic Informft~c;r~XChange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal rtQIJ~:

Unique Reference Number (Ucensee Supplied) I,-P_N_P_2_0_1_1_-{}_0_1 ---J 1) All rteld5 are required except those marked *optional'.

2) Entries in some form fields may result in information Submission Update - check this box only if this is an update to a prevK>us submission. in being auto-populated into other fuml fields.

O which case you must use the same Unlque Reference Number. 3) Use Adobe Reader 8 OT later for this lomJ to work properly. Select Facility Ipilgrim [50-293] Dale of Collection (mmJddJyyyy)103114/2011 Reason for 'esdng- 26.717(bX5) Pre-Access Testing Reason (optional) IPre-Access !Initial Authorization Employment Type - 26.717(b)(3) IContractorNendor Labor Category- 26.717(bX3) Please elaborate lather ISTATION CLEANER Refusal* 26.717(b)(7) & 26.75 Was this collection refused (Yes I No)? Test Results - 26.717(b)(4) Test Validity Ivalid Test Type(s) for Resull(s) Reported Drug Testing IDrug Only IUrine Was this collecdon observed (Ves/No)?- 26.717(bX7) & 26.1 INo 

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Substance - 26.717(b)(2) & (bX4) Additional Substance (as applicable) Additional Substance (as applicable) IMarijuana Iplease Select IPlease Select Use NRC Culoff (Yes I No).. IY'-'e:.:s'-_---' Use NRC Culoff (Yes I NO)L:IY"e"'s_ _--' Use NRC Culoff (Yes I No)IL:Y"e"'s_ _--' Is tl>is a 24-Hour Reporting Evenl (Ves/No)? - 26.719(b) LIN_O _ Subversion Attempts* 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8) Individual Sanction 13- Year Denial Reason(s) for the Action (select all that apply): (gJ MRO Confirmallon (gJ Firsl drug or alcohol positive D ResignationlWithdrawal o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule o Other: o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 {required}: IISECURITY COORDINATOR I dwilso3@enle'9y*com ID_I_AN_N_E_-.====- IIWILSON First Name Last Name -----"P'"'o""si7'tio=-=n~T 

                                                                                                               ..I".lle:----..J                      Email Address Person 2 (optional):

I----.F"'irs=tNu::: am= e = - - - - " - - - - .L--;a:::s>1 1Nu a:::m=e=----II'----.p.-:o-:'si;;rtio:::n:--TT;i7T tle=----' -----"E"'m=-=a'"il"A""d"""dr=e""::ss=------! Final Step (RequirfJd)

  • NRC will consider this form an official submission only when the "Validate & lock" button has been selected and all errors (Le., those highlighted in red) have been corrected. The "Validate & Lock" button wfll change to "Locked" after the data validation process has been successfully completed and the form is ready for SUbmission.

Form Locked On:IMar 18, 2011 at 10:57:11 AM I i save to ~~ I Prinl Single Positive Test Form version 1.2_24

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1-.1111""- I ~ Electronic Inform"t~a~Xchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note: Unique Reference Number (Licensee Supplied) I_P_N_P_.2_0_1_1_-o_0_2 ~ 1) All fields are required except those marked 'optionar

2) Entries in some form fields may result in inf6rmiltion Submission Update - check this box only if this is an update to a previous submission, in being auto*popufattNi into other farm fields.

D which case you must use the same Unique Reference Number. 3) Use Adobe Reader 8 or later for this form to work properly. Select Facilily IPilgrim [50-293] Dale of Collection (mmlddlYYYY)!03/1 4/2011 Reason fo, Testing - 26.717(b)(5) Pre-Access Testing Reason (optional) IPre-Access IReinstatement (Between 31 and 365 days) Employment Type - 26.717(b)(3) ILicensee Employee Labo, Category - 26.717(b)(3) IHP/RP Refusal* 26.717(b)(7) & 26.75 c-I Was this collection refused (Yes I No)? ~ Test Results - 26.717(b)(4) Test Validily Ivalid Test Type(s) for Result(s) Reported Alcohol Testing Drug Tesllng IDrUg and Alcohol !Breath lurine Was thIs collection observed (Yes I No)? - 26.717(b)(7) & 26.1 IN_O__-, Substance - 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) ICocaine IPlease Select IPlease Select 

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Use NRC Cutoff (Yes I No)"lvc.:e"s_ _--' Use NRC Cutoff (Yes I NO)Llv:.:e"'s'-_--' Use NRC Cutoff (Yes I NO)L!v:.:e"'s'-_--' Is IMs a 24-Hou, ReportIng Event (YeslNo)?

  • 26.719(b) IL.N_O _

Subversion Attempts* 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b}(8) Individual Sanction 114- Day Denial Reason(s) for Ihe Action (select all that apply): f8l MRO Confirmation l'8I First drug or alcohol positive 0 ResignatlonNVithdrawal o Subversion 0 Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule 0 Other: o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required); IL.D_IAN_N_E_-r=== First Name I WILSON I SECURITYCOORDINATOR I 

                                           ----Ll,-;;;s"t<IName::---- '------,P,.o"'s"'iti.,-on"""'Ti"'tie.,-------'

dw;lso3@entergy.com Email Address Person 2 (optional); I,--~::::--II--------;-:=r.=-----,II--=~- FIrst Name Last Name Position Title Email Address Final Step (Required)

  • NRC will consider this form an official submission 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" atter the data validation process has been successfully completed and the form is ready for submission.

Form Locked On:IApr 22. 2011 aI9:48:36 AM r--;;l..oc::... PC I, I _ P!lnl ~J Single Positive res! Form 

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( ~ Elect~onic Inform~ion Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal N9~: Unique Reference Number (Licensee Supplied) Ic..P_N_P_-_20_11_-oD __ 3 ---' 1) All fields are required except those marked *optional'.

2) Entries in some form fields may result in information Submission Update - check this box only if this is an update to a previous submission, in being auto*popufated into other (orm fields.

O which case you must use the same Unique Reference Number. 3) Use Adobe Reader 8 or later fOt this form to work properly. Select Facility Ipilgrim [50-293] Date of Collection (mmlddfyyyy) 103116/2011 Resson lor Testing - 26.717(b)(5) Pre-Access Testing Reason (optional) Ipre-Access !Initial Authorization Employment Type - 26.717(b)(3) IContractorNendor Labor Category - 26.717(b)(3) Please elaborate lother IWAREHOUSE. STOCK KEEPER Refusal- 26.717(b)(7) & 26.75 Was this collection refused (Yes I No)? EJ Test Resufts - 26.717(b)(4) Test Validity Ivalid Test Type(s) for Result(s) Reported Alcohol Testing Drug Testing IDrug and Alcohol IBreath IUrine Was this collection observed (Yes I No)? - 26.717(b)(7) & 26.1 ILN_O_ _--' Substance - 26.717(b)(2) & (b)(4) Additional Substance las applicable) Additional Substance las applicable) IMarijuana IPlease Select IPlease Select Use NRC Cutoff (Yes f No)"ly:..:e:.:s_ _----' Use NRC Cutoff (Yes f NO)!'-'Y-"e"s_ _--' Use NRC Cutoff (Yes J NO)!'-'Y-"e"s_ _--' Is this a UHour Reporting Event IYes/No)? - 26.719(b) N_o Ic.. _ Subversion Attempts - 26.717(b)(7) and 26.75(b) If this result retates to a subversion attempt, select one or more of the following choices as applicable, If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions* 26.717(b)(8) Individual Sanction 13- Year Denial Reason(s) for the Action (select all that apply): 181 MRO Confirmation 181 First drug or alcohol positive o ResignationiWithdrawal o Subversion o SUbsequent positive test result from testing o Misuse 0 Violation of ~hour abstinence rule o Other: o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): dwilso3@entergy.com 'c..D_IAN_N_E_-..=== IILWl_L_S_O_N_-.===:-_ _---CIISECURITY COORDINATOR First Name Last Name Position Title Email Address Person 2 (optional): < - - - I~~II,---~=-----,II,---~=-- First Name Last Name Position Title Email Address Final Step (Required)

  • NRC will consider this form an official submission only when the ~Va[jdate & 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 vatidation process has been successfully completed and the form is ready for submission.

Form Locked On: lAp' 22. 2011 at9:5439 AM

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         ,    ~                 Electronic                                         Inforrri~~~~xchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal NJllit:

UniqU~ Reference Number (Licensee Supplied) I_P_N_P_.2_0_1_1_.00_4 _ 1) AU fields are required except those marked 'optlonal',

2) Entries in some form fields may result;n information Submission Update - check this box only if this is an update to a prev"'us submission, in being auto*populated into other fam) fields.

O which case you must use the same Unique Reference Number. 3J Use Adobe Reader 8 or later for this form to work properly. Select Facility IPilgrim [50*2931 Dale of Collection (mmiddlywy)103/28/2011 Reason for Testing' 26.717(b)(5) Pre-Access Testing Reason (optional) IPre.Access !Initial Authorization Employmenr Type* 26.717(b)(3) IContractorNendor Labor Category* 26.717(b)(3) IMaintenance (Craft) Refusal* 26.717(b)(7) & 26.75 r::::::--I Was Ihis collection refused (Yes I No)? ~ Tesl Results* 26.717(bX4) Test Validity Ivalid Test Type(s) for Result(s) Reported Alcohol Testing Drug Testing IDrUg and Alcohol IBreath lurine Was this collection observed (Yes INa)?* 26.717(b)(7) & 26.1 INo 

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Substance* 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) ICocaine IMarijUana Iplease Select Use NRC Cutoff (Yes I No)'-'IY~e~s_ _--' Use NRC Cutoff (Yes I NO)LIY:..:e"'s'-_---' Use NRC Cutoff (Yes I NO)LIY:..:e"'s'-_---' Is tllis. 24-Hour Reporting Eve", (Yes/No)?* 26.719(b) LIN_O_ _---' Subversion Attempts* 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the follOWing choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions* 26.717(bX8) Individual Sanction 13' Year Denial Reason(s) for the Action (select all thai apply): ti':I MRO Confirmation ti':I First drug or alcohol positive o ResignationlWithdrawal o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule o Other. o Sale. Use or Possession in PA Person(s) Responsible for Information Provided PefSOn 1 {required}: IOIANNE IIWILSON IISECURITY COORDINATOR I dwHso3@entergycom 

'----"FT::lrs"'IO:NT.:a=m:::e-----' '----TLa"'s"t"N"'a;;m::;e---- ----,.P.-:o:::si"'tio:::n"'T"it"'le::------' -----"""'E~m-a...,il:cA;-d:cd,-re-ss------I Person 2 (optional):
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II. .----.La;::s::tITNr;:a:::m:=e------J11---......,P;::O::;si"iItio:::n;-Tflirr.tle::-----' -----'E"m"'a"iI"A"d"'d"'re:::s:::s----- Fina! Step ('ReqUired) ~ NRC will consider this form an official submission 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 validation process has been successfully completed and the form is ready for submission. Form Locked On:IApr 22. 2011 aI9:58:56 AM Single Positive Test FOfm 'f6l"8ioo t.2.24 

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I ( ~ Electronic InformaJioo Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal 

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Unique Reference Number (Ucensee Supplied) I_P_N_P_-2_0_1_1_-0_0_5 -' 1) AU fields are required E'JtcPpt those marked 'optional'.

2) Entries in some form fields may result in information Submission Update
  • check this box only if this is an update to a previous submission. in being 8tJto~populatedinto other form fields.

O which case you must use the same Unique Reference Number. 3} Use Adobe Reader 8 or later for this form to 'NOrA properly. Select Facility Ipilgrim [50-293) Date of Collection (mmJddlyyyy) 103/31 /2011 Reason for Testing - 26.717(b)(5) Pre-Access Testing Reason (optional) IPre-Access !Initial Authorization Employment Type - 26.717(b)(3) IcontractorNendor Labor Category* 26.717(b)(3) IMaintenance (Craft) Refusal- 26.717(b)(7) & 26.75 r.:::--I Was this collection refused (Yes I No)? ~ Test Results - 26.717(b)(4) Test Validity IVaiid Test Type(s) for Result(s) Reported Alcohol Testing Drug Testing IDrug and Alcohol I Breath IUrine W.slhls collection observed (Yes/ No)? - 26.717(b)(7) & 26.1 LIN_o_ _--' Substance - 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) IAlcohol IPlease Select IPlease Select Use NRC CutOff (Yes I No)..,IV"'e"'s_ _--' Use NRC Cutoff (Yes I No}..,IV"e"'s_ _--' Use NRC Cutoff (Yes I No)..,IV"e"'s_ _---' Is this. 24-Hour Reporting Event (Yes/No)? - 26.719(b) I_N_o _ Subversion Attempts - 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8} Individual Sanction 11- Year Denial Reason(s) for the Action (select all that apply): I8J MRO Confirmation I8J First drug or alcohol positive o ResignationlWithdrawal o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule o Othec o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): I.. D _JAN_N_E_-c=== IIVlltLSON IISECURITY COORDINATOR I dwilso3@entergy.com 

                                         ----'La=:s"t"Nr::a=m:::e-----' -----,.P"o"'si"'tio:::n"'T"il;;:le,------J -----*E~m:::-a"il;-,A;-,dd=re:-:s.,.s-----I II

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NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal 

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Unique Reference Number (Licensee Supplied) I_PN_P_-2_0_'_1_-0_0_6 -' 1j All fie-Ids are required except those marked *optiona".

2) Enuies in some form fields may result in informatror1 Submission Update ~ check this box only if this is an update to a previous submission, in being aUlo~poplJJatedinto other fom) fields.

D which case you must use the same Unique Reference Number. 3) Use Adobe Reader 8 or later fOf this form to work. properly. Setect Facility Ipilgrim [50-293J Date of Collection {mmJddlyyyy)103/31/20" Reason for Testing- 26.717(bX5) Pre-Access Testing Reason (optional) Ipre-Access Iinitial Authorization Employment Type - 26.717(b)(3) IComractorNendor Labor Category - 26.717(b)(3) IMaintenance (Craft) Refusal* 26.717(b)(7) & 26.75 r.::::---l Was this collection refused (Yes I No)? ~ Test Results - 26.717(b)(4) Test Validity Iva lid Test Type(s) for Result(s) Reported Alcohol Testing Drug Testing IDrUg and Alcohol !sreath lurine Was this colfectlon observed (Yes I No)?- 26.717(b)(7) & 26.1 ILN_O_ _--' Substance- 26.717(bX2) & (bX4) AdditJonal Substance (as applicable) AddWonal Substance (as applicable) ICocaine IMarijUana IPlease Select Use NRC Cutoff (Yes I NO)!LY"e;;:s_ _--' Use NRC Cutoff (Yes f NO)LiY"e"'s'-_--' Use NRC Cutoff (Yes I NO)L!Ycoe"'s'-_--' Is tl!is a 24-Hour Reporting Event (Yes/Noi? - 26.719(b) LIN_O _ Subversion Attempts* 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the fof/owing choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8} Individual Sanction 13- Year Denial Reason(s) for the Action (select all that apply): 181 MRO Confinnation 181 First drug or alcohol positive o Resignation,Withdrawal o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule o Other: o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person t (reqUired): ID_'_AN_N_E_-.===:- First Name IIW'LSON IISECURITY COOROINATOR I dwilso3@ ente 

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                                            '----rCa"'s"t"N"'a::::m::::e---- '-----,P,..o-si"'Uo,..n:-T"'i""lIe---- ------;E'"'m=a"'i1'Ac:dc:d=rec:sC"s-----

Person 2 (optional): I~===----,IIL-~=---II---=~--, _---;==:~_I First Name Last Name Position Title Email Address Final Step (Required) NRC will consider this form an official submission only when the ~Validate & Lock~ butlon has been selected and all errors (Le.. those M highlighted in red) have been corrected. The "Validate & Lock" button will change to "locked" after the data validation process has been successfully completed and the form is ready for submission. Fonn Locked on:IAp' 22,2011 at 11:11:22 AM I [SM~~I Pllnl ~"] I SlnglB Positive Test version 12.24 

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( ~ Elect~onic Information . ~ '- Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note,' Unique Reference Number (Ucensee Supplied) L- --' 1) AU fields are- requirod except those marked 'optionaL Entries in some form fields may result in information Submission Update check this box o~ly if this is an update to a previous submission, in be,ing aulo-,pOI,uh.te,rj ;,)to other form fields, O w which case you must use the same Umque Reference Number, 3} Use Adobe Retider 8 or later for this form to worK properly. Date of Collection (mmiddlyyyy) 104/04/2011 Reason for Testing- 26.717(b)(5) Pre-Access Testing Reason (optional) IPre-Access llnitial Authorization Empfoyment Type* 26.717(b)(3) IcontractorNendor Labor Category* 26.717(b)(3) IMaintenance (Craft) Refusal* 26.717(b)(7) & 26.75 Was this collection refused (Yes I No)? Test Results - 26.717(b)(4) Test Validity lvalid Test Type(s) for Result(s) Reported Drug Testing lurine Substance* 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) IMarijUana IPlease Select IPlease Select Use NRC Cutoff (Yes I No)",IY.::e",s_ _--, Use NRC Cutoff (Yes I No)"'IY.::e:.;::s_ _--' Use NRC Cutoff (Yes I No)I. Y. "e:.::s_ _--' Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) IN_o_ _- , Subversion Attempts* 26.717 (b)(7) and 26. 75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Reason(s) for the Action (select all that apply): I8l MRO Confirmation 181 First drug or alcohol positive o ResignationlWithdrawal o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of &-hour abstinence rule o Other: o Sale. Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): I.O_IAN_N_E_-.==== 

 ..                                   --'IIV'ALSON                              II SECURITY COORDINATOR                       dwilso3@entergy.com First Name                               Last Name                               Position Title                                  Email Address Person 2 (optional):

First Name Email Address Final Step (Required) ~ NRC wilt consider this form an official submission 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 validation process has been successfully completed and the form is ready for submission, Form locked 

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( ~ Electronic Inform tiot"*:.~xchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note: Unique Reference Number (Licensee Supplied) Ip_N_P,_2_0_1_1_-00_8 _ 1) All fields are required except those marked 'opti<maf'.

2) Entries in some form fields may result In information Submission Update - check this box only if this is an update to a previous submission. in being auto~poplJJatedillto otlH;!r form flalds, O which case you must use the same UnIque Reference Number. 3) Use Adobe Reader 8 or later for this form to work properly.

Select Facility Ipilgrim [50,293] Date ot Collection (mmiddlyyyy)104/05/2011 Reason for Testing' 26.717(b)(5) Pre-Aceess Testing Reason (optional) Ipre-Access Iinitial Authorization Employment Type - 26.717(b)(3) IContractorNendor Labor Category - 26.717(b)(3) IMaintenance (Craft) Refusal* 26.717(b)(7) & 26.75 r.:::::--I Was thIS collection refused (Yes I No)? ~ Test Results - 26.717(bK4) Test Validity Ivalid Test Type(s) for Result(s) Reported Alcohol Testing Drug Testing IDrug and Alcohol IBreath IUrine Was this collection observed (Yes I No)? - 26.717(b)(7) & 26.1 ILN_O_ _- J Substance, 26.717(b)(2) & (b)(4) AddItional Substance (as applicable) Additional Substance (as applicable) IMarijuana Iplease Select IPlease Select Use NRC Cutoff (Yes I No)"lvc:e",s_ _- J Use NRC Cutoff (Yes I NO)Llv"'e"s'-_--' Use NRC Cutoff (Yes I No)"lvc:e"s_ _- J Is t!>is a 24-Hour Reporting Event (Yes/No)?* 26.719(b) LIN_O _ Subversion Attempts* 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the fo/lowing choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(B) Individual Sanction 13' Year Denial Reason(s) for the Action (select all that apply): r8l MRO Confirmation 181 First drug or alcohol positive o ResignationlWithdrawal o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule o Other: o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): ILD_IA_N_N_E_--,,=== IIWILSON IISECURITY COORDINATOR I dwllso3@entergy.com First Name '----rCa"'s"t'"Nr;;a;;;mr;;e---- ----"P""os"'i"'l/on=T"'it"'le,---- -------;E"'m=a"'II'A"d"'d= rec:s:c s- - - - - Person 2 (optional): 1---- 1"1i7. F rs:01"'N::-am=e-----'IIL---..-La::S:Tt"N;:;:a7.m::-e----"----"p;:;:O::1Siottlo::n"T"'it"'te:----' -----'E"'m::a'"il'A"d"'d=re::-s"'s----- Final Step (Required) ~ NRC will consider this form an official submission only when the "Validate & Lock" button has been selected and all errors (l.e., those highlighted in red) have been corrected. The Validate & Lock" button will change to "Locked" after the data validation process has been successfUlly completed and the form is ready for submission. Form Locked On:IApr 22, 2011 at 11:09:04 AM I ~J Single Positi'l6 Test Formversioo 1.224

__ '\lit , u. S. NRC /'1<1/" flllX /'r0l"" .lIl</ r/., 1 nr" "'"1/'11/ I . ( "-.J Electronic Inform~$iQn Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal 

                                                                                                        !'1rJte,'

Unique Reference Number (Ucensee Supplied) 1) Ali fields are required except those marked 'optional'. 

                                                      '--------------'                                      Entries in some form fields                      information Submission Update ~ check this box only if this is an update to a previous submission, in         being.ulo-/Jo"ul"te,; 11"0 other             fields.

O which case you must use the same Unique Reference Number. 3) Use Adobe Reader 8 or later tor this form to ',frork properly. Select Date of Collection (mmiddlyyyy) 104/07/2011 Reason for Testlng- 26.717(b)(5) Pre-Access Testing Reason (optional) IPre-Access IReinstatement (Between 31 and 365 days) Employment Type - 26.717(b)(3) IContractorNendor Relusal- 26.717(b)(7) & 26.75 r:::::---I Was this collection refused (Yes I No)? ~ rest Results - 26.717(b)(4) Test Type(s) for Result(s) Reported Alcohol Testing Drug Testing IDrug and Alcohol IBreath lurine Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.1 

                                                                        '-----'

Substance - 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) Use NRC Cutoff (Yes I NO)LIY",e",s,-_-...J Use NRC Cutoff (Yes I NO)LIY:..:e:.:s'-_--' Use NRC Cutoff (Yes I No)IYes L:..::.:'-------' Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) LIN_o_ _--' Subversion Attempts - 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Reason(s) for the Action (select all that apply): 181 MRO Confirmation I2l First drug or alcohol positive o ResignationlWithdrawal o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule o Other: o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): I_D_IAN_N_E_-",=== IIVV1LSON I I SECURITY COORDINATOR dwilso3@entergy.com First Name '----rL"'as"t'N'-'a""m"'ec-----' Position Title Email Address Person 2 (optional)' First Name Email Address 

                          ~

Final Step (Required) NRC will consider this form an official submission only when the "Validate & Lock" button has been selected and atl errors (I.e" those. JI highlighted in.red) have been corrected. The 'Validate & Lock" button will change to "Locked" after the data validation process has been successfully completed and the form IS ready for submission, Form Locked Is.,..lIIl.oCl11 PC II PrInIIhIa RiIpoIt I Single- "'-Te-st 'orm '1. . . . . .,iT:l14

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J~U'IJlI"I'..opl"'I".IIJ,r"II/."""".*.,.1 o£ i ~ Electronic Inforni tio~ Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal HpJ!!: Unique Reference Number (Licensee Supplied) ILP_N_P_,_20_'_'_,_O_,_O _ 1} All fields are required e-xcept those marked *optlona1'.

2) Entries in some form fields may result in information Submission Update - check this box only if this is an update to a previous submission, in being auto--populated into other fomf fields.

O whidl case you must use the same Unique Reference Number. 3) Use Adobe Reader 8 or later for this form to work properly. Select Facility Ipilgrim [So-293} Date of Collection (mmlddJyyyy)I04/07120' 1 Reason for Testing* 26.717(b)(5) Pre-Access Testing Reason (optional) Ipre,Access Iinitial Authorization Employment Type, 26.717(bX3) IContractorNendor Labor Category, 26.717(b)(3) IMaintenance (Craft) Refusal* 26.717(bX7) & 26.75 c::--l Was this collection refused (Yes I No)? ~ Test Results* 26.717(b)(4) Test Validity Ivalid Test Type(s) for Result(s) Reported ...A1_co_h_ol_T_e_S_ting...:.... -. Drug Testing IDrug and Alcohol IBreath IUrine 

                                                                '-------;:::::==:;-----'

Was this collection obselVed (Yes! No)? - 26.717(b)(7) & 26.1 LIN_O _ Substance* 26.717 (bX2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) IMarijUana Iplease Select IPlease Select Use NRC Cutoff (Yes I No)..,IY",e",s,-_--, Use NRC Cutoff (Yes I No)..,IY",e",s_ _--, Use NRC Cutoff (Yes I NO)!..,Y"'e"'s_ _--' Is thIs a 24-Hour ReportIng Event (Yes/No)? - 26.719(b) LIN_O_ _--, SubversIon Attempts .. 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt. select one or more of the following choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8) Individual Sanction 13' Yeat Denial Reason(s) for the Action (select all thai apply): F8I MRO Confirmation 18I First drug or alcohol positive o ResignatioruWithdrawal o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule o Other. o Sale. Use or Possession in PA PeTson(s) Responsible for Information Provided Person 1 (required): IOIANNE 

  -------.F"'ir.,.,s7"tN=am-e----'

IIWILSON IISECURITY COORDINATOR 

                                             ~---r[a"'s:i't"N""am=e----'----"P"'o.,.si"'tio""n""T""i-:;-tle:----

I dwilso3@enlergy.com Email Address Person 2 (optional): 1-------. "'i::rs7"tN=am=e----'II-------.Lr-:ac:S7"tN F . .a:::m::::e=----IIL----,p'i':Oc::S;.;fti:::on::-'i'Ti"-tie:-------' -----"E"'m"'a'"i1'A"'d"d:: rec:: ss:------1 Final Step (ReqUired)

  • NRC will consider this form an official submission only when the "Validate & Lock" button has been selected and all errors (Le., those I highlighted in red) have been corrected. The "Validate & Lock~ button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission.

L-!-lorAI PC I~~ ISIngle Positive T6St Foon version 1.2-24 

 '_. I u.s. N I~ C                                                                                                I',ufr, r:"X I'r"plr ./1/,1 rI., I '.r 1'1' "f I

( ~ Electronic Information .., ~ Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal NQt~: Unique Reference Number (Licensee Supplied) ILP_N_P_-_20_'_'_-O_,_, _ 1) All fields are required eKcept those marked 'opt/onar

2) Entries in some form fields may result in information Submission Update - check this box only if this is an update to a previous submission, in being auto~popuJatedinto other form fields.

O which case you must use the same Unique Reference Number, 3) Use Adobe Reader 8 or fater for this form 10 work properly. Select Facility !Pilgrim [50-293] Date of Collection (mmiddlyyyy) 104/07/20" Reason for Testing - 26.717(b)(5) Pre-Access Testing Reason (optional) Ipre-Access Iinitial Authorization Employment Type - 26.717(b)(3) IContractorNendor Labor Category - 26.717(b)(3) IMaintenance (Craft) Refusal - 26.717(b)(7) & 26.75 r=--I Was this collection refused (Yes I No)? ~ Test Results - 26.717(b)(4) TestValidily IValid Test Type(s) for Result(s) Reported rA_Ic_O_ho_I_T_e_Sti_*ng-=- _ Drug Testing IDrug and Alcohol ILB_re_a_t_h _ JUrine Was this collection observed (Yes I No)? - 26.717(b)(7) & 26.1 I_N_O_ _--' Substance - 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) IMarijUana IPlease Select IPlease Select Use NRC Cutoff (Yes I NO)o..;IV:..:e:.:s_ _--' Use NRC Cutoff (Yes I No)I...,V..::e"'s_ _--' Use NRC Cutoff (Yes I No)I...,V..::e"'s_ _--' Is this a 24-Hour Reporting Event (Yes/No)? - 26.719(b) I.. N_o_ _--' Subversion Attempts - 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable. It not a subversion attempt. do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8) Individual Sanction 13- Year Denial Reason(s) for the Action (select all thai apply): 131 MRO Confirmation 131 First drug or alcohol positive o ResignationlWithdrawaJ o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule o Other: o Sale. Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): IDimNE II_W_l_S_O_N_.,.,=== -'IISECURlTY COORDINATOR I dwilso3@entergy.com First Name Last Name Position Title Email Address Person 2 (optional): 1-----..r~_II---;-;=-_II----,.;;,~- First Name Last Name Position Title Email Address Final Step (Required) - NRC will consider this form an official submission only when the "Validate & Lock~ button has been selected and all efrors (Le., those highlighted in red) have been corrected. The "Validate & Lock" button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission. Form Locked On:lAPr 22, 2011 at 11 :06:39 AM I 

        .. 1; lJ S_. N [{C           .~                              .                           .d      I'rot"'lIIgPt'oplt'<llIdt/.rf."'*/I""",rrlf I
        ,    ~                 Electronic                                  Inforin...m~<I~xchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note:

Unique Reference Number (Licensee Supplied) t) All fields are required except those marked 'optional', Entries in some form 1'lall1s ITIa'v ",)Sulf li1 ir,fol'm',tion Submission Update check this box only if this is an update to a previous submission. in beingau'o-l,ormli,t,,,1irltootl:'etfcrm fields. O which case you must use the same Unique Reference Number. 3} Use Adobe Reader 8 Of later for this fonn to work. properly. Date of Collection (mmldd/YYYY)!04/07/2011 Pre~Aceess T 85ting Reason Employment Type - 26,717 (b)(3) IContractorNendor Labor Category - 26.717(b)(3) IMaintenance (Craft) Refusal* 26.717(b)(7) & 26.75 ~ Was this collection refused (Yes I No)? ~ Test Results 26.717(b)(4) Test Type(s) for Result(s) Reported Alcohol Testing IDrug and Alcohol IBreath Was this collection observed (Yes! No)? - 26.717(b)(7) & 26.1 

                                                                          '------'

Substance - 26.717(b)(2) & (b)(4) Additional Substance (as appffcable) Additional Substance (as applicable) IAlcohol IPlease Select Use NRC Cutoff (Yes I No)Ic.:Y-,e",s_ _- , Use NRC """oftIY,,. I. ' - " " " " ' -_ _.J Use NRC Cutoff (Yes I No)Ic.:Y.=e""s_ _- , Is tills a 24-Hour Reporting Even' (Yes/No)? - 26.719(b) Subversion Attempts .' 26,717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions 26.717(b)(8) Reasan(s) for the Action (select all that apply): 

 &EJ MRO Confirmation          I8l First drug or alcohol positive         o    ResignationtWithdrawal o    Subversion                                                          o    Subsequent positive test result from testing o     Misuse                  0   Violation of 5-hour abstinence rule    o    Other:

o Sale, Use or Possession in PA Person(s} Responsible for !nformation Provided Person 1 (required): dwilso3@entergy.com Email Address Email Address Fin'al :Step O<.'lu!I'ed)- NRC wi!! consider this form an official submission only when the "Validate & Lock" button has been selected and all errors hig,hlighled irHed) have been corrected. The "Validate & Lock" button will change to "locked" after the data validation process has been RIl"Ce,,,I.Jliv amithe !clrm is ready for submission" 

         \&        I I U.S. NRC                                                                                 I'"",. ""X l'r"pl. ,,,,,I,j,,                "I! '''1, "'

( '-...l Electronic Information , ..... Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal Note: Unique Reference Number (Licensee Supplied) IL.P_N_P_-_20_11_-D_l_3 ---' 1) All fields are required except those marked 'optional'.

2) Entries in some form fields may result in information

.0 Submission Update

  • check this box only if this is an update to a previous submission, in being a(Jto~popufatedinto other form fields .

which case you must use the same Unique Reference Number. 3} Use Adobe Reeder 8 or later for this form to work properly. Select Facility Ipilgrim [50-293J Dale of Collection (mmidd/yyyy) 104/11/20 11 Reason for Testing - 26.717(b)(5) Pre-Access Testing Reason (optional) Ipre-Access Iinitial Authorization Employment Type* 26.717(b)(3) IcontractorNendor Labor Category- 26.717(b)(3) IMaintenance (Craft) Refusal- 26.717(b)(7) & 26.75 r.:::--I Was this collection refused (Yes I No)? ~ Test Results - 26.717(b)(4) Test Validity Ivalid Test Type(s) for Resu~(s) Reported rAJc_O_ho_I_T_e_Sti_*ng..:... _ Drug Testing IDrug and Alcohol IBreath lurine 

                                                                '----;::::===::;-----'

Was this collection observed (Yes! No)?

  • 26.717(b)(7) & 26.1 I:..N_o _

Substance - 26.717(b)(2) & (b)(4) Additional SubsUtnce (as applicable) Additional Substance (as applicable) IMorphine IP_I:..e:..as:..e:..S:..e:..le_c_t -' IPlease Select Use NRC Cutoff (Yes I No)"IY..::e:,::s,-_.....J Use NRC Cutoff (Yes I No)...,IY..::e"'s_ _--' Use NRC Cutoff (Yes I NO)!...,Y..::e"'s_ _--' Is this a 24*Hour Reporting Event (Yes/No)? - 26.719(b) IN_o_ _....J Subversion Attempts* 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions* 26.717(b)(8) Individual Sanction 13- Year Denial Reason(s) for Ihe Action (select all that apply): 

  !8i   MRO Confirmation        gj First drug or alcohol positive                       o        ResignationlWlthdrawal o    Subversion                                                                       o       Subsequent positive test result from testing o     Misuse                  0  Violation of 5--hour abstinence rule                 o       Other:

o Sale. Use or Possession in PA Person(s) Responsible for Information Provided Pel"ion 1 (required): IDW<NE II_Wl_L_S_O_N_....,,=== --'IISECURITY COOROINATOR I dwilso3@entergy,com First Name Last Name Position Title Email Address PeBon 2 (optional): I----F"'i::rs:;-t.. N-:::am=e----II----iCLa:::s:;-t.. N-:::am=e---....JII-----np-:::OS;;;jtir.io"'n"'T"it"-lec---- Email Address Final Step (Required)* NRC will consider this form an official submission only when the ~Validate & Lock~ button has been selected and all errors (Le., those highlighted in red) halle been corrected. The "Validate & Lock" button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission, Form Locked On:!APr 22, 2Dll alll:04:09 AM I Single Positive Tes! Form vers]on 1.224 

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fllI,f, Prop/I ,,"'/ ,h,," '11''1110 I ~ Electronic Inforrr,~ti6~Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal ('jPJfJ: Unique Reference Number (Licensee Supplied) 1) AU fj~lds are required e-xcept those marked Entries in some form fields Submission Update check this box only if this Is an update to a previous submission, in which case you must use the same Unique Reference Number. Use Adobe Reader 8 Of Jater for this form fo work properly. Select Date of Collection (mmiddlyyyy)I04/11/2011 Reason for Employment Type - 26,717(b)(3) IContractorNendor Labor Category - 26J17(b)(3) IMaintenance (Craft) Refusal* 26.717(b)(7) & 26.75 Was this collection refused (Yes I No)? Test Results - 26.717(b)(4) Test Type(s) for Result(s) Reported Drug Testing IDrug and Alcohol lurine Substance - 26.717(b)(2) & (b)(4) Additional Substance (as applicable.) Additional Substance (as applicable) IMarijuana Iplease Select IPlease Select Use NRC Cutoff (Yes / NO)lIY"e"'s'--_ _ Use NRC Cutoff (Yes I NO)LIY"'e"'sc......_----' Use NRC Cutoff(Yes/ _"'-"'--_ _-' Is tllis a 24-llo"r ReportIng Event iYes/No)? - 26.719(b) INO 

                                                                  '-------'

Subversion Altempls 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Manageme'" Actions 26.717(b)(6) Reason(s) for the Action (select all that apply): 

!2l   MRO Confirmation        !8l First drug or alcohol positive         0  ResignationlWithdrawal o    Subversion                                                          0  Subsequent positive test result from testing D     Misuse                  0   Violation of 5~hour abstinence rule    0  Other:

o Sale, Use or Possession in PA Person(s} Responsible far Information Provided Person 1 (required): IISECURITY COORDINATOR dwilso3@entergy.com L.---7'i:===-----J '------r-La"'s""t"N"'a=m:::e---- Position Title Email Address Email Address lDLDcaI PC J L~ ~] 1-:224 

        ~         I lJ.S. N ){ ~                                                                             I'rut" t"'g 17,,/,1C' ."u/               ,I"~ I." """.", J:t I

( "'-...l Electronic Information Exchange ~, NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal 1Y2.m: Unique Reference Number (Ucensee Supplied) I'-P_N_P_-2_0_1_1_-D_l_5 _ 1) All fields ere required except those marked 'optional'.

2) Entries in some form fields may resu/r in information Submission Update - check this box only if this is an update to a previous submission, in being auto-populated into other form fields, O which case you must use the same Unique Reference Number. 3) Use Adobe Reader 8 or loter for this form to work properly, Select Fadlity IPilgrim [50-293J Date of Collection (mmlddiyyyy) 105/27/2011 Resson for Testing - 26.717(b)(5) For Cause Testing Reason (optional) Please elaborate (optional)

IFor Cause IObserved Behavior Individual did not 100k right". Comptained of being iQ Employment Type - 26.717(b)(3) ILicensee Employee Labor Category - 26.717{b){3) ISecurity Refusa/-26.717(b)(7) &26.75 ~ Was this collection refused (Yes I No)? ~ Test Resuffs* 26.717(b){4) Test Validity IValid Test Type(s) for Result(s) Reported Alcohol Testing Drug Testing IDrug and Alcohol IBreath lurine Was this collection observed (Yes / No)? - 26.717(b)(7) 8. 26.1 '-IN_O_ _--' Substance - 26.717{b)(2) 8. (b)(4) Additlonsl Substance (as applicable) Additional Substance (as applicable) IAlcohol IPlease Select ,Please Select Use NRC Cutoff (Yes I No) "'!v"e"'s_ _--' Use NRC Cutoff (Yes I NO)"'!V"e"'s_ _--' Use NRC Cutoff (Yes i NO)'V"es_ _--' fs this a 24-Hour Reporting Event {Yes/No}? - 26.719(b) IN_o__--' Subversion Attempts - 26.717{b){7) and 26.75{b) If this result relates to a subversion attempt, select one or more of the foJlowing choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions - 26.717(b)(8) Individual Sanction 114- Day Denial Reason{s) for the Action (select all that apply): o MRO Confirmation li!1 First drug or alcohol positive o Resignationl\Nithdrawal o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of s..hour abstinence rule o Other. o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): Irnanne Ilwd,on IISecurity Coordinato' I dwdso3@enter9y*com 

 -----;F"'i::rs"t"N=am=e-----J '----TLa"'s"'t"N;:;a;;m;;;e-----' '----,P"-o::s"'iti=on"'Ti"'tle=-----' -----...,E=-m-a~il,.,A,.,d"d,.,re-s-s-----1 Pef$(}n 2 (optional):

1---",==-------"11-----;-;==-------"1I--==-_ First Name Last Name Position Title Email Address Final Step (Required) ~ NRC will consider this form an official submission only when the "Validate & Lock~ button has been selected and all errors (i.e., those n highlighted in red) have been corrected. The ~Validate & Lock button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission. Form Locked On: IJun 23. 2011 at 3: 10:20 PM 

     -.\ISP      I u.s. N Il. C                                                                            1'1lI1"I:I'X Ih."I*.11,,1,1*,1 'I'I'.,*n",u'
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( "'-...J Electronic Inform~iqn Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal l!Lo.te: Unique Reference Number (Ueensee Supplied) IPNP-201 H116 1) All fields are required eKcept those mar~ed 'optiona/'. 

                                                         ------------                                          2) Entries in same form fields may result in information Submission Update
  • check this box only if this is an update to a previous submission, in being auto-populated into other form fields.

O which case you must use the same Unique Reference Number. 3) Use Adobe Reader 8 or later for this form to work properly. Select Facility !Pilgrim [50-293J Date of Collection (mmiddlyyyy) 106/14/2011 Reason for Testing - 26,717(b)(5) IRandom Employment Type. 26.717(b)(3) ILicensee Employee Labor Category - 26.717(b)(3) INon-Licensed Operator Refusal* 26.717(b)(7) & 26.75 ~ Was this cellection refused (Yes J No)? ~ Test Results* 26.717(b)(4) TestVatidily Ivalid Test Type(s) for Result(s) Reported Alcohol Testing Drug Testing IDrUg and Alcohol IBreath IUrine Was this collection observed (Yes / No)? - 26.717(b)(7) & 26.1 I_N_o _ Substance* 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) I Alcohol IPlease Select IPlease Select Use NRC Cutoff (Yes I No) ... IY:..:e:.:s_ _--' Use NRC Cutoff (Yes I No) l-'IY"e",s_ _- , Use NRC Cutoff (Yes I No) I...,Y-,:e",s_ _- J Is this a 24*Hour Reporting Event (YeslNo)?* 26.719(b) IN_O_ _--' Subversion Attempts* 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable. If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions* 26.717(b)(8) Indi....idual Sanction 114- Day Denial Reason(s) for the Action (select all that apply): o MRO Confinnation I8l First drug or alcehol positive o ResignationI'Mthdrawal o Subversion o SUbsequent positive test result from testing o Misuse 0 Violation of ~hour abstinence rule o Other: o Sale. Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (requIred): I'----Diann*~~llvwson II Seou';ly Coordinato. I dwilso3@entergy.com First Name Last Name Position Title Email Address Pel1>on 2 (optional): 1----;F"'i;:rsTI"N:::am:::e=----.JII----Lo:a::sTt"N:::am:::e=----..JII---....-,;p::-OS:citi"-.o::nC"TCOit"-leC---- EmaIl Address Final Step (Required) - NRC will consider this form an official submission only When the ~Validate & Lock" button has been selected and all errors (i.e., those n highlighted in red) have been corrected. The ~Validate & Lock button will change to "Locked" after the data validation process has been successfully completed and the form is ready for submission. Fonn Locked On:IJun 24,2011 at 11:11:28 AM I

_"i) U.S. N ll.C 11" 1/11;< !'t*"pl,* .11,,1 rI*, 11111,,,"'11.111 I . ( '-........J Electronic Inform,~tiQ,t:1 Exchange NRC FFD Program Performance Data Reporting System Single Positive Test Form for the EIE General Submission Portal NJ:lte~' Unique Reference Number (Licensee Supplied) L.- -' 1) All fields $re required exce-pt those marked 'optional', Entries in some form fields information Submission Update check this box only if this is an update to a previous submission, in being.wto-I'OF,ul/,te,' i,'Jooth,erlorm fields. D which case you must use the same Unique Reference NumbeL 

                              ¥ S)       Adobe Render 8 or !ater for this form to work properly, Date of Collection (mlnld,dlyyy;') ~'!!..l2:~':":'_J Refusal- 26.717(b)(7) & 26.75                       ~

Was this collection refused (Yes I No)? ~ rest Results - 26.717(b)(4) Test Validity Ivalid Test Type(s) for Result(s) Reported Alcohol Testing Drug Testing I Drug and Alcohol IBreath IUrine Was this collection observed (Yes I No)? - 26. 717(b)(7) & 26.1 LIN_o_ _--' Substance* 26.717(b)(2) & (b)(4) Additional Substance (as applicable) Additional Substance (as applicable) IPlease Select Use NRC Cutoff (Yes I No)IL;Y~e",s_ _--, Use NRC Cutoff (Yes I NO)L;IY~e",s_ _--, Use NRC Cutoff (Yes I NO)L;IY~e",s_ _--, Is this a 24-Hour Reporting Event (YeS/No)? - 26.719(b) IN_O _ Subversion Attempts* 26.717(b)(7) and 26.75(b) If this result relates to a subversion attempt, select one or more of the following choices as applicable, If not a subversion attempt, do not select any of the four boxes. Physical Evidence Observed Actions/Behaviors o 0 Refusal to Cooperate Other o 0 Management Actions* 26.717(b)(8) Individual Reason(s) for the Action (select all that apply): o MRO Confirmation 121 First drug or alcohol positive o ResignationlWithdrawal o Subversion o Subsequent positive test result from testing o Misuse 0 Violation of 5-hour abstinence rule o Other: o Sale, Use or Possession in PA Person(s) Responsible for Information Provided Person 1 (required): dwilso3@enter9y*com Email Address Email Address

Fatigue Rule Waivers Issued for 2011 Facility: Pilgrim Nuclear Power Station Period of Report: 1/112011 -12/31/2011 Facility Outage During Report Period: Yes 

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Online Outage Online Outaae Online Outaae Online o 0 1 0 0 0 0 2 0 0 0 0 0 0 o 1 1 0 0 0 0 

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Online Online Outaoe Online Outaae 10h between work periods I 0 0 0 0 0 3~h. in. an Y9-da s_ 0 r . y I 01 - I --:- I - I, J - I I - I 2 L-Q0 .. iF- 0 0 

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. Mimmlln DaVI Qff - f\tnt= 1 MOO Iwk; 8h shift 2 MOO Iwk; 10h shift 2 MOO Iwk; 12 hr shift 2.5 MOO Iwk; 12 hr shift 3 MOO Iwk; 12 hr shift Minimum Days 00'- Ol,.!tage:. 1 MOO / 7 days (rolling) 3 MOO / 15 day period 4 MOO / 15 day period NUMBER OF WAIVERS PER INDIVIDUAL EMPLOYEE cC) NUMBER OF WAIVERS OPERATIONS MAINTENANCE SECURITY HP/RAOPRO CHEMISTRY FIRE BRIGADE (B) 1 4 46 5 2 0 0 2 0 12 0 0 0 0 3 0 5 0 0 0 0 4 0 0 0 0 0 0 5 0 0 0 0 0 0 6 0 0 0 0 0 0 

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Highest number of waivers for 1 3 1 1 0 0 an individual employee}}

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