ML20057C826
| ML20057C826 | |
| Person / Time | |
|---|---|
| Site: | Palisades  |
| Issue date: | 02/24/2020 |
| From: | Summers S Entergy Nuclear Operations |
| To: | Office of Nuclear Security and Incident Response |
| Shared Package | |
| ML20057C816 | List: |
| References | |
| PAL-2019-06 | |
| Download: ML20057C826 (1) | |
Text
~ 1 LJS N f> (~ ' FFD Prog ram Performance Data Report ng System
"--' *'- * ~ - - NRC Forr1 890 S ngl c Pos '1ve Test Fo r*11
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- 1) All fields required except thou marked 'optionar APPROVED BY 0MB: CLEARANCE NO. 31S0-0148 EXPIRES: 04/30/2021
- 1) Entries In some fields auto-populate Information in other fields Estimated burden per response to compfy with thi& colection request is 30 rrinutes . TM JJ Mouse over form fields to view additional Information form II a voluntary means ofreporting the information required under 10 CFR 26.417(b)(2)
.fJ Use of Adobe RHdtr 8 or later Is required and 26 .717. The Information iuequired by NRC to obtain on an annual basis site specific fitness-for-duty (FFD) prog,am pertormance data on drug and alcohol p,og,ams from licensees and othe, entities. Send comments rega,ding butden estimate to the FOIA, Submission D Update Privacy and Information Collection Bfanch (TS.-F53), US Nuclear Regulatory ComlRssion ,
Washington oc 20555.0001. or by e-mail to lnfocoJlrai:t$ Rcsouruu@tfflC goi , and to lhe Desk Officer, Office of lnfo,mation and Regulatory Affairs , NEOB -1020, (3150 -0146). Office Uni ue Reference ID Licensee Su lied of Management and Budget, Washington DC 20503. If a means used to irl'4)ose PAL-2019-06 information conection does not display a currently vatid 0MB control number, lhe NRC may not conduct or sponso, . and a person is not required to ,espond to , lhe information Facility collection jPai sades [50-255] Date of Collection (mmldd/yyyy)
I 0412212019 I.
Reason for Testing - 26.717(b)(5) Pre-Access Testing Reason (optional) Please elaborate (optional)
IPre-Access jReinstatement (Between 31 and 365 days) Day and Z1mme1man.Craft Employment Type - 26.717(b)(3) Outage Worker (optional)?
lcontractorNendor jNo Labor Category
- 26 717(b)(3) Please elaborate on the Labor Category selected
!Other Ironworker Is this a 24-hour reportable event under 26.719(b)? ~
Was this collection refused? . 26.717(b)(7) & 26 75 ~
Subversion Attempt
- Did this collect1on involve a subversion attempt? - 26 717(bK7) and 26.75(b) LI_ _ v_e_s_ _ ~
D Did not appear for testing D Specimen characteristics (e g , color, odor. proopitant) Please elaborate on the cholcetsl selected.
D Shy-bladder (no medical condotion) 0 Invalid test result (initial specimen collected)
- 26 18S(n Specimen presented to collector had a temp out of range lndiVldual refused to submit to second tesl unde, direct D Refused to provide initial specimen D Refused to follow dlrecbons observation 181 Refused to provide second specimen D Donor admitted to subversion attempt 181 Specimen temperature (out of range) OOther D Specimen paraphernalia identified Management Actions . 26.717(b)(8) & 26 75 Reason tor the Action lsubversion attempt Sancbon Applied (NRG Minimum or Licensee Administrated)
INRC Minimum Specific Sanction Appl,ed
'Permanent Oe 111al Person(s) Responsible for Information Provided Pe,son 1 (1equired);
ILs_c*_*_ _ ~~=-----1 F(rst Name lsummers
~ --
IIAAIFFO Supervisor
-.La-s~t~N~a-m_e_ _ _ _ ~----,P"'o"'s7rtic:-o=-n"'ns.
I ssumme1@entergy.com 1U"'e---~ -----=c-om-pa-n-y""E,_m-a""il~A~dd,..,...re_s_s_ __
Pe,son 2 (optional):
~=~11~~==,----~II~ First Name Last Name
..=~~
Position Title
- ~ =Company ==- r=-=---
Email Address Final Step (Requfred)
- NRC wi11 consider lhis form authentic in accordance wilh 10 CFR 26. 11 onty when lhe "Va6date & Lock" button Is clicked and all errors (highlighted In 1ed) 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 .
Form Locked On:!Feb 24, 2020 at 4.14:19 PM j Save to Local PC 11 Print this Report j Single Positive Test Fann (version 1.8.0 - April 2018) NRC Fann 890 (12/2014)