ML20057C818
| ML20057C818 | |
| 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-2019-02 | |
| Download: ML20057C818 (1) | |
Text
~' ! lJ S N p ( ' ' FFD Prog ram Performance Data Repori *t'g System
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~ _, NRC For*n 890 S1'lg e Pos '1ve Tesr For "'
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- 1) All fittlds required except those marlced *optionar APPROVED BY 0MB: CLEARANCE NO. 3150-014' EXPIRES: 04/30/2021
- 2) Entries In some fields auto-populate lnfonnation in other fields Eslimated burden per response to compty 'Mth this colection request is 30 ninutes. This JJ Mouse over form fields to view additional Information form Is a votunta,y means oheporting the informalion required under 10 CFR 2fi .417(b)(2) 4} Use of Adobe Ruder a or later l s requfred and 26.717 The information is required by NRC to obtain on an annual basis site specific fitness-for-duly (FFO) program performance data on drug and alcohol programs from licensees and other entities Send comments regarding burden estimate lo the FOIA Submission D Update Privacy and Information Collection Bfanch (T5-F53). U.S . Nuclear Regulatory Comrrission ,
Washington DC 20555-0001, or by e-mail to ~ Rs&9:urcc@NRC goy and to the Desk Officer, Office of Information and Regulatory Affairs. NEOB-1020. (31SO-OU6). Office Uni ue Reference ID Licensee Su lied of Management and Budget, Washington DC 20503 If a means used to impose PAL-2019-02 infonnation collection does not d"isplay a currently va6d 0MB control number. the NRC may not conduct or sponsor , and a perun is not reqwred to respond to , the infonnation collection Facility
!Palisades (50-255} Date of Collect/on (mm/ddlyyyy)
I.
02 /06/20 19 j Reason for Testing
- 26. 717(b)(5) Pre-Access Testing Reason (optional) Please elaborate (optional)
IPr~Access j1nitial Authorization ENTERGY NEW HIRE FOR SECURITY.
Employment Type 717(b)(3) Outage Worker (optional)?
ILicensee Employee jNo Labor Category - 26.717(b)(3)
!security Is this a 24-hour reportable event unoor 26.719(b)? ~
Was this collection refused? - 26.717(b)(7) & 26 75 ~
Test Results
- 26 717(b)(4)
Test Type(s) for Result(s) Reported - 26.717(b)(2)
!Alcohol Only Substance
- 26.717(b)(2) & (b)(6)
Alcohol Specimen Tested
!Breath
'Mtat 26.103 BAC level was exceeded?
jo.04 or greater Subversion Attempt- Oid th,s co\lect,on involve a subversion attempt? - 26.717(b)(7) and 26.75(b) l~__ N_o
_ _ ~
Management Actions - 26.717(b)(8) & 26.75 Reason fo, the Action I First drug o, alcohol posftive Sanction Applied (NRC Minimum o, Licensee Administrated) lucensee Administrated Specific Sanction Applied j1- Year Denial Person(s) Responsible for Information Provided Person 1 (required):
Lls_co_n_ _ ~~-:7'------'l First Name lsummers IIAA/FFO SupeMSor
~---,L=as"'t7N"a"'m"e_ _ ___, ~--~P~o-s~iti~ on~TI~tl-e---~
I ssumme1@enlergy.com Company Ema1I Address Person 2 (optional) :
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Firs, Name Last Name Position Title Company Email Address Final Step (Required)* NRC will consider lhis form authentic in accordancewilh 10 CFR 26.11 only when lhe Vatidate & Lock* button is clicked and all errors (highlighted in red) have been corrected. The Vahdate & Lock* button will change to *Locked* after the data validation process has been successfully com~eted Indicating the form is ready for submission Form Locked an,!Feb 24. 2020 at 3:34:44 PM I Save to Local PC 11 Print this Report I Smgle Pos1bve Test Fann (version 1 8.0 -April 2018) NRC Fann 890 (12/2014)