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Category:License-Fitness for Duty (FFD) Performance Report
MONTHYEARML23072A3652023-03-13013 March 2023 Annual Report Form for Drug and Alcohol Tests for 2022 ML23059A4702023-02-28028 February 2023 Annual Fitness for Duty Program Performance Report, and Annual Fatigue Report for 2022 ML22335A4462022-12-0101 December 2022 Annual Fatigue Report Form for 2021 - Supplemental Information ML22335A4422022-12-0101 December 2022 Annual Fatigue Report Form for 2020 ML22335A4452022-12-0101 December 2022 Annual Fatigue Report Form for 2021 ML22335A4432022-12-0101 December 2022 Annual Fatigue Report Form for 2020 - Supplemental Information ML22152A2132022-06-0101 June 2022 Single Positive Test Form Collected on 03/12/2021 ML22053A0822022-02-21021 February 2022 Electronic Submittal of Annual Fitness for Duty Program Performance Report and Annual Fatigue Report for 2021 ML22047A2022022-02-16016 February 2022 Annual Report Form for Drug and Alcohol Tests for 2021 - Attachment ML22047A2072022-02-16016 February 2022 Single Positive Test Form Collected on 03/17/2021 ML22047A2112022-02-16016 February 2022 Single Positive Test Form Collected on 03/11/2021 ML22047A2172022-02-16016 February 2022 Annual Fatigue Report Form for 2021 ML22047A2132022-02-16016 February 2022 Single Positive Test Form Collected on 09/27/2021 ML22047A2042022-02-16016 February 2022 Single Positive Test Form Collected on 04/28/2021 ML22047A2052022-02-16016 February 2022 Single Positive Test Form Collected on 11/29/2021 ML22047A2012022-02-16016 February 2022 Annual Report Form for Drug and Alcohol Tests for 2021 ML22047A2162022-02-16016 February 2022 Single Positive Test Form Collected on 04/19/2021 ML22047A2082022-02-16016 February 2022 Single Positive Test Form Collected on 01/25/2021 ML22047A2062022-02-16016 February 2022 Single Positive Test Form Collected on 11/29/2021 ML22047A2122022-02-16016 February 2022 Single Positive Test Form Collected on 03/12/2021 ML22047A2182022-02-16016 February 2022 Annual Fatigue Report Form for 2021 - Attachment ML22047A2032022-02-16016 February 2022 Single Positive Test Form Collected on 11/10/2021 ML22047A2142022-02-16016 February 2022 Single Positive Test Form Collected on 03/10/2021 ML22047A2092022-02-16016 February 2022 Single Positive Test Form Collected on 04/05/2021 ML22047A2152022-02-16016 February 2022 Single Positive Test Form Collected on 03/03/2021 ML21056A4572021-02-25025 February 2021 Annual Fatigue Report Form for 2020 ML21056A4592021-02-25025 February 2021 Single Positive Test Form Collected on 09/14/2020 ML21056A4582021-02-25025 February 2021 Annual Report Form for Drug and Alcohol Tests for 2020 ML21056A4602021-02-25025 February 2021 Single Positive Test Form Collected on 06/23/2020 ML21056A4612021-02-25025 February 2021 Single Positive Test Form Collected on 12/18/2019 ML21056A4622021-02-25025 February 2021 Single Positive Test Form Collected on 07/27/2020 ML21056A5602021-02-25025 February 2021 Submittal of Fitness for Duty Program and Fatigue Report for 2020 ML20058H0962020-02-27027 February 2020 Single Positive Test Form Collected on 09/18/2019 ML20058H0832020-02-27027 February 2020 Annual Report Form for Drug and Alcohol Tests for 2019 ML20063J2372020-02-27027 February 2020 Electronic Submittal of Annual Fitness for Duty Program Performance Report and Annual Fatigue Report for 2019 ML20058H0912020-02-27027 February 2020 Single Positive Test Form Collected on 09/23/2019 ML20058H0872020-02-27027 February 2020 Single Positive Test Form Collected on 09/26/2019 ML20058H0992020-02-27027 February 2020 Single Positive Test Form Collected on 10/28/2019 ML20058H1012020-02-27027 February 2020 Annual Fatigue Report Form for 2019 ML20058H0892020-02-27027 February 2020 Single Positive Test Form Collected on 09/18/2019 ML20058H0942020-02-27027 February 2020 Single Positive Test Form Collected on 12/16/2019 ML20063J2342020-02-24024 February 2020 Annual Report Form for Drug and Alcohol Tests for 2019 ML20063J2472020-02-18018 February 2020 Single Positive Test Form Collected on 12/16/2019 ML20063J2522020-02-18018 February 2020 Annual Fatigue Form for 2019 ML20063J2732020-02-13013 February 2020 Single Positive Test Form Collected on 09/26/2019 ML20063J2402020-02-13013 February 2020 Single Positive Test Form Collected on 10/28/2019 ML20063J2322020-02-13013 February 2020 Single Positive Test Form Collected on 09/18/2019 ML20063J2282020-02-13013 February 2020 Single Positive Test Form Collected on 09/18/2019 ML20063J2652020-02-13013 February 2020 Single Positive Test Form Collected on 09/23/2019 ML19064A3642019-03-0505 March 2019 Single Positive Test Form Collected on 12/10/2018 2023-03-13
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- U.S.NRC FFO Prog ram Performance Data Reporting System NRC Form 800 S11191e Posrtrve Test r'o T I '"'~ !' , t*I, ,011/ 1h, I 11, 11, 1!11' ,
- 1) All fields required except those marked 'optional' APPROVED BY 0 MB: CLEARANCE NO. 3150.014' EXPIRES: 04/3012021
- 2) EntrlH In some fields *uto-popula,. Information In othff' fields Estimated burden per responae to compty wtth thil collection ~ 18 30 mlnutee. This
- 3) MouH ovw fonn fields to view additional Information form is a voluntary means of reporting the i"lfonnation ~ e d under 10 CFR 26.417(b)(2)
- 4) Use of A doh R..der I or leter I* Aqulred and 26 .717. The information ti fltqlked by NRC to obta6n on an annual basis site specific fitness-for-duty (FFO) program perlormanc. data on drug and alcohol programs from D Submiuion Update o:~~~ssion licensees and oCher enttlfee. Send commentl regarclna burden Ntlmate to fie FotA, Privacy and lnfonnation Conection Brandl (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-()()()1, or by *maU to lnfocollects Resource@NRC aov. and to the Desk Officer, Office of Information and Regulatory Affairs . NEOB* 1020, (3150.0146), Office Unlg_ue Reference ID (UcensN SullPl*ll of Management and Budget, Wahington OC 20503. If
- mean* UHd to Impose jo2-1&
I information collectton don not display a currentty valid 0MB control number, the NRC may not conduct or sponsor, and
- peraon la not req..ilred 1D relPC)l'ld to, the information collection .
Fsclllty 1-c... [50-482]
I Date of Collection (mm/ddlyyyy)
I 09/23/20 19 I Reason for Test/ng - 29.717(b)(5) f'n>.Access Testing Reason (optional) Please elaborate (optional)
,~....
1--
Employment Type - 26.717(b)(3)
Labor Category - 26.717(b)(3)
I I
llnltialAulhorization Outage Worker (options/) 7 IY* I I
I I IMalnllraa<~io I Is this a 24-hour reportable event under 26.719(b)7 ~
Was this collect/on refused? - 26.717(b)(7) & 26.75 ~
Test Results - 26.717(b)(4)
Test Type(*) for Reault(a) Reported
- 26.717(b)(2) Drug Spedmen T -
1Drug0nly I junna I Test Validlly jvai<t I Was this collect/on observed? - 26.717(b)(7) & 26.75 ~
How many substances ware confinned positive for this individual? I I
,~
1 UseNRC lnttial Confirmatory Umltof Substance - 26.717(b)(2) & (b)(6)
Cllloffs? Cutoff Cutoff Detection IAmphetamine I
Subversion Attempt - Did this collection Involve a subversion attempt?* 26.717(b)(7) and 26.75(b) I No I
Management Act/ons -26.717(b)(8) & 26.75 Reaaon for the Action jForst drug or alcohol positive I Sanction Applied (NRC Minimlffl or lJcensM Adminiltnmd)
INRCMirimum I
Specltlc Sanction ~ed 114- Day Danlaf I
Person(s) Responsible for Information Provided Person 1 {requ ired):
IPAMELA IIBlACK I!ACCESS BPECIAUST I PABUICKIIIIWCNOC.COM FlratNalna LiitName Poiiilon Title Company Email Address Penon 2 (optionol):
lac>>IYA II- ,,SUPERVISOR ACCESS SCREENING I SOJONESCIIWCNOC.COM Flri!Name l.iitName Poilaon tffli Company Ematl Address Final Step (Required)* NRC wlU conaldar thla fonn authentic In accordance Vtfltl 10 CFR 28.11 only \Wien the -Validate & Lock* button II clicked and all .,.ora (hlghUghted In red) have been corrected . The "Validate & Lock" button v114111 change to *Locked" der the data validation procea hH been aucceafully completed indicating the form la ready for aubmlHion.
- Fonn Locked On:!Feb 13, 2020 at8:04:35 PM I I Save ID Local PC 11 Print this Report I Single Positive Teet Fonn (version 1.8.0 - April 2018) NRC Fonn 890 (12/2014)