ML20063J232

Single Positive Test Form Collected on 09/18/2019

ML20063J232
Person / Time
Site:	Wolf Creek
Issue date:	02/13/2020
From:	Black P Wolf Creek
To:	Office of Nuclear Reactor Regulation, Office of Nuclear Security and Incident Response
Shared Package
ML20063J382	List: ML20063J228 ML20063J232 ML20063J234 ML20063J237 ML20063J240 ML20063J247 ML20063J252 ML20063J265 ML20063J273
References
D1-19, RA 20-0016
Download: ML20063J232 (1)

Text

\

• U.S.NRC I

F F D Program Periorman c e Data Reporting System NR C Fo,111 800 S111 11'" Pos1t1v0 Test f-01111 I' ,111.., l',,1*/, 1111/1/,, 1,,,,,,,,,,1

1) All fl.,d* required axcept those marl<ad 'optional' APPROVED BY 0MB : CLEARANCE NO. 3150.41 .. EXPIRES: 04/30/2021

2) Entries In aome fields auto-populate lnformatlon In other tfelds Estimated burden per responH to comply with thil collection requnt la 30 mtnutN. Thi*

3) Mouse over form fields to view *ddltional Information form is a voluntary means of repcring lie Information required under 10 CFR 2e .417(b)(2)

4) Use of AdotJ. RNder I or later Is required and 26 .717 . The information ii re(IUWed by NRC to obtain on an annual bnia site speciflc fitness-for-duty (FFD) program performance data on mug and alcohol progranw from D Submission Update o~..:.~.. k>n licensees and other entitles. Send comments regarclng burden estimate to the FOIA.

Privacy and Information Coltectton Branch {T'5-F53), U.S. Nuclear Regulatory Commission, Waahlngton DC 2055S-0001, or by e-mail to lnfocoHects Ruourg@ NRC gqy and to the Desk Officer, Office of lnforma11on and Regulatory Affairs, NEOB-1020, (3150..01 48), Office Unlg_ue Reference ID (l.icenlN Suaolledl of Management and Budget, Wuhlnglon DC 20503. If

• means used to lmpoee jc1-1e I information collection does not <bplay a curren1ty Vlllld 0MB oontrol oomber, ... NRC may not concb:t or aponaor, and a person la not recpred to respond to, the information collection.

Facility 1- CIWlk [5CM82]

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

I OW 8/20l&

1 I

Reason for Testing - 2e.717(b)(5) Pre-Access Telling Reason (optional) Please elaborate (optional) ll're-Acceu I llritial Authorization I

Employment Type - 26.717(b)(3) jca-....v.NIDr I Outage Worker (optional) 7 jves I I I Labor Category - 26. 717(b)(3)

IMallllll*ICI (gennl Idly) I Is this* 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)

Tut Type(s) for Resutt(I) Reporled

• 26. 717(b)(2) Crug Specimen T -

1Drug0ny I ju~ne I TNIValldity jvaiid I

Was this collect/on observed? - 26.717(b)(7) & 26.75 ~

How many substances were confirmed positive for this indlvldulll? I 1 I

UseNRC Initial Confirmatory Limit of Substance - 26. 717(b)(2) & (b)(6)

Cutoffs? Cutoff Cutoff Celectlon IMarijuana I I~

Subversion Attempt

• Cid this collection involve a subversion attempt?* 26.717(b)(7) and 26. 75(b) j No I

Management Actions - 26.717(b)(8) & 26.75 RNIOll for the Action jFrrst drug or alcohol positive I

Sanction Applied

!NRC Minlmirn o r ~ Admlni1tral9d)

INRCMirnum I

Specitlc Sanction Applied 114- cay Denial I

Person(*) Responsible for Information Provided Person 1 (required):

IPAMELA FirltName IIBLACK l.iitN-IFSPECWJBT Paihion tlai I

PABLACK@\NCNOC.COM Company Email Address P.,.on 2 (opllonlll):

1~A FliiiN-IIJONES LiiiN-I18UPERVISORACCESS SCREENING I SOJONESO\NCNOC.COM PoilBon tllli Company Email Address Fln* IStep(Requ/rwd) - NRC wllcon-lhlolom,ou'*111cinoccordonoe-10CfR21!.11only-lle'\l-&Lod<"-lo-...ondal.,...~inted)hove been corrected . The "Validate & Loci( button wtl changa to *Locked" after the data valldation procen ha been succeafully comp4eted Indicating the form la rndy for IUbmiuion.

- Form Locked On:!Feb 13. 2020 at 5:58:57 PM I I Save to Loc:al PC 11 Print 1111a Report I Single Positive TNI Form (version 1.8.0- April 2018) NRC Form 890 (12/2014)