ML21056A560

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Submittal of Fitness for Duty Program and Fatigue Report for 2020
ML21056A560
Person / Time
Site: Wolf Creek Wolf Creek Nuclear Operating Corporation icon.png
Issue date: 02/25/2021
From: Benham R
Wolf Creek
To:
Document Control Desk, Office of Nuclear Reactor Regulation, Office of Nuclear Security and Incident Response
References
RA 21-0018
Download: ML21056A560 (9)
v • d • e


Text

P.O. Box 411 l Burlington, KS 66839 l 620-364-8831 Ron Benham Director Nuclear Regulatory Affairs February 25, 2021 RA 21-0018 U.S. Nuclear Regulatory Commission Attn: NRC Document Control Desk Washington, DC 20555-0001

Subject:

Docket No. 50-482: Electronic Submittal of Annual Fitness for Duty Program Performance Report and Annual Fatigue Report for 2020 To Whom It May Concern:

Please be advised that Wolf Creek Nuclear Operating Corporation (WCNOC) submitted the Annual Fitness for Duty (FFD) program performance data and Annual Fatigue Report for 2020 to the Nuclear Regulatory Commission (NRC) FFD Program Performance Data Reporting System through the U.S. NRC Electronic Information Exchange on February 25, 2021. This submittal meets the requirements in 10 CFR 26.203, 10 CFR 26.717 and 10 CFR 26.719. In accordance with 10 CFR 26.11, copies of the reported information are also enclosed with this report for the appropriate regional office and Senior Resident Inspector.

This letter contains no commitments. If you have any questions concerning this matter, please contact me at (620) 364-4204.

Sincerely, Ron Benham RDB/rlt ENCLOSURE: Copies of 2020 FFD and Fatigue Reports CC: N. OKeefe (NRC), w/e S. A. Morris (NRC), w/e Senior Resident Inspector (NRC), w/e S.S. Lee (NRC), w/e

Enclosure to RA 21-0018 P.O. Box 411 l Burlington, KS 66839 l 620-364-8831 Copies of 2020 FFD and Fatigue Reports (This enclosure contains 7 pages in addition to this cover page)

FFD Program Performance Data Reporting System NRC Form 891, Annual Reporting Form for Drug and Alcohol Tests (EIE General Submission Portal)

Tests Conducted in the Calendar Year Reason For Testing Licensee Employees Total Number of Positive, Adulterated, Substituted, and Refusal to Test Results Contractors/Vendors Random Pre-Access For Cause Follow-up Post-Event Total (Calculated)

Total Number of Tests Conducted 74 419 1

1 526 166 1

301 4

0 0

0 129 0

4 1

4 31 Period of Report 2020 Total size of the random testing pool throughout the period (Calculated) 1,039 Average number of contractors/vendors 213 Average number of licensee employees 826

1) All fields required unless marked 'optional'
2) Use of Adobe Reader 8 or later is required
3) Mouse over fields for additional information Annual random testing percentage achieved for the testing pool 52 WARNING: The percentage(%) entered does not equal the ((Total number of RANDOM tests conducted

("Licensee Employees" + "Contractors/Vendors" )] / ["Total size of the random testing pool")) x 100.

Substances Tested Did your program only test for NRC-required substances AND at the NRC-specified minimum cutoff levels? (Yes / No) Yes Substance Use NRC Cutoffs?

Initial Cutoff Confirmatory Cutoff Limit of Detection (LOD) Testing?

Comment (Optional)

Alcohol Yes Not Applicable Cocaine Yes Yes Marijuana Yes Yes Amphetamines Yes Yes Opiates Yes Yes PCP Yes Yes FFD Program Random Testing Population and Rate Facility Wolf Creek [50-482]

Submission Update Does your program conduct LOD testing permitted in 26.163(a)(2)? (Yes / No)

Yes No HHS-Certified Laboratory (Primary)

Clinical Reference Laboratory HHS-Certified Laboratory (Backup)

None Identify your Blind Performance Test Sample supplier(s)

ElSohly Laboratory Laboratory Testing

- Page 1 of 2 -

Does your program use a Licensee Testing Facility?

(Yes / No)

Annual Report Form (version 1.9.0 - January 2020)

Total Number of Dilute Specimens (Special Analyses Testing Conducted) 0 Total Number of "Dilute" Specimen Test Results (Optional)

Special Analyses Testing Results APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 04/30/2021 Estimated burden per response to comply with this collection request is 108 hours0.00125 days <br />0.03 hours <br />1.785714e-4 weeks <br />4.1094e-5 months <br />. This form is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2) and 26.717. The information is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFD) program performance data on drug and alcohol programs from licensees and other entities. Send comments regarding burden estimate to the FOIA, Information Services Branch (T6-A10M), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

NRC Form 891

Save to Local PC Print this Report Final Step (Required) - NRC will consider this form authentic in accordance with 10 CFR 26.11 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.

Locked Form Locked On: Feb 25, 2021 at 11:47:50 AM Topic 1 Description Access Authorization / FFD failed to successfully implement a psychological reassessment and reinvestigation process for Fitness for Duty Program Personnel. (MRO and MRO staff members)

Condition Report #143387 - implemented electronic process within SSIS application to provide 90 day, 60 day, and 30 day notifications for Fitness for Duty Program Personnel.

Summary of Management Actions - 26.717(b)(8)

Topic 1 Other(s)

Add an additional Topic Please elaborate:

Licensee identified NCV - medical review officer (MRO) expired reassessment and reinvestigation dates 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 3 to report any additional topics.

Person(s) Responsible for Information Provided Company Email Address Pam.Black@evergy.com First Name Pamela Position Title Access Specialist Position Title Supervisor Access Screening First Name Sonya Last Name Jones Last Name Black Company Email Address Sonya.Jones@evergy.com Person 1 (required):

Person 2 (optional):

Annual Report Form (version 1.9.0 - January 2020)

- Page 2 of 2 -

Substances Tested - continued NRC Form 891

NRC FFD Program Performance Data Reporting System 10 CFR Part 26, Subpart I - Managing Fatigue (EIE General Submission Portal)

NRC Form 892, Annual Fatigue Reporting Form Period of Report 2020 Summary of Waiver Issuance - 26.203(e)(1)(i-ii)

Exceeded 16 work hrs in any 24 hr period Daily Work Hours 26.205(d)(1)

Number of Waivers Issued Operating or on-site directing of the operations of systems,as described in 26.4(a)(1)

Operating Outage (days 1-60)

Exceeded 26 work hrs in any 48 hr period Exceeded 72 work hrs in any 7 day period Performing health physics or chemistry duties, as described in 26.4(a)(2)

Operating Outage (days 1-60)

Performing duties of a fire brigade member, as described in 26.4(a)(3)

  • Operating Outage (days 1-60)

Performing maintenance or onsite direction of maintenance, as described in 26.4(a)(4)

Operating Outage (days 1-60)

Performing security duties, as described in 26.4(a)(5)

Operating Outage (days 1-60)

Outage Total (days 1-60)

(Calculated)

Combined Total (Calculated)

Less than 10 hr break b/t successive work periods (or 8 hr break accommodating scheduled transition b/t shifts)

Rest Breaks 26.205(d)(2)

Less than 34 hr break in any 9 day period Minimum Days Off Per Shift Cycle 26.205(d)(3)

Average of less than 1 day off per week for 8-hour shifts Average of less than 2 days off per week for 10-hour shifts Average of less than 2.5 days off per week for 12-hour shifts Average of less than 2 days off per week for 12-hour maintenance shifts Average of less than 3 days off per week for 12-hour security shifts Minimum Days Off for Outage Activities (during first 60 days of outage) 26.205(d)(4) and 26.205(d)(5)

Less than 3 days off per successive 15-day period 26.205.(d)(4)

Less than 1 day off per 7-day period for maintenance personnel 26.205.(d)(4)

Less than 4 days off per successive 15-day period for security personnel 26.205.(d)(5)

Total

  • NOTE: For individuals performing fire brigade duties and other duties, please count them only under the fire brigade column. Do not double count these individuals.

1 Number of Waivers 2

3 Operating or on-site directing of the operations of systems, as described in 26.4(a)(1) 4 5

6 7

8 Performing health physics or chemistry duties as described in 26.4(a)(2)

  • NOTE: For individuals performing fire brigade duties and other duties, please count them only under the fire brigade column. Do not double count these individuals.

9 10 11 - 20 More than 20 Total Employees Issued Waivers (Calculated)

Most Waivers Provided to a Single Individual Distribution of Waivers for Individuals in Each Category - 26.203(e)(1)(iii)

Number of Employees Issued Waivers

[Note: Even if no waivers were issued for a given column, please enter a value (e.g., 0) in at least one of the cells in the column]

Performing duties of a fire brigade member as described in 26.4(a)(3)

  • Performing maintenance or onsite directing of maintenance as described in 26.4(a)(4)

Performing security duties as described in 26.4(a)(5)

Summary of Corrective Action - 26.203(e)(2) (as applicable)

Analysis of Waiver Assessment Data: (Limit 10,000 characters)

Zero waivers reported in 2020.

Analysis of Fatigue Assessment Data: (Limit 10,000 characters) 10 CFR 26.205(e), Reviews - Licensees shall evaluate the effectiveness of their control of work hours of individuals who are subject to this section. Licensees shall conduct the reviews once per calendar years.

6 fatigue assessments were done in 2020. 1 for self-declaration, 2 for post event, 2 for waivers and 1 for cause Fatigue assessments are being completed by the worker and by a qualified and trained Fatigue Assessor accurately and thoroughly.

No concerns noted from this program review. QH-2021-2132 Summary and Status of Corrective Actions: (Limit 10,000 characters)

The Fatigue Management Annual Program Review assessment did not document any performance gaps or additional issues.

Reference QH-2021-2132.

==

Conclusions:==

(Limit 10,000 characters)

No waivers issued for 2020 and no concerns noted from completed fatigue assessments. QH-2021-2132 Print this Report Save to Local PC Work Hour Controls NRC Form 892 (12/2012)

Outage Total (after day 60)

(Calculated)

Outage (after day 60)

Outage (after day 60)

Outage (after day 60)

Outage (after day 60)

Outage (after day 60)

Note:

1) Use Adobe Reader 8 or later for this form to work properly.
2) Hold your mouse over a form field to view additional information.

Operating Total (Calculated)

Submission Update - check this box only if this is an update to a previous submission.

Facility Wolf Creek [50-482]

Person(s) Responsible for Information Provided Company Email Address pam.black@evergy.com First Name Pamela Position Title Access Specialist Position Title Access Supervisor First Name Sonya Last Name Jones Last Name Black Company Email Address Sonya.Jones@evergy.com Person 1 (required):

Person 2 (optional):

Final Step (Required) - NRC will consider this form authentic in accordance with 26.11 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.

Locked Form Locked On: Feb 17, 2021 at 12:45:45 PM Did your facility issue any waivers in the reporting period? (Yes / No)

No 54 hour6.25e-4 days <br />0.015 hours <br />8.928571e-5 weeks <br />2.0547e-5 months <br /> maximum average Alternate to Minimum Days Off 26.205(d)(7)

General Comments (optional) (Limit 10,000 characters)

APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 04/30/2021 Estimated burden per response to comply with this collection request is 74 hours8.564815e-4 days <br />0.0206 hours <br />1.223545e-4 weeks <br />2.8157e-5 months <br />. This form is a voluntary means of reporting the information required under 10 CFR 26.203(e). The information will be used by NRC to evaluate fatigue program performance related to work hour controls and waivers. Send comments regarding burden estimate to the FOIA, Privacy, and Information Collection Branch (T5-F53), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

Annual Fatigue Reporting Form (version 1.5.0 - April 2018)

Facility Wolf Creek [50-482]

Reason for Testing - 26.717(b)(5)

Pre-Access Pre-Access Testing Reason (optional)

Initial Authorization Please elaborate (optional)

Employment Type - 26.717(b)(3)

Contractor/Vendor Labor Category - 26.717(b)(3)

Non-Licensed Operator 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 Alcohol Specimen Tested Breath Management Actions - 26.717(b)(8) & 26.75 Specific Sanction Applied 14-Day Denial Save to Local PC Print this Report Unique Reference ID (Licensee Supplied)

A1

1) All fields required except those marked 'optional'
2) Entries in some fields auto-populate information in other fields
3) Mouse over form fields to view additional information
4) Use of Adobe Reader 8 or later is required No 09/14/2020 Submission Update Person(s) Responsible for Information Provided Company Email Address pam.black@evergy.com First Name Pamela Position Title Access Specialist Position Title Access Supervisor First Name Sonya Last Name Jones Last Name Black Company Email Address sonya.jones@evergy.com Person 1 (required):

Person 2 (optional):

Single Positive Test Form (version 1.9.0 - January 2020)

Final Step (Required) - NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the Validate & Lock button is clicked and all errors (highlighted in red) 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.

Locked Form Locked On: Feb 17, 2021 at 11:55:58 AM Reason for the Action First drug or alcohol positive Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b)

No Subversion Attempt -

Sanction Applied (NRC Minimum or Licensee Administrated)

NRC Minimum Delete Submission FFD Program Performance Data Reporting System APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 04/30/2021 Estimated burden per response to comply with this collection request is 30 minutes. This form is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2) and 26.717. The information is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFD) program performance data on drug and alcohol programs from licensees and other entities. Send comments regarding burden estimate to the FOIA, Information Services Branch (T6-A10M), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

NRC Form 890, Single Positive Test Form (EIE General Submission Portal)

NRC Form 890 Is this a 24-hour reportable event under 26.719(b)?

No No Substance - 26.717(b)(2) & (b)(6)

Alcohol What 26.103 BAC level was exceeded?

0.03 and in work status at least 1 hr Date of Collection (mm/dd/yyyy)

Outage Worker (optional)?

Facility Wolf Creek [50-482]

Reason for Testing - 26.717(b)(5)

Pre-Access Pre-Access Testing Reason (optional)

Initial Authorization Please elaborate (optional)

Employment Type - 26.717(b)(3)

Contractor/Vendor Labor Category - 26.717(b)(3)

Non-Licensed Operator 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 Alcohol Specimen Tested Breath Management Actions - 26.717(b)(8) & 26.75 Specific Sanction Applied 14-Day Denial Save to Local PC Print this Report Unique Reference ID (Licensee Supplied)

A2

1) All fields required except those marked 'optional'
2) Entries in some fields auto-populate information in other fields
3) Mouse over form fields to view additional information
4) Use of Adobe Reader 8 or later is required No 06/23/2020 Submission Update Person(s) Responsible for Information Provided Company Email Address pam.black@evergy.com First Name Pamela Position Title Access Specialist Position Title Access Supervisor First Name Sonya Last Name Jones Last Name Black Company Email Address sonya.jones@evergy.com Person 1 (required):

Person 2 (optional):

Single Positive Test Form (version 1.9.0 - January 2020)

Final Step (Required) - NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the Validate & Lock button is clicked and all errors (highlighted in red) 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.

Locked Form Locked On: Feb 17, 2021 at 12:27:57 PM Reason for the Action First drug or alcohol positive Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b)

No Subversion Attempt -

Sanction Applied (NRC Minimum or Licensee Administrated)

NRC Minimum Delete Submission FFD Program Performance Data Reporting System APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 04/30/2021 Estimated burden per response to comply with this collection request is 30 minutes. This form is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2) and 26.717. The information is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFD) program performance data on drug and alcohol programs from licensees and other entities. Send comments regarding burden estimate to the FOIA, Information Services Branch (T6-A10M), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

NRC Form 890, Single Positive Test Form (EIE General Submission Portal)

NRC Form 890 Is this a 24-hour reportable event under 26.719(b)?

No No Substance - 26.717(b)(2) & (b)(6)

Alcohol What 26.103 BAC level was exceeded?

0.04 or greater Date of Collection (mm/dd/yyyy)

Outage Worker (optional)?

Facility Wolf Creek [50-482]

Reason for Testing - 26.717(b)(5)

Pre-Access Pre-Access Testing Reason (optional)

Initial Authorization Please elaborate (optional)

Final result date 01/09/2020. As result was not received until 2020 - captured on the 2020 Annual Report.

Employment Type - 26.717(b)(3)

Licensee Employee Labor Category - 26.717(b)(3)

Other Was this collection refused? - 26.717(b)(7) & 26.75 Test Results - 26.717(b)(4)

Test Validity Valid Test Type(s) for Result(s) Reported - 26.717(b)(2)

Drug Only Drug Specimen Tested Urine Was this collection observed? - 26.717(b)(7) & 26.75 Management Actions - 26.717(b)(8) & 26.75 Specific Sanction Applied 14-Day Denial Save to Local PC Print this Report Unique Reference ID (Licensee Supplied)

D1 Please elaborate on the Labor Category selected Information Services

1) All fields required except those marked 'optional'
2) Entries in some fields auto-populate information in other fields
3) Mouse over form fields to view additional information
4) Use of Adobe Reader 8 or later is required No No 12/18/2019 Submission Update Person(s) Responsible for Information Provided Company Email Address pam.black@evergy.com First Name Pamela Position Title Access Specialist Position Title Access Supervisor First Name Sonya Last Name Jones Last Name Black Company Email Address sonya.jones@evergy.com Person 1 (required):

Person 2 (optional):

Single Positive Test Form (version 1.9.0 - January 2020)

Final Step (Required) - NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the Validate & Lock button is clicked and all errors (highlighted in red) 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.

Locked Form Locked On: Feb 25, 2021 at 1:24:24 PM Reason for the Action First drug or alcohol positive Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b)

No Subversion Attempt -

Sanction Applied (NRC Minimum or Licensee Administrated)

NRC Minimum Delete Submission FFD Program Performance Data Reporting System APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 04/30/2021 Estimated burden per response to comply with this collection request is 30 minutes. This form is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2) and 26.717. The information is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFD) program performance data on drug and alcohol programs from licensees and other entities. Send comments regarding burden estimate to the FOIA, Information Services Branch (T6-A10M), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

NRC Form 890, Single Positive Test Form (EIE General Submission Portal)

NRC Form 890 Is this a 24-hour reportable event under 26.719(b)?

No No How many substances were confirmed positive for this individual?

1 Substance - 26.717(b)(2) & (b)(6)

Use NRC Cutoffs?

Initial Cutoff Confirmatory Cutoff Limit of Detection Marijuana Yes Date of Collection (mm/dd/yyyy)

Outage Worker (optional)?

Facility Wolf Creek [50-482]

Reason for Testing - 26.717(b)(5)

Pre-Access Pre-Access Testing Reason (optional)

Initial Authorization Please elaborate (optional)

Employment Type - 26.717(b)(3)

Contractor/Vendor Labor Category - 26.717(b)(3)

Maintenance (general facility)

Was this collection refused? - 26.717(b)(7) & 26.75 Test Results - 26.717(b)(4)

Test Validity Valid Test Type(s) for Result(s) Reported - 26.717(b)(2)

Drug Only Drug Specimen Tested Urine Was this collection observed? - 26.717(b)(7) & 26.75 Management Actions - 26.717(b)(8) & 26.75 Specific Sanction Applied 14-Day Denial Save to Local PC Print this Report Unique Reference ID (Licensee Supplied)

D2

1) All fields required except those marked 'optional'
2) Entries in some fields auto-populate information in other fields
3) Mouse over form fields to view additional information
4) Use of Adobe Reader 8 or later is required No No 07/27/2020 Submission Update Person(s) Responsible for Information Provided Company Email Address pam.black@evergy.com First Name Pamela Position Title Access Specialist Position Title Access Supervisor First Name Sonya Last Name Jones Last Name Black Company Email Address sonya.jones@evergy.com Person 1 (required):

Person 2 (optional):

Single Positive Test Form (version 1.9.0 - January 2020)

Final Step (Required) - NRC will consider this form authentic in accordance with 10 CFR 26.11 only when the Validate & Lock button is clicked and all errors (highlighted in red) 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.

Locked Form Locked On: Feb 17, 2021 at 12:39:42 PM Reason for the Action First drug or alcohol positive Did this collection involve a subversion attempt? - 26.717(b)(7) and 26.75(b)

No Subversion Attempt -

Sanction Applied (NRC Minimum or Licensee Administrated)

NRC Minimum Delete Submission FFD Program Performance Data Reporting System APPROVED BY OMB: CLEARANCE NO. 3150-0146 EXPIRES: 04/30/2021 Estimated burden per response to comply with this collection request is 30 minutes. This form is a voluntary means of reporting the information required under 10 CFR 26.417(b)(2) and 26.717. The information is required by NRC to obtain on an annual basis site specific fitness-for-duty (FFD) program performance data on drug and alcohol programs from licensees and other entities. Send comments regarding burden estimate to the FOIA, Information Services Branch (T6-A10M), U.S. Nuclear Regulatory Commission, Washington DC 20555-0001, or by e-mail to Infocollects.Resource@NRC.gov, and to the Desk Officer, Office of Information and Regulatory Affairs, NEOB-1020, (3150-0146), Office of Management and Budget, Washington DC 20503. If a means used to impose information collection does not display a currently valid OMB control number, the NRC may not conduct or sponsor, and a person is not required to respond to, the information collection.

NRC Form 890, Single Positive Test Form (EIE General Submission Portal)

NRC Form 890 Is this a 24-hour reportable event under 26.719(b)?

No No How many substances were confirmed positive for this individual?

1 Substance - 26.717(b)(2) & (b)(6)

Use NRC Cutoffs?

Initial Cutoff Confirmatory Cutoff Limit of Detection Marijuana Yes Date of Collection (mm/dd/yyyy)

Outage Worker (optional)?

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