ML14057A393

Single Positive Test Form, for Pre Access, Collected on 10/15/2013

ML14057A393
Person / Time
Site:	Palisades
Issue date:	02/13/2014
From:	Dotson B, Rabideau B Entergy Nuclear Operations
To:	Document Control Desk, Office of Nuclear Security and Incident Response
Shared Package
ML14057A574	List: ML14057A389 ML14057A390 ML14057A391 ML14057A392 ML14057A393 ML14057A395 ML14057A397 ML14057A398 ML14057A399 PNP 2014-016, Single Positive Test Form, for Pre-Access, Collected on 11/25/2013
References
2013-PAL-003, PNP 2014-016
Download: ML14057A393 (1)

Text

1201 3-PAL-003 Select Facility Palisades [50-255]

Date of Collection (mm/ddfyyyy) 10/15/2013 Was this collection observed (Yes / No)? - 26.71 7(b)(7) & 26.75 INO j Substance - 26.717(b)(2) & (b)(6)

Additional Substance (as applicable)

Amphetamines 7

Please Select Additional Substance (as applicable)

[re Select Use NRC Cutoff (Yes I No)?

yes is this a 24-Hour Reporting Event (Yes/No)? -26.71 9(b)INo I

Subversion Attempts

- 26.717(b)(7) and 26.75(b)

Did this collection involve a subversion attempt (Yes/No)? INO Management Actions

- 26.717(b)(8) & 26.75 Reason for the Action First drug or alcohol positive Sanction Applied (NRC Minimum sir Licensee Administrated)

I NRC Minimum Specific Sanction Applied

[Day Denial Person(s) Responsible for Information Provided Person I (reqsired):

First Name Last Name Position Title

,Petn 2 (0p0osl)

Company Email Address Dotson Licensing Speniulist bdotson@entnrsy,00m I-irst Name Last Name VOSition I tIe Company trmail Address 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 LockeE after the data validation process has bees successfully completed and the form is ready for submission.

Form Locked On:IFeb 13,2014 at 1:50:11 PM Save to Local PC PrInt this Report Hots Submission Delete

1) AS fields er. required eaoept those ma.*ed epfisoei.

Update Submission

2) EnUI.s in some form fields mayresulth, Infonnaao,, being auto popsdeted into ether to,m field..

Urugue Reference Number (licensee Supplied)

3) USe Adobe Reader 8erlst.r far this teen to wol* prop.fl)r,

4) Hold your mouse ever a teen, field to vice, additional mtoematio,,,

Reason for Testing - 26.717(b)(5)

Pre-Access Tenting Reason (optional)

I Pre-Access I

IUpdate Authorization Employment Type - 28.71 7(b)(3)

Licensee Employee Labor Category-26.7171b)13)

Security I

Please elaborate (optional)

Refusal-26,717(b)(7) & 26.75 Was this collection refused (Yes / No)? IN0 Test Results

- 26.717(b)(4(

Test Validity Valid Test Type(s) for Result(s) Reported - 26,717(b)(2)

Drug Only Drug Testing Urine Brian Barb I Rabideas I Supenvissr, Access AuthorizatiostFFD brebidn©entergv.nsm Single Positive Test Form )version 1,5.0

- January 1, 2014)

U.S.N H(-:

f-FO PrO<jIClIll PClfollllCll1ce 0;-]1;-1 r:~('pOltII19 System Sr.1Jlc /)0:':;1;1\\/-' li'*st I ( Iii D Submission o Delete Updete Submission f) All tI.,rIo aN,..,111,._ oxco". /1>0.0 _od 'Opf/oNI',

~ EnOoIH In __ """, tIo/rio mIIY _ullin 1nf_1>eI""._

Unique Reference Number (Weensee Supplied)

/>OfHIWod Info _""", tI-.

12013-PAl-003 I

,}u..A_R_'.,._""IIII.""",... _~,

of} Hold your mouN tN.,. fotm ""d to vI....."",.1rIIom:aefon.

Select Facility Ipalisades [50-255]

I Date of Collection (mmiddlyyyy) 11 0/15/2013 I

R ** on for T_nll - 26.717(b)(5)

Pr&-Access Testing Reason (optional)

Please elaborete (optional)

I Pre-Access I IUpdate Authorization I

I I

Employment Type - 26.717(b)(3)

ILicensee Employee I

Labo, Cat.goIy - 26.717(b)(3)

ISecurity I

Rerun/ - 26.717(b)(7) & 26.75 E:J was this collection refused (yes t No)?

Te" Re.ull8 - 26.717(b)(4)

Test Validity IVaiid I

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

Drug Testing

!Drugonly I

IUrine I

W.. thl. coli_on observed (ye.1 No)? - 26.717(b)(7) & 26.75 INO I

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

Addltlon.' SulJaUnce ( ** applicable)

Additional Substance (a. eppllcable)

IAmphetamines I

IPlease Select I

I Please Select I

Use NRC Cutoff (Yes I No)? ~

Is thIs a UHourReportlnll Evenf (Yu/No)? - 26.719(b)~

SubversIon A_pta - 26.717(b)(7) and 26.75(b)

Did this collection inyolve a subversion attempt (yesINo)? INO I

MMr/Jf1ement Acf/on. - 26.717(b)(6) & 26.75 Reason for the Action IFirst drug or alcohol positive I

Sanction Applied (NRC Minimum or Ucens.. Administrated)

INRC Minimum I

Specific Sanction Applied

/14-Day Denial I

Peraon{.) Re.pon.lbI. for 'nfonn"'on ProvIded Penson 1 (reqJtr,d):

len,n First Name IIR~deaU List Name IlsuPervisor. Aoce ** AulhortzationIFFO PositionTrtle I

bnlbideQenterl/Y.com Company Email Addres.

Person 2 (option.l);

IBam Ilooman II Ue.. slng Spatlalls1 I bdotson@enle'l/Y.eom First Name Last Name Position lide Company Email Addross Flnel Step (RequIred)

• NRC will consider this form authentic in accordance with 26.11 only when tha 'Validate & Lock" button has b""n selected and all errors (i.e.. those highlighted in red) have b""n corrected. The 'Validate & Lock" button will change to "Locked" after the data validation process has been successfully complated and the form is roaely for submission.

Form LoCkedOn:IFeb 13,2014 at 1:50:11 PM I I

Save to Local PC I I Prfnt this Report I Singla Positive Test Form (yersion 1.5.0 - January 1, 2014)

U.S.N H(-:

f-FO PrO<jIClIll PClfollllCll1ce 0;-]1;-1 r:~('pOltII19 System Sr.1Jlc /)0:':;1;1\\/-' li'*st I ( Iii D Submission o Delete Updete Submission f) All tI.,rIo aN,..,111,._ oxco". /1>0.0 _od 'Opf/oNI',

~ EnOoIH In __ """, tIo/rio mIIY _ullin 1nf_1>eI""._

Unique Reference Number (Weensee Supplied)

/>OfHIWod Info _""", tI-.

12013-PAl-003 I

,}u..A_R_'.,._""IIII.""",... _~,

of} Hold your mouN tN.,. fotm ""d to vI....."",.1rIIom:aefon.

Select Facility Ipalisades [50-255]

I Date of Collection (mmiddlyyyy) 11 0/15/2013 I

R ** on for T_nll - 26.717(b)(5)

Pr&-Access Testing Reason (optional)

Please elaborete (optional)

I Pre-Access I IUpdate Authorization I

I I

Employment Type - 26.717(b)(3)

ILicensee Employee I

Labo, Cat.goIy - 26.717(b)(3)

ISecurity I

Rerun/ - 26.717(b)(7) & 26.75 E:J was this collection refused (yes t No)?

Te" Re.ull8 - 26.717(b)(4)

Test Validity IVaiid I

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

Drug Testing

!Drugonly I

IUrine I

W.. thl. coli_on observed (ye.1 No)? - 26.717(b)(7) & 26.75 INO I

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

Addltlon.' SulJaUnce ( ** applicable)

Additional Substance (a. eppllcable)

IAmphetamines I

IPlease Select I

I Please Select I

Use NRC Cutoff (Yes I No)? ~

Is thIs a UHourReportlnll Evenf (Yu/No)? - 26.719(b)~

SubversIon A_pta - 26.717(b)(7) and 26.75(b)

Did this collection inyolve a subversion attempt (yesINo)? INO I

MMr/Jf1ement Acf/on. - 26.717(b)(6) & 26.75 Reason for the Action IFirst drug or alcohol positive I

Sanction Applied (NRC Minimum or Ucens.. Administrated)

INRC Minimum I

Specific Sanction Applied

/14-Day Denial I

Peraon{.) Re.pon.lbI. for 'nfonn"'on ProvIded Penson 1 (reqJtr,d):

len,n First Name IIR~deaU List Name IlsuPervisor. Aoce ** AulhortzationIFFO PositionTrtle I

bnlbideQenterl/Y.com Company Email Addres.

Person 2 (option.l);

IBam Ilooman II Ue.. slng Spatlalls1 I bdotson@enle'l/Y.eom First Name Last Name Position lide Company Email Addross Flnel Step (RequIred)

• NRC will consider this form authentic in accordance with 26.11 only when tha 'Validate & Lock" button has b""n selected and all errors (i.e.. those highlighted in red) have b""n corrected. The 'Validate & Lock" button will change to "Locked" after the data validation process has been successfully complated and the form is roaely for submission.

Form LoCkedOn:IFeb 13,2014 at 1:50:11 PM I I

Save to Local PC I I Prfnt this Report I Singla Positive Test Form (yersion 1.5.0 - January 1, 2014)