Document 6BLmXJK3DYDER9DXeOEGN9q9o

'*"**4*1. A/nO J*, M_.D. ' .tOET A. CAPUTI, M.O HARO'lD l. ORAPP. M.O. ' iOHN N. STPACHAN. M.O. NAMEi________ ___ __ . _ Frotout dvltot (Who! do you do) UWI PERIODIC iIlkWiWMb 7SS TONAWANOA STRUT SUFFALO, N. T. 14207 mUHONIi S7S1S14 HEALTH EXAMINATION REPORT DATS. 1/14/77 rmkoyu. Georgia Pacific hvy day_______________________Hrs./doy doy./wk. dwnlli/yr. Protriavi aipo.nrai wkoro -- wkan -- and ter kow tons Silica -- land laundry. Minins, aorryiag. coraaiict Silicates -- laic, otbcttoi (type) Mining, Milling, fakricalian, application, ,utile,. athar fori 1. Covgh INQUIRY 2. Choi! poio 3. SOS a, ml 4. SOS an effort 5, Expoctorotioo 6. Sloop dot h.B. 7. Pillow. 0 1 2 3 1. loti wgtn/oppotifo 9. IxrooBlog fotigoo 10. Dysphagia 11. Chong# in bowl hobit 13a blood lou Caafk Vomit Slaady .tael Slock stool Urino Skin 12. Smoking cigor/pipo/cig,t. YES i 1 1 ____ tSL_ 1 a NO A' A> AA A s""` S' tS IS PHYSICAL EXAMINATION AGE, MUCOUS MEMBRANES (pigmont, pallor, naeplasia) CHEST, CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION HEIGHT, HEART, Rhythm, rat*, tonas, murmurs, B.P. ABDOMEN, Livar/Splaan EXTREMITIES, Edama, clubbing, atrophias - ' ` * NEUROLOGICAL PCN CUTANEOUS Darmatitis Pigmantatian Naoplasia Examinaa's Signature Signatura WEIGHT, DTR ADENOPATHIES SGP 0008937 M.D. VENTILATION F.V.C = Ol) F. E.V., = FEF 25 */. - 75 */. IMPRESSION. NORMAL sv7j fev*= 77/ litar/*ac. M. V. V. /Q ^__, C^OBSTRUCTIVI^ litara/minuta RESTRICTIVE ELECTROCARDIOGRAM Anoxia: Q P Pulmonala: Right Haart Strain: Abnormalitias of rhythm: Abnormalities of conduction: Other: NO DIAGNOSTIC ABNORMALITIES ST-T sagmant changai BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA i 2/60: See Attoched SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: No+ K+ Mg+ + SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: See Attached BLOOD LEAD: MICROGRAMS % MISCELLANEOUS: ACHLORHYDRIA (DIAONEX): OCCULT BLOOD: URINALYSIS: ALBUMIN____ SUGAJ URINE LEAD. -MICROGRAMS/LITER URINE SULPHATE RATIO -V. CHEST XRAY rm NORMAL ABNORMAL UICC/GNC1NNATI Moderate prominence of the right root. Some increased radiability in both uppers and in the left base. At the left base at this time are noted some pleural changes lying immediately above the diaphragm; these are not evident in the preceding film, #8894, taken 10/21/75. Lateral projection also suggests some alteration in the left leaf of the dia- OTHER phragm, some tendency to blunt the costophrenic sulcus. Changes are not evident in the earlier film. Attention is directed to the history which indicates some pulmonary complaint and some change in the bowel habit. It should also be noted that ventilation studies have been depressed slightly over the previous study. ENVIRONMENTAL DATA: Sampla typoduration Examinee does have an abnormal chest and abnormal ventilation studies; he asbestos: Number Fibor* > 5 Mu./Cucm. should be so informed. Please advise. Audiometric OTHER* study, incidentally, is entirely satisfactory. SIUCA Mg./M* MlSC & SUMMARY: r c~ M.D. SGP 0008938 3UF7A1Q INDUSTRIAL .VJSiCAL C2N7S 7it tonawanoa snnrr suffaio. n. y. umy foWpfcww I7S-I5M K2A3IXG EVALUATION SU??L2.V3.T PREPLACEMENT PERIODIC BASELINE [Ym] No] EXAMINEE-.. EMPtfYYFB ........ 110-10-8715 Georgia Pacific ______________ IOB ASSIGNMENT. 64 PREVIOUS OATS. FO* WHOM. MimM HiiMfyi. IS PERSONAL PROTECTIVE EQUIPMENT WORN |Yo|Nol EXAMINATION frfinnf Modicof - Ailfgiot__ Hnod Injury- Binding in Eon^ Mitt. ___ .Yurtigo-- .FaJnfol Cor*. Military Sorrier Duh'>--- . Duration-- AFFUCANT** {VALUATION OF HCAftINO STATUS Normal O Not Normal Q Geantont Q VaHoWo Q 0Mt FrogruKiun Q Ho* troublu Soaring In Groups Q In Avdiloria Q In Noity Flocoi Q At Oislonco Q Bodio-TV Com Toiophono Womon and Cbildron Q locautn of Binging in Sort Q Q Ears Drums Canal Noso Throct Tuning Pork S L AUD!OK27n2C E^rCATICM Dote: - IK UlkJTL , Tim*i .Interval since last noise exposure:. 125 miouency - Mirrz S00 lose (h) 3000 //// NjrpJ} ___ L__ 2 J... sJ 5! =J IA 1/ a "v i l / /4 j i, IS V So. / SB r'N, 1 V - ' u \r / "\ / <0 a a a tip Aran % w\\k trf*4 Uninm ^ l/Uftili( AvTutvilv' iaW/Ss/TM'sM H a a ICQ examinee's Signature:.... Examiner: . ... ........ SGP 0008939 SGP 0008940 POSITION THIS EDGE MEANEST CABINET IOE*Tv>.r CAPUT), M.D H^JtOU) l. GRA77, M.D. JOHN N. STKACHAN, M.D. 'WM | 4K>, . w I Wfelt 755 TOMAWANOA STRUT lUIVAlO, N. V. 14207 mHONI> S7S-1SU PERIODIC HEALTH EXAMINATION REPORT NAME). _0ATi_ 1/26/77 .EMMOYEEi. Georgia Pacific 7rM.nl d.fi.i (Wfcol do yov do I ytrv^*-vj <7------ 7c <y> U*S*Pv7 Every day Hct./doy doyl/wk. onths/yr. tari Vyrw-i. Prov'ient anpesorai wkar. -- who* -- ood (or liow loop Silica -- .and fo.ndry, aiiaiog, evarryiag, aroaucs Silicalat -- laic, otkatlea (lypo)i aining, ailliog, (obricalien. application, lanliiai. other z, d~r*Jkj J INOUItY YES NO 1. CotfQk 2. CKitl pain 3. SOS at ret* 4. SOI on effort 5. Expectoration 6. Sleep flol h.t. 7. Tillowt 0*1 - 2- 3- 1. Lott wpt./oppetile 9. Incroatiftff fotiffee 10. Oysphegio 11. Oionffe ie bowe) habit 12. Stead lots Col/p h Vomit Bloody stool Slock ttool Urine Skin 13. Seohit 6gor/pipe/ciff*U ^ 1 # pks./doy lor^ ^ t yeort yT- ft 1/ i/ . pio/Vtf-/ / '*>lSo L. J-0/30 1 Jk>/SO \f S iS S tS \S i/ -------------------------------------- ,1--------s.. - . ............... PHYSICAL EXAMINATION AGEt 54 MUCOUS MEMBRANES (pigment, pallor, noopiasio) HEIGHT) WEIGHT) / 0 CHESTt CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION HEART) Rhythm, rato, tones, murmurs, B.P. ABDOMEN) livgr/Spleen EXTREMITIES) Edomo, clubbing, atrophies NEUROLOGICAL PCN DTR CUTANEOUS Dermatitis Pigmentation Neoplasia Examinee's Signature Signature ADENOPATHIES SGP 0008941 M.D. P Pulmonalei Right Heart Strain: Abnormalities of rhythmi Abnormalities of conduction! Otheri 31000 COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60i See Attached SERUM ENZYMESi_________________________ SERUM ELECTROLYTES! No* K+ Mg++ SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS! See Attached BLOOD LEADi MICROGRAMS V. MISCELLANEOUS 1 ACHLORHYDRIA (DIAGNEXIi OCCULT BLOOPi_____________ URINALYSIS. || AL3UMIN______ SUGAR_____ l| URINE LEAD CHEST XRAY (f'ioRMAp ABNORMAL MICROGRAMS/LITER URINE SULPHATE RATIO UICC/CINCJNNATI s % other Mild prominence of the root areas, few small calcific densities in each. Peripheral lung fields exhibit only minimal increase in bronchovascular markings. Heart shadow and bony cage are normal. Chest x-ray is considered to bo satisfactory. Attached ventilation study satisfactory Examinee1s overall health status Insofar as these studios are concerned. would seem to be quite satisfactory, and present no significant change, from the studies of 1975. Please advise examinee; status wouid seem satisfactory. ENVIRONMENTAL DATA: Somplo typo____________duration ASBESTOS: Numbor Rbor* > 5 Mu./Cucm. OTHER. SILICA MgyMJ MIC* 0 '____ M.O. SGP 0008942 BUFFALO BCBUSTSAL &25XAL CSOT2 7SS TONAWANDA STRHT SUFFAIO, R Y. 14207 TI**Im R7S-IJ14 K2AS&3G SVAIUArCX So??L2','lSSJT nPREPLACEMENT PERIODIC 3: BASELINE [Ym] No| EXAMINEE:. EMPLOYER- Georgia Pacific s.s. n. ,062-18-7798 ,r.E 54 PREVIOUS OATEt JOS ASSIGNMENT) FOR WHOM. Parfinant Occupational Hfolary* IS PERSONAL PROTECTIVE EQUIPMENT WORN [Yes I No | Parlinnnf Madicol Hiltaryi. Ailorglni__ Hood Injury. Ringing in Cors... Mk. ....--_____ .binbl Corn , Vrti9. -tunning bn. Military Snrvka.. Duliai.--._______ . OlMtiM. APPLICANTS EVALUATION OP HEASING STATUS Normal Q Nol Normal Q Caaifonf Q VaHaWa Q Onial Q Progruisian Q Hoi troubin hoofing U Grwpi In Auditor* O At Diitonca Q In Noiiy PJacai Q Gain Q Taiapbana Codio-TV Woman and Childran Q ftaCOOM < tinging in lor* Q Q Ears Drums Canal N'oso Throat Tuning Fork R L " ~ss.--'^sto*** Dote:_____ 1Z2.6ZZ7Tim*: Examinee's Signature... '12kS& Examiner:__ /j yOZCi, ___ Interval tine* last noil* exposure: *.aaa imiM OSMA PtOPOtCD |YSTIMmm Ure*M Hi ltd Hr < 250 ? /a : 1000 7S"-: 2000 ,*= !' M.Q.l #JM0^ MjSTA 4000 /o 4000 (0 1000 AVIRAGC ML- r.S. In 44 *sT 10 AUDIOMETER AM. NAT1 STAND SFEC. (ANSI-1969) AIR RONE HCPAKT ILUR X RCIGAHRT ICO o /N SUMO. SGP 0008943 7500 . * HIMAi HlTVMlr* c. o( ) SM MNN *<VC. COPVtnir *tj A I SGP 0008944 . 1.0. ' ROBERT CA7UTI. MJ> WAROLD L ORAM, M.O. JOHN N. STRACHAN. MS). vWitnw< 7SS TONAWANOA STREET BUWAiO, N. T. 14207 mVHONIi S7S.1J14 PERIODIC HEALTH EXAMINATION REPORT NAMIOATI. 2/23/77 ^l#i (What 4a yaw RMTIOYRR. --------- _ ----------- -- ----- buy dayHccVday 4y./wk. ________ awnHu/yr. ProYiaw. upMni whor* -- wkon -- oa4 lor Raw long Silk* -- m*4 laundry, inlne, eoenrying, carawka Silkstn. -- lok. alWilw (typa) *i*ln9. illiaa, fobrkolion, application, tutilai, alhor fori INQUIRY j YES 1. CotPQh 3. Oip.l pain f- 3. SOft at ra*t 4. SOft aa aflart S. tRpactaratiai* 6. Slaap ftat h.i. 7. Pillow. 0 - 1 - 2 3 - A I, Last wfio/appatita . Incroaiiag lillgn 10. Dytphogle 11. Ckaneo la fcowal kabil 12. IMIcu Covgk V<Miit Bloody .tool Black .tool Uriaa Skla 13. Smoking <igar/pip*/cig`l* ______________ # pkt./doy Iof________ yaor. NO x A _. _ y i. x i. i x x x * PHYSICAL EXAMINATION___________ AGE. 61________ HEIGHT. MUCOUS MEMBRANES (pigment, pallor, neoplasia) - 5*10** * CHEST. CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION HEART. Rhythm, rote, tones, murmur*, B.P. ABDOMEN. Liver/Spleen EXTREMITIES. Edema, clubbing, atrophies NEUROLOGICAL PCN CUTANEOUS Dermatitis Pigmentation Neoplasia Examinee's Signature Signature N WEIGHT. 215 DTR ADENOPATHIES SGP 0008945 P Pulmonale: Right Heart Strain: Abnormalities of rhythm: Abnormalities of conduction: Other: BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attached SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: No+ K+ Mg++ SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: See Attached BLOOD LEAD: MICROGRAMS V. MISCELLANEOUS: ACHLORHYDRIA (DIAONEX): OCCULT BLOOD:_____________ URINALYSIS: ALBUMIN SUGR=----- URINE LEAD - MICROGRAMS/UTER URINE SULPHATE RATIO V. CHEST XRAY NORMAL ABNORMAL UICC/CINCINNATI Mild prominence of both root areas. Some Increased bronchovascular markings in both lower lobes. No evidence of specifio parenchymal disease. No evidence of pleural dysplasia. Lateral projection does demonstrate some increased radiabilhy behind the sternum. This is essentially unchanged over the pre- ____ vlous film. -------- OTHER ENVIRONMENTAL DATA: Somplo typo___________ duration ASBESTOS: Numbor Fibort > 5 Mu./Cucm. OTHER: SIUCA Mg*./M* i -.iimmauv- RmiHf nap Iiaa a no mini Vpm I. i 1 n I i on nl.iirly, OIias'I. x-rny |fl inolin ii ji oil. Ami i miio ) i l : o Mon I nn i j ini I uh Loo it liiJ.it torn L tumlot'tt l.o fid in' lug. .1iri* . I'liiiiao advise examinee. _________ M.D. SGP 0008946 CUTvALO IMDUS72IAL tVJSICAL CSCZi 7U TONAWANDA STREET SUrEALO. K. Y. W207 TthpliMt E7S-1JI4 PREPLACEMENT H2A3NG 2VALUA~M SUP?L1V^7 EXAMINES) employs Georgia Pacific _S.S. No.i 111-05-3015 AGE. 61 JOB ASSIGNMENT* PERIODIC BASELINE [YmI No| PREVIOUS DATEi FOt WHOM* IS PERSONAL PROTECTIVE EQUIPMENT WORN j Y-- ) No} Pnrtinnnr OttvpolinnnJ Hittoryt. BCAKStARON Parliaanf MnOicoJ Hiltaryi. Allargini__ _ Wand lajary- tiftgi*Q 4ft Enri_ Mite. -PninM En. .Vaftign^ JUaning Ea. Military Sarvica~ .Pnwllffc. APPLICANT* (VALUATION OP HIAftSNO STATUS Normal 0 Nol Normol 0 Hoi troabla hio/ing Constant VortaWa Yot 0 Onto! 0 ProgroMlon 0 In Oroopi 0 a Avditario 0 Al DtitaACo Q lodio-TY 0 In Noliy Plocot Goto 0 Talapbona Wow oita CbUdran 0 0 Socoato of tinging in tort Q Ears Drums Canal Nosa Throat Tuning Park R b aus:c;:j7TJ2 e::jna7:cm Dot: 2/23/77 . Tim*i Jntoool sines lost noiss oxpoiuro: Kooc! // //FKOUB4CY HHTZ (Hi) ITS 3SO SM 1000 11 . 1. __ I ajlo o trmu ,, OSHA HOfOUO fTSTCM.... Klhi tar H . laft Nr 1 teztj _______1______v or*A Si iGUJ f" i Z t: <A 2M - L/X, i^l^Ara* ^ 7h CrN WMtawV /1*: T*?| tf nirVisIv ` \t&S'//ss/s/sM c% r< VA y g > t / s H uv h p! JA b ' ri ls PZ& m K 2S0- a.a.Ci.. ./S" ! <hO 1000 !rf 3000 A 0:! t-?Si X-.o soi.i.SL MJ000 t <b.\ 4000 In a 4000 000 nfi tyn AVIftAOl T,J. in 44 AUDIOMETER AM. NAM STAND SPEC. (ANSI-1949) AIR RONE IKIFATI LUt X (?) tICOAHRT UD O o Examine*' Signatur*i cxaminari SGP 0008947 SGP 0008948 XOtr 'CAFUTl, M O KASOIO l. G*A7f. M.O. JOHN N. STSACHAN. M.O. U v i'l Mt>V 7SS TONAWANOA STUIT SUSSAtO, H. V. 14207 TUtmONIi >71.1*14 PERIODIC HEALTH EXAMINATION REPORT NAMEi._________________ , I tfvlia* (What * yo ). 7rizJ~i DATe.-l/26/27a-:------ EMnoYM.__foQrgjia^ Pacific. - y**1 -//fIy&i^V***--^ Iwf 4oy Hn./poy |Soqyri/wkA. k.monthocnl/hyc/ryr..fori Srovievi p*tm whom -- who* -- on4 for how tong Silica -- uo4 founOry, aiiaiag, ouorrying, coramia Silkoloi -- talc, obato (typo) I mining, milling, fabrication, application, laxtilai, othor \ INOUItY YES 1. Caufth 1 2. Chast pain 3. SOS at rotf / 4. 501 on a#ort 5. EiptxlofHon 5. Slaap Sat h.s. 7. Pillow. 0 . I 3 3 1. lot* wgt./appatila 9. lAcr*a*4Afl fatigaa 10. Dyiphogia 11. Chong* in bowl habit 13. >1o*4 lot. Cough Vomit lloo4y ttool Slack .tool Urino Skin 13. Smoking cigar/pipa/cig'U ________# pki./Uoy for________ yoan NO V y < V t iV V x. V * V ' a'' y ._ \ v V PHYSICAL EXAMINATION AGE: 61 HEIGHT: MUCOUS MEMBRANES (pigment, pallor, neoplasia) . CHESTt CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION O. : HEARTt Rhythm, rat*, ton**, murmurs, B.P. ABDOMEN: Liver/Spleen EXTREMITIES: Edema, clubbing, atrophies NEUROLOGICAL PCN CUTANEOUS Dermatitis Pigmontation Neoplasia Examinee's Signature . Signature WEIGHT: ' * *- * DTR ADENOPATHIES SGP 0008949 M.D. P Pulmonale, Right Heart Strain, Abnormalities of rhythmi Abnormalities ofconduction, Othen BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60, See Attached SERUM ENZYMES,_________________________ SERUM ELECTROLVTESi Na+ K+ Mg++ SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESISi See Attached BLOOD LEAD,______________ _____MICROGRAMS % MISCELLANEOUS, ACHLORHYDRIA (DIAONEX). OCCULT BLOOD, URINALYSIS, 5 rALBUMIN____ CHEST XRAY SUGAR- URINE LEAD. NORMAL ABNORMAL -MICROORAMS/UTER URINE SULPHATE RATIO UICC/C1NCINNATI Mild prominence of the root areas, some general Increase in broncho- vascular markings throughout all lobes. No evidence of specific parenchymal disease. Lateral projection indicates that the diaphragms are smooth and sharp and the sulci are clear. No evidence of significant rarii oliir.rmgy. Heart: shadow ard hrmy rage art! normal._________________ ** OTHER ENVIRONMENTAL DATA, Samplo typo___________ duration ASBESTOS, Number Fiber* > 5 Mu./Cuem. OTHER, SIUCA Mg*./M5 Examinee has no subjective complaints. Ventilation studies suggest A, r.tlMMAUV. n, ,,||a ihihIqqI rani rlrl I \<o ilnfoi I, milillv In, lonnoil ,,va,- Ilia n I ,I i ii n ui 1 U/j, but flow L'ales otherwise satisfactory. Clicsi x-ray is satisfactory. Advise examinee of minimal change with regard to ventila tion study. Otherwise satisfactory-^. Attached audiogram indicates sig nificant bilateral hearing loss. /)T '~ n SGP 0008950 DUTvALO INDUSTRIAL .VJSICAL C2N7Z2 7SS TONAWAN0A STUZT BUFFALO. N. Y. 14307 Tolopbono E7S-1SU EXAMINEE: caabiovpo Pirtintnl Occupational H2AXJSSJG EVALUATION SU??iraSNT Georgia Pacific -S.S. No.i. JOB ASSIGNMENT) .AGE. 61 PREPLACEMENT Ec< PERIODIC BASELINE [Y*i | No PREVIOUS OATEi POI WHOM. IS PERSONAL PROTECTIVE EQUIPMENT WORN [YeslNol im exa.vjnat:on d rve>t^cr *X Prtinnt Mndkol HiilOfyi AJJorgi*_ Ho4 Injury^ Singing in Cvl. -Painful fort. 'CKy^Cf' -tunning Eru Gera Drums Ccnal N'oso RL r \SVL tacJt Dul.ut ,. ..................-- i APPLICANT'S EVALUATION OF HEAIINO STATUS Normal Not Normal Conllonl Vnrlobln Onwt Frngmuiba not troublo Soaring In Orwpi Q In Anbilorio In Noy Placo* Al Oitlancn Clow Q TalopKoao RoOio-TV Q Woman on4 ChIMrnn Q Socman ol Ringing in Eon Q Q Three* TuhIrq For!: Dotg: . AllfTmn^nnr-^n* A * , 1/26/77_____tirmi . ______________ In.grval sine# last noijg gxposurai. ////PCIOUENCY NHTZ (Hi) A A A (VtTIM ,, % OlHA rtOfOMO SYSTIM.____ 10 tlht In/ Hi luff Hr 1o HO rOO r 30... 500 \so <3 r3for 1000 2000 ;lj 0\ <9 * * a * i | o 1.2C 5000 H 4000 AT 4000 ro 000 no u AVIUOI T.S. U 4h W tfMASKi-- Examingg't Signatorgi Examingrt. AUOIOMETEt AM. NAT'l STAND SPEC. (ANSI-19491 AIS BONE HPT IAS IICHT lAt llUf SCO X o it SGP 0008951 SGP 0008952 loatir A..CAfUTI, M.O HA2O10 L OEAW, MG. JOHN N. JTEACHAN, MG. 7S$ TONAWANDA STUtT WMIO. N. V. UaOT TUTHONIi E7S-U1* PERIODIC HEALTH EXAMINATION REPORT NAME.DATE. 2/23/77EMPLOYEE. Georgia Pacific NhiI daiiai (Wket do yea dal _____ E-vfy day_______________________HflVdoy_________________days/wk. monllo/yr. f,-ov.oai npnwai whan -- wkaa -- aad (dr fcew leaf Silica -- Mad laundry, laiaiag, ^carrying, CTfiaci Silicates -- laic, atbattas (tykal > iaiag. aillliag, (abricatiaa, applicatiaa, textiles, ether tor, EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION HEARTi Rhythm, rata, ton**, murmur*, B.P. ABDOMEN. Liver/Spleen EXTREMITIES) Edema, clubbing, atrophias NEUROLOGICAL PCN CUTANEOUS Dormaliti* Pigmentation Neoplasia Examinee's Signature * ' ' Signature DTR ADENOPATHIES r. M.D. SGP 0008953 r.v.c. = y'fsv F^. E. V.. v7^ f. e. v.j = FEF 25% -75% 3, b liter*/* M. V. V. IMPRESSION: OBSTRUCTIVE *?// F- E. V.j = y^ litr*/minut RESTRICTIVE ELECTROCARDIOGRAM Anoxia: Q P Pulmonale: Right Heart Strain: Abnormalities of rhythm: Abnormalities of conduction: Other, NO DIAGNOSTIC ABNORMALITIES ST-T tegment change* BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attached SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: No* K+ Mg+ + SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: See Attached BLOOD LEAD:-MICROGRAMS % MISCELLANEOUS: ACHLORHYDRIA (DIAGNEXI: OCCULT BLOOD:______ m URINALYSIS: ALBUMIN _ SUGAR_____ URINE LEAD - - MICROGRAMS/LITER URINE SULPHATE RATIO CHEST XRAYX33 NORMAL ABNORMAL ' UICC/C1NCINNATI V. Moderate fibrosis of both roots. Moderate fibrosis of all lobes. Some few areas, fibrosis is already is assuming flbronodular properties. Lateral" projection indioates some increased PA diameter of the chest. No evidence of pleural dysplasia. Compared with #9124, taken 6/75 indicates in essence no ------ changa.------------------------------------------------------------------------------------------------------------------------------- ,--------------- OTHER ENVIRONMENTAL DATA: Somple typeduration ASBESTOS: Number Fibers > S Mu./Cucm. OTHER, SlUCA Mgs./M* SGP 0008954 ir :uwtu:. Von ( | 1 n ( I nil s l.ml I o :-o oil I I ro I j- liurwnl AuiiinniuLi'iu uxutitlita L ion Xii.licu tus uulil bilateral heurinu ^i\)ss ^`obubiy acoustic origin. Please advise examinee. .0.1 1\ M.D. BUFFALO :.\DUS721Al .'."ESiCAL CBBSt 7IS TONAWANBA STUIT UIWAIO. K. V. 14207 Talaphan* 875-1514 EXAMINEE:. employer____ Georgia..Pacific. Pftrtinnl Occupational History*............ .. . ... tAPMLVVt Vh^Vif PREPLACEMENT PERIODIC BASELINE |Ym1 "No] +-4603 AriP 46 PREVIOUS . JOB ASSIGNMENT. 0AT8. FOR WHOMt IS PERSONAL PROTECTIVE EQUIPMENT WORN [Yes | No| ftriiAAi Medical History* - Aliftrgi|.____ ned Injury-. Singing in Kars. Mix. -Painful Kars. Vrtiga_ .JUnning Eoa. Military Sarvka-. Duties.-..-... . Deration. APPLICANT'* (VALUATION OP HKAKINO STATUS Normal Q Not Normal Constant Q Variable Q Onset Progression Q Hot troublft bearing In Creeps Q In Auditoria Q In Noisy Pieces Q At Distance Q Ootft Telephone Rodie-TV Woman and Children Q Socoaso of Kinging in Kars Q Q cars Drums Canal N'oso Throat Tur.bg Fork R L 2/23/77 AL'DiC.r^TTJC BXTNt^tsiiiLWfte Dale:__ Timet ______Intervol line# lost noise exposure: FREQUENICY . HHEI RTZ (Hi) # _p p <4 ns *00 1000 *000 *T & f !111 ii i J-a5 ii i________ ___ 1 I [2 l r ) f Tk ftf; \ / -M \ > \v\ AJL.O.O. TOTEM, OSHA PtOPOSIO $YST1Mm, tfbr Ser Hs left Bar 290. 3T 'So 1000 UQ 2000 /* :! LL&r MC..J ns 4000 <rs (vAi O j^ls >fnf-- ly V< (jrK // * Z1 & YO 4000 qn n 4000 AVKIAGR -3HLP_|TT.4S. iInn4b l,3y 0C | / //2/ ^//Ay y yfrUrxH rt Ak.Vm!` WML Ife ^or __1__ AUDIOMETER AM. NAT*l STAND SPEC (ANSM969) HPT EAR IIOHT EAI AIR DONE 1 iiui | VA KEO o I o vO Examinee's Signature* 1 IJcXacJ Examiner: SGP 0008955 SGP 0008956 -Ooci;~A. CANJTI, M.O ,'HAEOIO l. GkAW. M.O. JOHN N. $TEACHAN, M. PERIODIC 713 TONAWANOA STUIT 3U7EAIO, N. Y. 14307 TELETHONS. 373-1314 HEALTH EXAMINATION REPORT name. fty ray __________ _:--oati,--1/14/77---------------------- employee, ftaorgi, a Pacific Prai.nl d.liai (Wkdt 4* yen 4o> Evory day ______________ Hn./dy deyi/wk. oionthi/yr._________________ tori Praioi avaurni wkora -- whom -- mod tor how loog Silica -- sand foundry, auaiog, quarrying, carafaici Silkatai -- laic, atdaitos (fypa). owning, * King, fabricsliaa, application, laililai. other rmort. INQUIEY l. CouQk 2. Chost poin 3. SOft at rm%i 4. SOB on otlort 5. Expectoration 6. SlHp Aol h.i. 7. Pillows 0 * 1 - 2 3 I. lost w^t./appotita 9. Inaootinff fatiaoo 10. Dyspkogia 11. Chonflo in bowol habit 12. Blooblo** Covqh Vomit Sloody ttool Block stool Urino Skin 13. Shaking cigor/p'.ga/cig'ti -C, # pk./doy tor | YES 1 f Oyaori HO A--'-' A---"" A--"* PHYSICAL EXAMINATION___________ AGE.________________ HEIGHT._________________ WEIGHT. MUCOUS MEMBRANES (pigment, pallor, neoplasia) CHEST. CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION ' HEART. Rhythm, rat*, tong*, murmurs, B.P. ABDOMEN. Livr/Spl*n EXTREMITIES. Edma, clubbing, atrophias NEUROLOGICAL PCN CUTANEOUS Darmatitis Pigmentation Ngoplotia Examinee's Signature Signature DTR ADENOPATHIES SGP 0008957 M.D. P Pulmonale: Right Heart Strain: Abnormalities of rhythm: Abnormalities of conduction: Other: BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attoched_________________ SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: No+ K+ Mg++ SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: See Attached BLOOD LEAD: MICROGRAMS % MISCELLANEOUS: ACHLORHYDRIA (DIAGNEX): OCCULT BLOOD: URINALYSIS: ALBUMIN___ SUGAR URINE LEAD. SloCHEST XRAY NORMAL ABNORMAL MICROGRAMS/LITER | URINE SULPHATE RATIO UICC/CINCINNATI V. Mild prominence of the root areas, some calcific densities noted on the left. Peripheral lung fields generally not remarkable. The lateral pro jection would suggest some increase in radiolucency behind the sternum, but this is not grossly abnormal. Heart shadow normal in size. Bony cage ---------------- Is nuimat-:--In'esseuce, ao change-from previous film #8691,--taken"10/21/7! other Chest x-ray considered satisfactory for examinee's age. Incidentally, no evidence of pleural dysplasia. ENVIRONMENTAL DATA: Somple typo____________duration ASBESTOS: Number Fiber* > S Mu./Cucm. OTHER: SIUCA Mgi./MJ Micr C1IUMABY. History of some shortness of breath noted. Studies include only ' ventilation and chest x-ray,are both noted to be satisfactory and compared favorably with the previous studies. Audiometric examina tion likewise satisfactory. Please advise examinee. _______________ M.D. SGP 0008958 BUFFALO INDUSTRIAL //^ICAL CEJI21 7SS TONAWANDA STUZT RUPFALO. N. Y. U207 TliA*M <71-1514 KEA&MG EVAILATZCN SU??!VJ^T PREPLACEMENT PERIODIC n BASELINE [Ym] No] EXAMINEE: $4. Nai 112-12-6442Aftp 59 PREVIOUS DATEi EMPiOYER...GeQr&ia-.Ea.cifl.C- JOS ASSIGNMENT!. FOR WHOMi IS PERSONAL PROTECTIVE EQUIPMENT WORN lY|No) Pfrtinanf OccvpatiaaaJ Hiilaryi ... .- ........ - EXA.VJNA7:CN Pnrlinnnt Madkai Hiiloryi. Hod Injury. Binging in ion. Mix. _Pain<l bn. .Virtlga. ^Svnaing lao. cars Drums Cena! Noso R L Military Sarvica.. . Dvrattan- APPLICANT** (VALUATION OP HRASING STATU* Normal Q Constant Not Normal Q VaHoblo 0 Hoi tfowolo kaoring Yo* OoMt Progroision 0 In Groapt In Avditorio 0 In Noisy Plocot 0 At OiitoiKa Goto Tolopkona RoOio-TV Q Woman and Ckildran 0 lacoaaa of Singing in Bars 0 0 Throct Tuning Fork AI ' Tr. tpm rs*A ' "M Dot#: 1/14/77 Tim*: . ______Intoryal tine* last noito oxpoturo: T3 *> " :) !/> 5J z 'l 5K FIEQUMCY HfITZ (Hi) & # # *00 TOM TOM * r f & I _______ I_______ 4-l. TT 1. / |K /A t / o vn s 1 i 1 _ OSHA PROPOSED |Y*TCM___ HtIlfbf iff laft hr fo 250 to ,.LCU 5 /S 500 1000 2000 /i I r* iu.c... MJ000 4< L/..6.J / o 4000 ID /& 4000 /<; /c 4000 /'/: XZ'l U~4 Asm ^ Xl* *t AiWmhs4. Vs/ss/ss/sssA m Ml LbAVIIAOI T.S. In #0 p audiometer AM. NATU STAND SPCC (ANSI-1969) LCFT CAR RIGHT BAR AIR RONE !RUM X 1 oJUS | O Examine*'i Signotufi SGP 0008959  I ; SGP 0008960 7 5 0 0 ! ! * j I I --I_________ J J LI -____ 1 --------------!----- -- I-------! -- 7 5 '-------- 1----- ! Z ------ 1-------- 1-------1-------1------ 1-------1-------1-------!-------!------- 1-------!------- MAH;., fTt i. /AM* Uofi, M.D. ROftEtT A. CAPUTI, M.O HAftOLO L GRAPP, M.O. JOHN N. STRACKAN, M.l NAME,___________________ Pr..nl 4tk. (Wkal do ye. 4*1 OWiVAkW ww i tttrtk mwWi W/\b 755 TONAWANDA JTM5T UFPAIO, N. Y. 14207 mVHONI, >75.1514 PERIODIC HEALTH EXAMINATION REPORT date 2o 10/77employes. Georgia Pacific cvry day_______________________ Hnjday dov./wk, monflu/yT. fmiwi oxpovr.i whom -- whoa -- ond lor how long Silk* -- Mn4 foundry, mining, goorrying, caroak. Silkota. -- Hk, aibfiai (typo) mining, milling, fabrkolien, application, l.itil.,, olh.r far,________________yton. INQUItY | YES 1. Cough 2. Chttl poin ! I 3. $Oft of nil 4, soft fion 5. Expectoration 6. $lp Rot Jt.s. 7. Pillow. 0 - 1 2 - 3 ft. Iom wgt./oppotite { 1 ^ r- 9. lncrMiinft fatiflva 10. Dytpboftio 11. Oiouftt in bowti habit 12. ftioorflou Cpvfik Vomit lloody .tool ftiock stool Urino Skin 13. Smoking cigar/pipa/cig'L _____________________ # pk./4y for________ you NO | 1 i/a W ,/{/ o /J) J/77J, i v 'j 7 / PHYSICAl EXAMINATION___________ AGE, 60________ HEIGHT, 5*7"_________ WEIGHT, MUCOUS MEMBRANES (pigment, pallor, neoplasia) - 4- , - 15Q CHEST. CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION HEART, Rhythm, rat*, ton**, murmur*, B.P. ABDOMEN, Liver/Spleen EXTREMITIES. Edoma, dubbing, atrophig* NEUROLOGICAL PCN DTR CUTANEOUS Dermatitis Piomonlalion Neoplasia examinee's Signature Signature ADENOPATHIES SGP 0008961 rEF 25 V. - 75 V. IMPRESSION: ^t NORMAL - 7>/ F. E. V., =- litors/toc. M. V. V. / ______________(OBSTRUCTIVE V F. E. V.j = litori/minuta ^ ^ffiOTRICTlVE J ELECTROCARDIOGRAM Anoxia: P Pulmonale: Right Heart Strain: Abnormalities of rhythm: Abnormalities of conduction: Othar: NO DIAGNOSTIC ABNORMALITIES STT segment changes BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: Saa Attochad_________________ SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: No+ K+ Mg + + SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: Saa Attochad BLOOD LEAD:____________________MICROGRAMS % MISCELLANEOUS: ACHLORHYDRIA (DIAGNEX): OCCULT BLOOD: URINALYSIS: ALBUMIN SUGAR URINE LEAD 5^7CHEST XRAY- NORMAL ABNORMAL . MICROGRAMS/UTER URINE SULPHATE RATIO UICC/CINCINNATI /. Mild prominenoe of both root areas. Some increased radiabllity in both uppers, and in the left base.Lateral projection indicates increased radiability behind the heart and behind the sternum. Diaphragms are flat and in the lateral proj ection. Chest x-ray suggests pulmonary emphysema of & modest degree and in --essegccaa Change from previous-film #9019' lateen-10/30/75.---------------------------------- OTHER ENVIRONMENTAL DATA: Sompla typo____________duration ASBESTOS: Number Fibort > 5 Mu./Cucm. OTHER: SILICA Mgs./M* R-nminpe has evidence of mild pulmonary emphysema, essentially on- ft l.y *'.V- I m( I * mm l l I l< j * *.* *! 1` tjoiu obstructive aiul res trio Li vo liuiuot. A^uiu ossoulia l Ay iiih;Iuui/;oU i ***** ***; previous studies. Please advise examinee he does have pulmonary^emphysema al though not disabling. Incidentally, studies of the chest does hot demonstrate the presence of any pleural dysplasia, Attached audiogram demonstrates moderate -'a!- inRs of a sensori-neurol variety. --111 1 ii i : ------ ---------- .-- ^l /s SGP 0008962 DUSvALO 1K3US72AL .VESICAL CEffld 7SS TONAWANOA STRICT IUFFAIO, N. Y. 14207 TakptraM (73-llU K2A2JNG EVALUATE SU??1583I7 EXAMINEE:. employer___ Georgia Pacific _$. No.t. J03 ASSIGNMENT:. . AGE. 60 PREPLACEMENT PERIODIC BASELINE fYeT] No| PREVIOUS DATE: FO WHOM: IS PERSONAL PROTECTIVE EQUIPMENT WORN [YetlNol Parlinant Occupolional HUtofyi --- sxa.y.k&'rcn PrliitAi M*4kal Hillarys. Allargiaf___ Hod Injvry. Kinging in Cart.. Mite ______ ____- -Painful Cart. .Vaftlga..Running Cart. Mililory Sanrica- . Dwralian- APPIJCANT'S EVALUATION OF HCAftINO STATUS Normal 0 Constant 0 OftMl Not Normal Q VaHabla Q Fregraui** Q Hos trouola haoring In Gr*i Cin Avditorio 0In Noiiy Fiacot At DUtonca 0 Ciota 0 Talopbono0 Rodio-TV 0 Womon and Children 0 lacavM of tinging in Ian 0 2ars Drums Canal Nosq Three? Tuning ?erk X L 2/10/77 Date: . Timet MUJiV<iM(iwW LrvSVM4MrS4(wW ----- ----------- Interval since lost noise exposure:. osha norouo rniw___ tl|kt Car Ht loft Car iiJ0JO . JS0 1000 3000 3kv<r i o o ;i >#3000 __ i n Zii 4000 *000 76' *V \ 1000 'H -213, 3SAVERAGE T.S. In dfc AUDIOMETER AM. NAT'l STAND SPEC (ANSM969) IIFT EAR RIGHT EAR AIR HUE | X *10 | O CONE cxomineo*s Signatures -- examiner:. SGP 0008963 SGP 0008964 1 'j. ObcIT A. CAPUTI. M.D HAtOLO l. ORAPP, M.D. JOHN N. STtACHAN. MM. NAME. __ Prnt dul.# (Whot do you do) uwn'HhVJ iiwwwMu.iti 755 TONAWANDA STREET (UWAIO, N. 7. 14207 TELEPHONE: (75.1514 PERIODIC HEALTH EXAMINATION REPORT ... OATEi 2/23/77 employes Georgia Pacific vary day______________________ Hr>./dcy dgyi/wk.__________________monlht/yT. PrtviOwi upyiyrti wftKi -- whan -- and (or how long silica -- .and foundry, alining, quarrying, cranio Silica**! -- talc, aibotMt (typo) i mining, milling, fabrication, application, toatilai. olhar for, INOUIIY 1. Cough 2. Choit poin 3. SOI at rail 4. SOI A offort 5. Eipoctorotion 6. Sloop flat h.i. ! YES 1 l j ' 1 7. Pillow. 0 1 2 - 3 /1 1. loti wot./eppotito 9. Irvcrootiog fotlgoo 10. DytphogSo M. Chang* in bowol hobit 12. Stood loti Cough Vomit ftloody ttooi Hock itool Urino ---- a Skin 13. Smoking cigor/pipa/cig't. _______________ / # pki./doy for 2>Q yor NO y | yS S y s s S' / s S' / PHYSICAL EXAMINATION AGE: 49 HEIGHT: 5'10" MUCOUS MEMBRANES (pigment, pallor, neoplasia): C . CHEST.- CONTOUR :. .. EXPANSION . MOBILITY DIAPHRAGMS AUSCULTATION , ,c* . i -1 ' *i : *' T '"Z ' * v WEIGHT: 150 * s . ' i v~ - ( i` * * :. i : l, # * . .Zi" * . j ' k . 0' e * * HEART. Rhythm, rate, tones, murmurs, B.P. ABDOMEN: Liver/Spleen EXTREMITIES: Edema, clubbing, atrophies NEUROLOGICAL PCN DTR CUTANEOUS Dormatitis ' Piontcnlalion Neoplasia Exominoe't Signoluro ' * Signaturo*- ADENOPATHIES ''* 4 ' w .i . . . _ M.D. SGP 0008965 P Pulmonale: Right Heart Strain: Abnormalities of rhythm: Abnormalities of conduction: Other: BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attoched SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: No+ K+ Mg + + SERUM ALPHA I, ANTI TRYPSIN SERUM ELECTROPHORESIS: See Attached BLOOD LEAD: MICROGRAMS V. MISCELLANEOUS: ACHLORHYDRIA (DIAGNEX): OCCULT BLOOD: URINALYSIS: ALBUMIN____ SUGAR URINE LEAD MICROGRAMS/LITER URINE SULPHATE RATIO % CHEST XRAY NORMAL ABNORMAL . UICC/CINCINNATI SLt. fibrosis of both roots. There is evidence of pleural thickening at the summit of each lung, probably as indicative of old inflammatory disease. No evidence of specific active disease however. Heart shadow, bony cage are nrml. This film compared with #9018 taken 10/75 indicates in essence no change. OTHER ENVIRONMENTAL DATA: Somple typo____________duration ASBESTOS: Number Fiber* > 5 Mu./Cucm. OTHER: SILICA Mgt./M? Ventilation study at this time although satisfactory, does indicate 3 ci i' i' i r.. . ^m | ill i oiliti4`(t*ii ill Mm I n limit r l lu I i:|iui>l l,V mul (Im inn \ I un mi m'un uiiiig ca4pacit^y, as com*pared to the euriiui- stud*y* . O----n---e--Ss'-u----x---^\r--a---Yy -i--s-- -----u----n- changed. Audiometric examination indicates the presence >of mild bilateral hearing loss. Examinee^ status in general appears to b6 unchanged . Pleeaase advise. M' rvr Ar ______ _ M.D. SGP 0008966 DUrvALO INDUSTRIAL .V- GAL Cnvk 7SS TONAWANDA tTUZT SUEEALO. N. Y. 14207 Tolopbono <75*1514 PREPLACEMENT HEARING EVALUATION SU?H2L7N7 EXAMINEE:______________________________________ 103-24-3225 S.S. No.:------------------------------------------------ employer_____ Georgia. Pacific ___________IOB ASSIGNMENT:__________ PERIODIC BASELINE | Yes | No) PREVIOUS DATE: FOR WHOMi IS PERSONAL PROTECTIVE EQUIPMENT WORN jYeslNol Portinont Occupational History* A AMV 44Wt\ Pertinent Medico! History i. Ears Drums Canal Noso R L Pulioi n. , . ....... ............ APPLICANT S EVALUATION OP HEARING STATUS Normol Q Not Normal Q Hot trowblo hoofing Yot No in Awditorio C At Diltance Rodio*TV Q CoAitont Q Vortoblo Onto* Pregrettion In Groups In Noisy Placet ciot a Telephone Women o*d Children Q Q Hcobm ! Ringing in Ears Q Throe* Tuning Fork 2/23/77 . Timo aud;o;,127?jc la* A A A yW4\i .Interval tine* last noite exposure: . a a o a ftvrrs* OSHA PROPOSI0 SYSTEM Riht Ur Hi toft Cor l]u 750 O.X... 500 JlSx7. i< 0 1000 AS :p 0 3000 ^000 ^ r rc' 4000 ftp} l<r 4000 K 000 p/. (c AT.VSE.RleAG0E4 7i<* r> AUDIOMETER AM. NAT'l STAND SPEC (ANSI-1969) AIR BONE LEIAFRT CLUE /\N/ REIGAHRT RED I O /-N kj Examinee's Signature: Examiner: -- SGP 0008967 SGP 0008968 /. . . rv.i). ' i >e*t a. cafuti, m'.o HAROLD l. GRAFF. M.O. JOHN N. ST EACHAN, M.C WWI I < PERIODIC 75$ TONAWANOA STRUT BUFFALO, N. Y. 14207 TUiFHONI: *75-1514 HEALTH EXAMINATION REPORT name,BAT*, 1/14/77 Praiont duties (Whot do you dal EMFLOYt*. Georgia Pacific ----- Evry day HnVday days/wk. monthi/yr. Previous exposure i wKtfi -- whan and foe bow long Silica -- toitd foundry, Mining, quarrying, coroaks Silicate* -- 10k, asbestos (typo)i Mining, Milling, fabrication, application, textiles, othor fori yoars. INQUIRY 1. Cough 2. Chest pain 3. SOS of rast 4. SOS on effort 5. Expectoration 6. Slop Sot h.i. 7. Fillewt 0 /l/ 1 3 1, lou wgt./oppotito 9. Incraaiing fatigue 10. Oytphogia II, Chonga in bowel hoblt 12. Stood toss Cough Vomit llody itaol Slack stool Urina Skin 13. Smoking cigor/pipo/cig'ts # pks_/day for YU I I I 1 1 . yoors NO iy y< K. 1/ PHYSICAL EXAMINATION AGE: MUCOUS MEMBRANES (pigment, pallor, neoplasia) ee CHEST: CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION ' HEART: Rhythm, rate, tones, murmurs, B.P. ABDOMEN: Liver/Spleen EXTREMITIES: Edema, clubbing, atrophies NEUROLOGICAL PCN CUTANEOUS Dermatitis Pigmentation Neoplasia Examinee's Signature HEIGHT: WEIGHT: Signature DTR ADENOPATHIES *" -- SGP 0008969 P Pulmonale: Right Heart Stroini Abnormalities of rhythmi Abnormalities of conduction! Other: BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attached SERUM ENZYMESi_________________________ SERUM ELECTROLYTES; No* K+ Mg-H~ SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS! S* Attached BLOOD LEADiMICROGRAMS % MISCELLANEOUS i ACHLORHYDRIA (DIAGNEX) i OCCULT BLOOD: URINALYSIS: AL3UMIN___ SUGA URINE LEAD MICROGRAMS/UTER URINE SULPHATE RATIO V. CHEST XRAY S"jf Gl** NORMAL ABNORMAL UICC/CINCJNNATI other Mild prominence of the root areas, minimal increase in bronchovascular markings over the lower halves of both lung fields. Trachea in midline.Lateral projection does not demonstrate flattening of the diaphragms. Heart shadow has some broadening in the region of the thoracic aorta. The bony cage is not remarkable. No evidence of pleural dysplasia noted. Chest x-ray is considered to oe satisfactory for examinee's age and compared with #8890, taken 10/21/75, in essence, no change. ENVIRONMENTAL DATAi Sample type____________duration ASBESTOS: Number Fibers > 5 Mu./Cucm. OTHER: SIUCA Mgj./M1 Ventilation studies, chest x-ray are both satistactory and essenmisc & summary: tially unaltered. Audiometric examination is satisfactory. Please note, no other studies done. ... m.d. SGP 0008970 BUIvALO INDUSTRIAL 7S9 TONAWANDA STUCT ::cal CZ.TRR lUFFALO, N. Y. 14207 TtkpkMM 7i-UU KSAXXG EVALUATION $U??13X5N7 EXAMINEE: -- ....................... SS Kin . EMPLnvpst Georifia Pacific ma assignment. AftF 60 PREPLACEMENT PERIODIC BASELINE | Yes | No I PREVIOUS OATfi FOR WHOMi Q Pnrtinnnl 0vpaliMl HUloryi IS PERSONAL PROTECTIVE EQUIPMENT WORN [Yes | No| exa.vjnat:cn Pnrtinnnf Modkoi HiMoryi Altnrgim------ ------- ---- -- ----------- --------------------- Hood Iftjury------------ -- - _ -- - i - Eo/S. ... -______ ____ ......_______ Poinfwl Ease - --.................... Sinking in . -- ----------- MilC. - -- ------------- ----- -- --------- ------------ Militory - OutigB.--------... ... ----- 0Ttion. n.-- .---- - , Throat APPLICANT'S EVALUATION OP HEARING STATUS Normal 0 Conitont 0 Onto* Not Normal 0 VoriobU Q Hoi treubln hoofing Yt No Progression In Groups 0 Tuning ?r!c In Awdilorio 0 In NoUy Plat#* At Oitloncn Rodio-TY 0 Com 0 Tnlophonn 0 Womii ond Children 0 0* Ringing in lore 0 | Date: 1/14/77 Time: AUDSOrJSTTJ r1* vP ,A f**'L*n ..Interval since lost noise exposure: SGP 0008971 ;75CO I*'') SPECIFY 7.S LITEM. TYPE JPIOOSA L4 SGP 0008972 . . I, M.O. *OSE.> X. CA7UTI, M.O NAkO'C l. GlAff, M.O. JOHN N. 5T5ACHAN. M.O. NAME)__ ______________ Pranl dwft (Whot do row do) V 755 TONAWANDA 5TRI5T 5UFM1.0. N. Y. 14207 TIUPHONI: 575-1514 PERIODIC HEALTH EXAMINATION REPORT pah. 2/10/77 tMnoYEtt.GfeQirgj-s Pacific Evory doy Hrt./doy doya/wh. montht/yr. Proviowa poawrai whoro -- wbon -- and far how long Siiico -- aond favndry, mining, ^worrying, coromic* Silicotaa -- tak, oaboatoa (typo)i Mining, milling, fabrication, application, toxtiioi, othor far won. 13. Smoking cigor/pipa/cig'tt i f-z. # pk./day far +>c* yaora PHYSICAL EXAMINATION___________ AGE: __________ HEIGHT: 5'8" MUCOUS MEMBRANES (pigment, pallor, neoplasia I WEIGHT: 175, CHEST: CONTOUR EXPANSION ' MOBILITY DIAPHRAGMS AUSCULTATION HEART: Rhythm, rata, tonai, murmur*, B.P. ABDOMEN: Livar/Splaan EXTREMITIES: Edama, clubbing, atrophias NEUROLOGICAL PCN DTR CUTANEOUS Dermatitii Pigmentation Neoplasia Examinee's Signotura Signature ADENOPATHIES Hr .. . _ . M.5. SGP 0008973 P Pulmonale: Right Heart Strain: Abnormalities of rhythm: Abnormalities of conduction: Other: 31000 COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attached SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: Nqt Kf Mgtt SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: See Attached BLOOD LEAD: MICROGRAMS % MISCELLANEOUS: ACHLORHYDRIA (DIAGNEX): OCCULT BLOOD. URINALYSIS: AL3UMIN I SUGAR___ 1 ' *Ji URINE LEAD . , 1 MICROGRAMS/LITER 1 URINE SULPHATE RATIO V. CHEST XRAYNORMAL J ABNORMAL UICC/CINCiNNATI Mild prominenQeo^the root areas. Peripheral lung fields generally not re markable. Trachea is inmidline. Diaphragms are smooth and all sulci are clear. There is some very equivocal evidence of pleural dysplasia along the left par ietal border. It is not marked. Heart shadow, bony cage are normal. Chest x-ray should be considered satisfactory. OTHER ENVIRONMENTAL DATA: Somple typo____________durotion ASBESTOS: Number Fibers > 5 Mu./Cocm. OTHER: SIUCA Mgs./M) t juiwi-n,. Slit no tv'IMl t.o Hio mIi"I 7-vbv nml vonl I 1 n I i mm olu.lli.tj i<ti In: :m l< Ui I in: Lu:ay . l'Li:*in: ml V I ut: . Ami I uhhi l>:' I ii y Lit ny u at this line is quite satisfactory. _______M.D. SGP 0008974 DU77ALG JXBUS7TJAL 7Si TONAWAN&A ST2IIT TelepliM* 175-1514 CSJTSJ SUffAlO. N. Y. 14207 EXAMINEE:. K2A2KS EVALUATION SU??iS7iV.2laViV!7i ________________________________ S.5. No.i ~22- )-4S66 AftP 49 employer___ Gfi-O JOB ASSIGNMENT: PREPIACEMENT PERIODIC BASELINE rv5T| No| PREVIOUS DATE. FOR WHOM. IS PERSONAL PROTECTIVE EQUIPMENT WORN | Yes | Nol Pertinent Occepotionol History'. . ......... --....................-- -- Pertinent Medico! History. Allergies Head Injury...- dinging in Ears... MiK.--------------- ..Painful tor* . -Vertigo..^--. -Running fo Military ServiceDuties.,,--...------- . Dwttiiu APPLICANT'S EVALUATION OP HEARING STATUS Normal 0 Nol Normol 0 Constant Q Variable 0 Onset 0 Progression 0 Hos trouble hearing In Groups 0 In Audilono C In Noisy Places At Distance 0 Cose 0 Telephone flodio-TV Q Women and Children 0 lecouse of Ringing in Ears 0 0 Ears Drums Canal Naso mroct Tonsr.o rorlc X l Date: 2.10.77 Timet ______________ Interval since lost noise exposure: SGP 0008975 ** 1*TJ SGP 0008976 ROCCTT ,4. CAPUTI, M.O HAROIO l. CRAPP. M.O. JOHN N. SIRACHAN, M.O. PERIODIC 755 TONAWANDA STRUT SUPPAIO, N. Y. 14207 TEUTHONt. 575-1514 HEALTH EXAMINATION REPORT .2123/22NAME. DATii_ __________________________________________________________________EMTioYMi Pr.ionl dull.. (Who! 00 yo Mol Georgia Pacific {vary May______________________ Hfi./doy 5ay/wk. monthi/yr. Proviowi oxpoiwroi 'Kora -- fc* -- and (of too long Silica -- >oa0 (ornidry, mining, qsorry,ng, ceramics Silicates -- tolc, asbestos (rypa) i mining, Milling, fabrication. application, tcstil.i, ether (on INQUIRY 1 YU 1. Cough 2. Cheit pain 3. SOS ol roit 4. SOS on affect 5. Expectoration 6. Sleep riot h.i. 7, Pillow* 0 - 1 - 2 - 3 1. lost wgt./appetite 9. Increoiing fatigue ! ! 1 10. Dysphagia 11. Change in bevel habit 12. Stood fan Cough | Vomit Sloody stool | Slock stool Urine Skin 13. Smoking cigar/pipa/cig'ts _________ # pki./Ooy (of________ yoari NO AM)A/O /yt - A/t-Mi, )V0 fUO /w >VO i PHYSICAL EXAMINATION__________ AGEt 50_________ HEIGHT. 5*11" MUCOUS MEMBRANES (pigmgnt, pallor, ngoplasia) CHEST. CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION HEART: Rhythm, rat#, ton#s, murmurs, B.P. ABDOMEN. Liver/Spleen EXTREMITIES. Edema, clubbing, atrophies NEUROLOGICAL PCN CUTANEOUS Dermatitis Pifinicitlalion Neoplasia examinee's Signature --L .. _ v Signature WEIGHT; 235 DTR ADENOPATHIES . M.O. SGP 0008977 P Pulmonale: Right Heart Strain: Abnormalities of rhythm: Abnormalities of conduction: Other: 81000 COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attached_________________ SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: Not Kt Mg + -r SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: See Attached SLOOD LEAD:_______ -MICROGRAMS /. MISCELLANEOUS: ACHLORHYDRIA (DIAGNEX): OCCULT BLOOD: ______ URINALYSIS: AL3UMIN___ SUGAR. URINE LEAD -MICROGRAMS/LITER URINE SULPHATE RATIO V. CHEST XRAY^yj^ NORMAL ABNORMAL i UICC/CINCINNATI Moderate fibrosis of both roots and all lobes. Some few areas, fibrosis is beginning to exhibit fibronodular characteristics which is generally re flecting examinee's body build. Heart shadow, bony cage are nrral. Very min imal Increase in peripheral fibrosis as compared to previous film 9125, -------taken--11/S/-75-.---------------------------------------------------------- ----------------------------------------------------------------- OTHER ENVIRONMENTAL DATA: Somplo typo____________durotion ASBESTOS: Numbor Fibon > 5 Mu./Cucm. OTHER: SIUCA Mg*./M3 Ventilation study s nf. i Ton hory t f n foot pnmowlmt. f ni|n-nvnil aver r. .HMMAHi , (,|ia study nf I'J'/Ti. li||Onl j--ioy ^onoin I I y mil. mumi ImMu, lin i.v I ili.m.i. of plourol dysplasia, which would suggest uuy usbostos exposure. rloaso ad vise examinee. _______ M.D. SGP 0008978 aU7?AIO 1NDUSTCAL .Y^wLL CZC7Z2 755 TONAWAUDA STESZT 5UFFAIO. N. Y. 14207 TaUphm 575*1514 EXAMINEE:. FAAPinvFB Georgia K2ATJXG Pacific SVAIUATJCM S^11VJL\T PREPLACEMENT PERIODIC BASELINE |YmJ nS] s.s. 106-20-2676 ^50 PREVIOUS DATEi JOS ASSIGNMENT* FOR WHOMi pk IS PERSONAL PROTECTIVE EQUIPMENT WORN lYcs|No| Pertinent Occupational Hiitoryi ................. -- swj.xcat:cn Pertinent Medico! Hitloryi. Allergies______ Heod Injury-- Singing in Eori._ Mile.__________ ..Painful Ears. ^Vertigo..,,....... ..Running Eon- Military Sarvka~ Dutiei~~. . Duration- APPLICANT'S (VALUATION OP HEASING STATUS Normal 0 Not Normal 0 Constant 0 Vonablo 0 Onsat Q Progmision 0 Hoi trouble hearing In Growpt Q In Audiloria 0 In Noisy Places 0 At Distance 0 Cloi# 0 Telephone ftodio-TV 0 Woman and Childran 0 Bacavia of tinging in Eon 0 0 Throe? Tuning Fork # %vidiWJ *W Date:____ 2/23/77. __ Interval sine# last noise exposure: . PIEOUINCY HEtTZ (Hx) ^ o a a i:s 2so 2000 *r ^ & < nroVr * 1/1 J1 ____ 'i>\ o i 'l <br? f------ r '"V ! '2 .. .V / . 1iS0tt; <: 3fcJ* *> i i<AS> ~ 1 w Ay yj/x / UZ..-M ktuAa V>X aW[/' s/s//sX^sTt/*swr/fsMr * / 22WL IAA.O.O. SrSTlM __________ OSHA FEOFOSED SYSTEM______1 tight tar Hr left tar i Lin... s 1 250 . "b-.j 1000 (n ;3000 3000 (p 4000 (0\ M 4000 /s 1000 U/.C<3l.'i /< L.U Ul.AVERAGE T.S. in dfc AUDIOMETER AM. NAT'l STAND SPEC (ANSM969) LEFT EAR RIGHT EAR AIR i \t SLUE ! /\ 11ED O BONE o SGP 0008979 ft SGP 0008980 t ........ n, M.i>. ROBERT A. CAPUTf, M.D HAflOlO GRAFF, M.O. JQMN N. STRACHAN. M.O. NAMli__________________________ Prant dwlio* (Whot do you 4) k>VI I PERIODIC |4 < < 755 TONAWANDA STRUT 5UFFAIO, N. Y. 14207 TSUTHONfi* 175*1514 HEALTH EXAMINATION REPORT dam. 2/10/77EMPLQYtti Georgia Pacific t.ry doy_______________________Hr./oor day/wlc. wontht/yr._________________ far. Frcvioua oxpoiuroi whtra -- when -- and for hew long Silk -- aond foundry* mining* quorrying* coromic* Siltcotoi -- tolc, otboiloi (fypo)i wining. Milling* fabrication, application* toxfiJos* alhr 13. Smoking cigor/pipo/cig'ti / fi-K # pki./doy <0, _ yor PHYSICAL EXAMINATION AGE: 62 MUCOUS MEMBRANES (pigment, pallor, neoplasia) CHEST: CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION HEART: Rhythm, rate, tones, murmur*, B.P. ABDOMEN: Liver/Spleen EXTREMITIES: Edema, clubbing, atrophies NEUROLOGICAL PCN CUTANEOUS Oormotili* rivJlimnfuljoit Neoplasia Examinoo's Signature HEIGHT: 5'7' WEIGHT: 170 Signature DTR ADENOPATHIES SGP 0008981 M.D. ? Pulmonol*: Right Heart Strain: Abnormalities of rhythm: Abnormalities of conduction: Other: 81000 COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attached SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: Na^ K+ Mg + + SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: See Attached BLOOD LEAD:___________ MICROGRAMS */. MISCELLANEOUS: ACHLORHYDRIA (DIAONEX): OCCULT BLOOD: URINALYSIS: ALBUMIN___ SUGAR URINE LEAD. -MICROGRAMS/LITER URINE SULPHATE RATIO -V. CHEST X RAYNORMAL ABNORMAL UICC/C1NCINNATI Mild fibrosis of both roots. Moderate fibrosis of all lobes. Multiple small calcific densities in each. Some evidence of pleural thickening at the summit of each lung. Heart shadow although rather full, is not abnormally so. Later projection demonstrates a distinot increase in the PA diameter of the cheat OTHEERR a!, aemonstratea in the ventilation study. ENVIRONMENTAL DATA: Somplo typo ` ASBESTOS: Numbor Fibora > 5 Mu./Cucm. OTHER: SILICA Mgi./M> duration rianhic prnhnhly lina very mllil |iul ronnory ft i f f.i.nnl 1r, |* y no 1/ ll i . 9 iiilltHii'Kil hy llo GUI ly imooj f j* I t V* y otupliyooum v lulu II ttmt^Ki i . l ull l ;/pOiU, labuil iu/iO/75 Indicates iluuu juilU iuoi'ouuu in' peripheral IlUiOulu nil.I more importantly some changes in the heart shadow size and inf it's oonfijurut. E:caainee should be advised of these changes and directed to Consult vith his personal physican. Overall pulmonary funotidh, appears to be/unchanged.____ MD SGP 0008982 DU."ALO IMD'JSTTUAI. .".".SICAL C3R3J 7SS TONAWANOA STUfT SUFNU.O. N. Y. 14207 T*kpkM S7S-1S14 X2AZX3 SVALUA7&X 2C??L1VJL\7 EXAMINEE:. S. i No.P?.5.-.0.3.r.UJi-.., AGE- fmpiqyfb Georgia Pacific JOB ASSIGNMENT; PREPLACEMENT PERIODIC n BASELINE [Yes] No| PREVIOUS OATEs FOR WHOM* IS PERSONAL PROTECTIVE EQUIPMENT WORN |Yes|No| fr*irtrtt OcCwpaltOftOl NillOfyi .1 -.... . ...... I 2XAt.VXA~.CN Partinant Modkol Hiitoryi. Allarg'**'--~- Hod lnjvry~ Singing in Eort_. Mi. ............ - -Painful Cor*. -Vortigo.. ....... -Running lor*.- Military SarvkaPutU-------------- . Deration.. APPLICANTS EVALUATION OP HEARING STATUS Normal CD Not Normal Q Has trowbla haaring Constant Varlobla *** Q OnMt Q Progression Q In Groups CD In Awdiforia Q In Noisy Plocos CD At Oittonca 3 Cloo Q Taiaphona Rodio-TV Q Woman and Children Q tacausa of tinging in fort 0 Q Throe* Tuning Ferk KoioiviVMtMvn Dole:2/1.0/12____________ Time: .Interval since last noise exposure: il____135 / / / /7KOUENCY . Htrrz (Hi) ,o 110__ *00 1000 1000 1> > ) AA.O.O. lYTtm------ _ OSHA MOfOUO Ulkt far Hx (0 ..LSOI 750 10 1000 \ 7000 i..sr.$ _JOOO_ loft far (O i `A s: 4000 4000 v<,< S 000 0- lIV AVItACi T.S. in 04 Iw '.tt'.r/.'N//?/,/*k/i"/s/t/jf/*r/*t AUDIOMETER AM. NAT'l STAND SPEC (ANSM949) itn tAI tICHT fA3 AIR SONS 1 %/ HUE i A ieo | o j o Examinea's Signature:---------------Examiner;----------------------------------- SGP 0008983 7400M L I z oawuj tfi x z 0. p O' o; a. ; I SGP 0008984 loaEsr a. CAfuri. m* HAIOID L. G*A, M.O. JOHN N. STftACHAN. M.O. NAM Ei ____________ ________ Pr.:.nt 4vtia (What 4o you 4a), 74 4 TONAWANOA STSEfT IUEEAIO, N. V. 14207 TSU7HON4: *74-1*14 PERIODIC HEALTH EXAMINATION REPORT -------- _0ATI. 1/26/2.1------ _EMPtOYE.--Ggargj a f4r Cvocy day Hn./Soy ^tyt/wk. montht/yr. Eraviavi axpatvrai whara -- whan -- a4 lor haw Ian* Silica -- land toun4ry, Mining, worrying, cwoaia Silicalat -- talc, aibatiai (typa): mining, milling, fabrication. application, taxiila*. other yaor*. INOUfCY YES \. CovQh 2. Choit pain 3. SOI at rail 4. SOS on offort 1 1 5. fipoctorotion 6. Sloop Sot h.. 7. Pillow* 0 1 2 - 3 ft. Ion wgt./oppotito 9. Increasing fotigvo 10. Dysphagia 11. Chongo in bawal habit IS. IMiou CowfK Vomit tloody iteal Slock iiool Urino Skin ' 13. Smoking cigof/pipo/cig't* _________________ # ph*./4oy tar________ yaor* NO v.. r is tr* ( i^-~ 4-- i-- *-- 4-" PHYSICAL EXAMINATION . AGE: 60 MUCOUS MEMBRANES (pigm*nt, pallor, n*opla*ia) CHEST: CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION *' " HEART: Rhythm, rat*, ton**, murmur*, B.P. ABDOMEN: Liv*r/Spl*n EXTREMITIES: Ed*ma, clubbing, atrophia* NEUROLOGICAL PCN CUTANEOUS Dermatitis Pigmentation Naoplasia Examine*'* Signatur* HEIGHT: '' :- : WEIGHT: 1 "' a Signatura DTR ADENOPATHIES - SGP 0008985 P Pulmonale: Right Heart Strain: Abnormoiitie* of rhythm: Abnormalities of conduction: Other: BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attached SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: No+ K+ Mg+ + SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: See Attached BLOOD LEAD:____________________MICROGRAMS /. MISCELLANEOUS, ACHLORHYDRIA (DIAONEX): OCCULT BLOOD: URINALYSIS: ALBUMIN___ SUGA CHEST XRAY S7SI RUjE LEAD ABNORMAL MICROGRAMS/LITER URINE SULPHATE RATIO UICC/CINCINNATI V. Moderate prominence of the root areas. Peripheral lung fields are generally not remarkable. Heart shadow normal In size, position and configuration. The bony cage is normal. The lateral projection does seem to indicate some Increase in retrocardiac area raalolucency. OTHER ENVIRONMENTAL DATA: Sample type____________duration ASBESTOS: Number Fiber* > 5 Mu./Cucm. OTHER: SIUCA Mgi./M* I7"militieo ilripq praaonl- in I lie Imio fnnr.Men qlmlloq pviiloii. a ,,f ai * >1 *a L i HCl I oil j Culii^a icJ LO Like &Lktlles uf i'J / y , Id 1^ im> I ku 1. Chest x-ray is unchanged. Examinee denies, incidentally, any subjective complaint. / He should be advised as to the presence of some airway obstruction, a1, changed over the studies of 1975. His ' '............... * * l*,vr..V ' i' ------- --------r--;--------------- MJ `' SGP 0008986 DU77ALO INSUST21AI /.IZXCAL C2CT TSt TONAWANDA TUir HJFFAIO, H. Y. 14107 TtbphMM S75-1S14 K2AS2&G i-VALUATICM SU??LS.V3IT PREPLACEMENT n PERIODIC xgtpc BASEUNE fYes] No| EXAMINEE i fmpidycb Georgia Pacific S.S. No,^.^,3~.12.~36j2.............................................P...R....E..V...I..O...U...S............... age._Q- JOE ASSIGNMENTi. DATE: FOX WHOMi IS PERSONAL PROTECTIVE EQUIPMENT WORN lYe|No| 0<cv^iiMl History*, PtrtiMAf Hillwyi. Hod Ujary.. ftiafliaf i* Cart. Mi. -Pminimt Cart. ..Vortlgo^ _ftv*al*9 Ear*_ Military Soviet. Dwliat .. ........ AmiCANTI CVAIUATION OF HfACiNO STATUS Normal Q Not Normal Q Hot frowtoU fcaoriaf Yat No la AvOitorio Q Al OUtonca Rodio*TV Q Coatlont G VarfoMa Q OtMl Q Prograuion Q la Groapt G In Noity Ciocat Q Clata Q TaiopHoao WomoA and CKiMraa Q iacaa of Kinging Cart Q Ears Drums Canal Noso Tfcroct Tuning fork 8 L auo:c;;j7Tjc Date.-1/26/-?-?--------------------Time: ______Interval since last noise exposure: E"ECEOQUU-B-4-C--Y. HE' ETZ (Hi) A if.123___________ 3SO$00___________ 3000 loeo <r & & <F osha Morocco y*TiM___ Cifltr far He Loft Car /o 350 to rf o #wo_ s~ i 1000 <r 3000 o ;; J000 i( /.s.TIj <rs> 4000 V n " < 4000 h'S 000 '..s" JL2l AT.VSI.RlaAG4kI 3>*S AUDIOMETI1 AM. NAT'l STAND SPEC (ANSI-1969) an CAR RIGHT CAR AIR StUE | X oRfO SONS <S> G Examinee's Sigrtalu^: examiner.-_______r,, SSMASXS.. D72$. SGP 0008987 SGP 0008988 \ MARV.N'L AMOUR, M.D. CO'lUl A. CAPUTI, m'o HAROIO 1. CRAPP. M.O. ;OHN N. STRACHAN. Mj. OWlTdAfeW U^Jy^lUlAk HlhWlWhb WlklVtlilV 755 TONAWANOA STRUT UffAlO, N. V. 14207 nU7HON5i 575*1514 PERIODIC HEALTH EXAMINATION REPORT namiioati,2/10/77______ ^^QY^ASKSZXSXnfS Georgia Pacific Pr.ioni dulio. (Who* do you dol _____________ Ev.ry day Hr./doy doyi/wk, monlWyr. loci Proviau. ..poturui whom -- wfcon --_and lor fcow lo*0 Silica -- land laundry, mining, quarrying, encomia Silicolai -- lak. aibuilai (typa)i mining. milling, fabrlcalian, application, tonliloi, o.hoc______________ INQUIRY 1 YES 1, Cough 2. Chl pain 3. SOS ot nil 4. SOS on (ftd 5. tipidowliRR 6. Sloop Aot h.i. 7. Pillow. 0 -(\> 2 - 3 i 1 1. lost wgt./oppotito 9, Incroocing foliguo 10. Oytgliogis 11. Chango id bowot habit 17. Stood lou Covf h Vomit tloody ifool Stock stool Urino Skin 12. Smoking cigor/gipa/cig'ta ________________ # pki./dgy lor________ yuan PHYSICAL EXAMINATION______________AGE: NO ! d"" >- | e.-- ^0____________HEIGHTi ^'l"____________ WEIGHT. 245 MUCOUS MEMBRANES (pigmgnt, pallor, naoplasia) CHEST. ' CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION > . c 'v . . . . .J HEART. Rhythm, rat*, ton**, murmurs, B.P. ABDOMEN. Uvgr/SplMn EXTREMITIES. Edma, clubbing, atrophigs NEUROLOGICAL PCN DTR CUTANEOUS Dormatitif I'iumnniMlion Neoplasia Examine#'* Signature Signature ADENOPATHIES M.D. SGP 0008989 F.V.C = FEF 25 V. -75% IMPRESSION. F.E.V., = /? F. E. V. litars/MC. M. V. V. OBSTRUCTIVE F.E.V., = litan/minuta RESTRICTIVE ELECTROCARDIOGRAM Anoxio. O P Pulmonolai Right Haort Strain. Abnormalitiai of rhythm. Abnormaiitia* of conduction. Othar. NO DIAGNOSTIC ABNORMALITIES ST-T tagmant chonga* BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60. Saa Attochad SERUM ENZYMES._________________________ SERUM ELECTROLYTES. No+ K+ Mg+ + SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS. Saa Attochad BLOOD LEAD.______________ _____ MICROGRAMS % MISCELLANEOUS. ACHLORHYDRIA (DIAGNEX). OCCULT BLOOD;_____________ URINALYSIS. ALBUMIN______ SUGA ---------------- ------7 URINE LEAD . ..... CHEST XRAY^>^ NORMAL ABNORMAL MICROGRAMS/LITER URINE SULPHATE RATIO UICC/C1NCINNATI V. Moderate fibrosis of both roots, sit. fibrosis of all lobes. Some increased radiability in both uppers, particularly the left. Nairy fibrosis is-not spec ific. There is no evidence of pleural dysplasia. The heart shadow appears broadened in it's transversed diameter. This film compared with previous study #9015-talcea 10/30/75-.indicates la essenoe no change.---------------------------------------------------- OTHER ENVIRONMENTAL DATA. Sompla typa ASBESTOS. Numbar Fibori > 5 Mu./Cucm. OTHER. SIUCA Mgt./Ml duration S SIKAI.UU.; r>ami.noe does have evidence of mod or a pulmonary :fi\hroala <<r a ....i.--to|io* I I I u . IJ.* L o rto.*.; I <i . >1 I Mi t.tty u V I iki...;.. . i |M. ............... ;/ JuiicLLoii defect. Clio to L x-ruy umi ventilation stuitiVin uro imcimup/od over KlmUoto of 1975. Please advise. Attached audiro^ram ,is sati^aitory. -M.D. SGP 0008990 BUIvALO INDUSTRIAL .VESICAL CZN7Z2 7 TONAWANSA ITUZT SUFFALO. N. Y. 14207 TO-1J14 K2ASLNG EVALUATION SUPPLEMENT PREPLACEMENT PERIODIC BASELINE [Yc | No] EXAMINEE;. faapioyfb Georgia Pacific S.S. No.; fi9.5~Q..L~igO.Q. . AGE.. 61. JOB ASSIGNMENT; PREVIOUS DATE. FOR WHOM* IS PERSONAL PROTECTIVE EQUIPMENT WORN 1 V | No| Partiaaaf OecwpatOftal Hiitwyi. BCAMRARCN Parlinant Hiilttyi. All#rgiai___ Haod Injury-. Ringing in fort-- Mite . Palatal fort. _J*aaiog I Military . Paraiina- APPLICANT*} EVALUATION OP HIAUNO STATU} Normal 0 Not Normal Q Hat trowbi* haaring Caa*taat VoHoWa Vat 0 Q Ofttat 0 Piafiftulmi 0 la Graapt 0 In Aadilorio 0 la Naity Placat 0 At OittaiKa Goto 0 Talaplioaa Radio*TV 0 Woiaaa and Childraa 0 Eacawta of Ringing ia Ears 0 0 Ears Drums Canal Noso Throat Tuning rorlc R L 2/10/77 Dal: . Timo* rdJ^kWr4M i imW afO^MikMWt * Intorvnl sine* lost noiso oxposuroi 4its -J~i --81i JJ-vi J . 3 FREQUENCYf.HHIERTZ (hi) ^ ^ ^ ^ ts 10-- ____V __________ __________ _________ / .V r -/ Isv-- EL /J \ > 7 N%J < \A 1 0 10 10 so M AJLO.O. OEHA PfeOPOUO SYSTtMM-- IffM Sar Hi Uftlar 350 31 10 #M0# l r re' 1000 ir 2000 10 I vfe __ i__ L/C... *v<r JW0# 4000 *000 000 y <r S"7' />G'Z'UU,4Am Ctyj Ki4m j |7U-!h of At4r*rf*! W&///JV////SSA a m co WZL/ \ ISO JJLJJl. AVUAOI T.S. U 4b IAAAIV1 f/4-S AUDIOMETER AM. NAH STAND SPEC (ANSM949) AIR IONS LIFT CAR RIGHT EAR IUI RED V/ y\ O o Examined'* Signalurdi Examinor* SGP 0008991 SGP 0008992  3IRT A. CAFUTI, M.O KAROLO U GRAFF, M.D. JOHN N. STRACHAN, M.O. w* inw ws >.v wwitihK 7SJ TONAWANOA STBHT UffAlO, N. Y. 14207 iumonIi 07S.1S14 PERIODIC HEALTH EXAMINATION REPORT name.DATti 1/14/77tM7ioYi. Georgia Pacific Frtsont dtfiios (Whol do yow do! _ ------ - -- - - -- - - ____________ _ _ gyry doy Hrs./doy doys/wk. moaths/yr. Pr*vio oaposvroi whor* -- wfcoo -- ond for kow Wog Stlko -- lond fovndry, miniog, cacooie* Silicotos -- tok, osdostos (typo)* mining, MiltiAQ, foWkotion, opplkotion, loxtilos, othor fori INQUIRY 1. Coogk 2. Chost pain 1. SO* at rail 4. SOB on offort 5. Expoctorotion 6. Sloop Rot h.B. 7. Pillow. 0 1 2 9 1. lost wgt./oppotito 9. Incroosing fotigvo 10. Dtnebaaia 11. Cbaae* ia bowal babi. 12. Mood low CoogH Vomit Rloody stool Mock stool Urino Skin 12. Rooking egor/pipo/cig *ts ____________ Tic # bk.Vday tor YES NO / 71^. 7L<P "2^ >1* yon PHYSICAL EXAMINATION___________ AOEi________________ HEIGHT._________________ WEIGHT. MUCOUS MEMBRANES (pigment, pallor, neoplosia) CHEST. CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION HEART. Rhythm, rot*, ton**, murmur*, B.P. ABDOMEN. Liv*r/Spl**n EXTREMITIES. Edma, clubbing, atrophl** NEUROLOGICAL CUTANEOUS Darmatiti* Pigmentation Neoplosia Examinee's Signature , . PCN ... Signature DTR ADENOPATHIES SGP 0008993 M.D. P Pulmonole: Right Heart Strain: Abnormalities of rhythm: Abnormalities of conduction: Other: BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attached SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: No+ K+ Mg + + SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: See Attached BLOOD -MICROGRAMS */. MISCELLANEOUS: ACHLORHYDRIA (DIAONEX): OCCULT BLOOD: Parenchymal lung fields are not remarkable. There is no evidence of pleural dysplasia. Heart shadow normal in size, position and configura tion. The bony cage is normal. In essence, no change from previous film ---------------- #889 3,--taken 10/31/35.----------------- 1----------------------------------------------------------------------------------- OTHER ENVIRONMENTAL DATA: Sample type____________duration ASBESTOS: Number fiber* > 5 Mu./Cucm. OTHER: S1UCA Mg*./M> MISC & SUMMARY: Note absence of subjective complaint, Ventilation studies and chest x-ray studies are satisfactory. Examinee presents a mild hearing loss for his right: ear, which is probably*Tfiixe<rr^n tHat iC IS not"'aTl "Hue to nois-. Please advise examii _____ M.D. SGP 0008994 BUFFALO INDUSTRIAL APICAL CENTS 7IS TONAWANOA STU1T SUFFALO. N. Y. 14207 TiU^m S7S-1J14 HEARING EVALUATION SUfrUAtENT PREPLACEMENT PERIODIC BASELINE | Yes | No] EXAMINEE:. -S.S. No.i .AGE_ PREVIOUS DATti employer....,Georgia Pacific. JOB ASSIGNMENT:. FOt WHOM. IS PERSONAL PROTECTIVE EQUIPMENT WORN |Ye> I No I Fortinonl Otcwpalioftol History. - BCAMIKAHON Prtinnl Medical Hiitoryi - AM*rgiB^__ Hod Jftjry_ Kinging in tonMitc.......... -*otnM 1 -tanning En. Military SarvkoPoHtt . OintiatL. AWICANTS CVA1UATION Of HKAtSNO STATUS Normal Constant 0 0*fot Not Normal Q Hob troubln flooring Var*oWo Yob No trograuion* Q In Groop In Avditorio O At Distant* Radio*TV Q In Noiiy Tlocoi Oobo Tolopbooa Woman and Children Q ftocoofo of tinging in ton Q Ears Drums Car.ci Noso Throat Tuning Fork R L Dot.: AUBIQKSTCSC SSUU.1^3ATiSN 1/14/7-7- ______________ Interval tine, last nois. .xposur.: FtfQUENCY - HERTZ (Hi) g g g ^ OSHA PtOfOSCD SYSTIMh_. tloMSor Hi U* far {<. . 350 (0 r5.5.T.. 500 ! A <17 1000 / <. '*:? *o h 3000 ;p 5000 j.o.A 4000 5000 -5 D 5'b' 000 2iL. AVICAGf T.S.In 40 AUOIOMtTII AM. NAfl STAND STIC (ANSM969) LIFT CAK RIGHT (At Alt 1LU1 ( /Vv/ US | O IONE <s> G cxamine.'i Signatur.: Examin.r:___________ SGP 0008995 *. SGP 0008996 . /IM..V?, *0. 304UT A. CAPUTI, M.O HAROtO % GRAFF, M.O. JOHN N. jTRACHAN. Mi). UUi I'MbW i Ww I\rk TSS TONAWANDA STRUT ftUFFAl.0, N. Y. 14207 mUHONti 174.1314 PERIODIC HEALTH EXAMINATION REPORT namJi._______ _________________________________________ DATI. Praionf dvtioft (Who! do YOw dal . - -- -- 1/26/77 EMKOYtt. Cgm-gi a Pari fi> _ Evry doy____________ Hr./doy doyt/wk. moMhi/yr. Pr*vioi OKpocwrot whoro -- when -- and for Row food Silko--*and foundry, Mining, ^worrying, caromic* $i(iolo -- lok, etboito* (typa)t Mining, Milling, fabrication, opplicotion, taxiiloi, otKr fori PHYSICAL EXAMINATION___________AGE: 38___________ HEIGHT:__________________WEIGHT: MUCOUS MEMBRANES (pigment, pallor, neoplasiaI CHEST. CONTOUR EXPANSION MOBILITY DIAPHRAGMS AUSCULTATION HEART: Rhythm, rot*, ton**, murmurs, B.P. ABDOMEN: Liver/Spleen EXTREMITIES: Edema, clubbing, atrophias NEUROLOGICAL PCN OTR CUTANEOUS Dermatitis Pigmentation Neoplasia Examinee's Signature ' ADENOPATHIES Signature M.D. SGP 0008997 P Pulmonale: Sight Heort Strain: Abnormalities of rhythm: Abnormalities of conduction: Other: BLOOD COUNT NORMAL ABNORMALITIES BLOOD CHEMISTRIES SMA 12/60: See Attached SERUM ENZYMES:_________________________ SERUM ELECTROLYTES: No* K+ Mg + + SERUM ALPHA I, ANTI TRYPSIN__________ SERUM ELECTROPHORESIS: See Attached BLOOD LEAD:........................ .........MICROORAMS % MISCELLANEOUS: ACHLORHYDRIA (DIAONEXi; OCCULT BLOOD: ______ URINALYSIS: ALBUMIN___ SUGAR. -JJRINE LEAD CHEST XRAY^Xl 7^(NORMAABNORMAL MICROGRAMS/LITER URINE SULPHATE RATIO UICC/CINCINNATI % Moderate prominence of both root areas, some general increase in bronchovascular markings over all lobes. Heart shadow and bony cage are normal, essentially unchanged from previous studies. OTHER ENVIRONMENTAL DATA: Somple type____________durotion ASBESTOS: Number Fiber* > 5 Mu./Cucm. OTHER: SILICA Mg./Ml Examinee has no subjective complaints. Ventilation study demonstrates MIM A summary}"'t'V mil l ol*n|- rtu* L I vr> rliniiy.i', c.lti'r.l-. x-cnv in uni mu n ci nl I n. Ailvi'in i.\(mtiuco LltnL ;i-uLtuj L'etufiinu unchanged. Euch evidence oi mild aiewuy ob struction which he has, apparently does not produce complaint'. Audiogram indicates mild hearing loss in the right ear. M.D. SGP 0008998 BU77ALO INDUSTRIAL .V^DICAL C-XTZ2 7SS TONAWANBA STUZT SU77AIO. N. Y. 14307 TabpjMM S7S-1J14 H2ARLMG EVALUATION SUPPLS.'VENT EXAMINEE: employes Georgia Pacific $.5. No.i. JOB ASSIGNMENT*. PREPLACEMENT PERIODIC (3> 38 BASELINE (YeTl No| PREVIOUS DATEi FOR WHOM> IS PERSONAL PROTECTIVE EQUIPMENT WORN lYes l Nol PftiAnl 0tfpoilMl HUtaryi . -- eca.vjwat:cn firttKnl M4kol Hitloryi. Allnrgiat____ Hsod (ft)vry- fimging in Eort~ Mite. ______ -Painful fort. -Vqrtign .. . ..Running loa. Military SarvieoDuliat~-- --........ . Deration- APPLICANT'S EVALUATION OP HEARING STATUS Normal Not Normal G Cantlonf Q VaHobla Q Onto! O Pfogrottion Q Hat trowblo hoofing In Graupt G JnAwoiloria G AtOittanca Q Rodio-TY Q In Noisy Plocat Oota Q Taiaphona Woman and Childran Q Q Eacauta of Ringing in Sort Q Ears Drums Canal Noso Throat Tuning Perk R L Dote* 04 AUDJO.rJ7TJC 1/26/77 Time:: ______________ Interval tine* lad noise exposure:-. HIQUENnCcYy -. HMTZ (Hi) g g g a 2SO 500 100# AA.O.O. VTlm __ _ _ OSHA PIOPOSIO 5YSTIM.___ UM bf H* Lnft Car oo ,3S... pa 6 250 1000 2000 J rJO :i / O li i .1.0.... M100pJ_. .tsr..i JXG . 4000* t^^ i*r 4000* ?, 1000' AVCRAGe T.s. in tfb is' AUDIOMETER AM. NAT'L STAND SPEC (ANSI-)969) LIFT EAR SIGHT CAS " AIR 1 nut | X OED 1 SONE x-S. 4 Examinee's Signature' Examiner: Is' SGP 0008999 PO SITIO N T H IS EDGE NEAREST C A B IN E T '; f I ! SGP 0009000 January to May, 1977 Matos & Correspondence SGP 0008936