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t ' "'Name No. 35376 Interpretation of Single taken on 2/3/72 Plant: Millington, N. .. Reading Date roentgenogram of chest 2/15/72 No abnormality of the lungs is seen. Bilateral cancified pleura plaques on the diaphragm are noted. GEORGS W. WRIGHT, M. t>. Saiat Lake's Hospital 113X1 Shaker Boolevaxd Cleveland, Ohio 44104 r 4 s. 9 V '* *'7/4, r -* Warns No. Interpretation of takan os 55376 single 10-30-70 Plant- Millington, N.J. '' Reading Data 11-9--70 - ~~ " roentgenogram of cheet No abnormality seen within the lungs. There are bilateral calcified pleura plaques on the diaphragms. GSORGI W. WRIGHT. U. D. Saint Luka' Koapital 11311 Sb&kar Boulevard Cleveland, Ohio 44104 I> f / % f i * k K '^)S3 Nam* No. 35376 Interpretation of single taken on 8- 30-68 Plant. Millington, New Jersey Heading Date 9-XI-6 8 roentgenogram of cheat No significant abnormality seen. See previous reports regadding the pleura plaque calcifications. GEORGZ W. WRIGHT, M. D. $iat Luk' Hoipital 11312 Shikar Boulevard Cleveland, Ohio 44104 Name No.' 35376 Interpretation o! . single taken on 4-6-66 Plant: Millington, N.J Raiding Date 4-20-66 roentgenogram of chest . r. No significant abnormality seen in the lungs and a comparison of this film to others of 1953, 1955, 1957, 1960, and 1962 shows no appreciable change in the lung markings. In the current film there are small calcific deposits on the diaphragmatic surface of each lung field. In retrospect, these can be seen as early as 1955 but have increased in size. These are rather commonly seen in persons who have been exposed to ''talc" or other forms of asbestos but may originate from other causes* GEORGE W. WRIGHT, M. D. Saint Luka'a Hospital 11311 Shakar Bouiavard Clavalaad, Ohio 44104 ^ Name T*o. 92-62 Interpretation oi single taken on 6/21/62 Plant: Reading Date: roentgenogram oi chest Millington, N. j. 6/27/62 No significant abnormality seen* GEORGE W. WRIGHT, M. D. Saint Luke's Hospital 11311 Shaker Boulevard Cleveland 4, Ohio \ * 1. Kama NGC f Plant : Millington, New Jersey No. 11-60 Reading Date : Interpretation of single roentgenogram of chest takenon 3/22/60 compared with taken on 3/30/60 No significant abnormality seen. GEORGE W. WRIGHT, M. D. 8*ia Lake's Hospital 11311 Shaker Boulevard Cleveland 4, Ohio V v, \* i Kk % Georoe W. Wright, M. d Oe^ARTwcNj or EXrCRIMtNTAL MEDICINE January 3, 1956 T. UUKC* HO*riTAL nail tHAKCR LVO. CLtVCUNO 4 OHIO No. 55-23-B Name National Gypsum Co. Interpretation of single roentgenogram Millington, N. J. of chest taken on 12-1-55 compared with taken on 9-15-53 No change. George W. Wrjght, M.D. Department of Experimental Medicine saint luke's hospital iisii shaker slvd. CLEVELAND 4, OHIO Ho- R 3790 Name. Katl* Gypsum Co* Millington, K*J* Interpretation of stereo roentgenogram of chest taken on 4*"9"54 compared with taken on Stereo films as of this date show no noaulation* There is a moderate degree of increase of border vascular marking* The descending aorta is either very tor tuous or the site of an aneurysm* V t George W. Wright, M. D. 6tMTMCNT 0^ Experimental medicine January 3, 1956 *T. LUKt,a HOSPITAL nan ihakch slvo. CLCVCUANO +, OHIO Xo. 55-33-B Name * National Gypsum Co* Interpretation of single roentgenogram Millington, N. J. of chest taken on 11-30-55 compared with taken on 9-15-53 It 4-9-54 There has been no change. The abnormal degree of bronchovascular exaggeration persists. My records fail to show that I received an occupational history for this man. Same is still desired! A small calcific plaque in the left diaphragmatic pleura and a small circular cyst with slight bone density around it are seen in the 4th left and 3rd and 6th right ribs* These were present in 1953* \ % * K\<* xnno *  George W. Wright, M.D. \_ DEPARTMENT of Experimental Medicine SAINT LUKE'S HOSPITAL I till SHAKER ILVD. CLEVELAND 4, OHIO 10.36 Same il. Gypsuc Co. Llington, K.J. Interpretation of 6ire roentgenogram of chest taken on 9-15-53 compared with taken on The bronchovascular markings are markedly exaggerated throughout both lungs. In some areas, notably the middle thirds *n both sides, there are in distinct shadows suggestive of true no&ulation. A stereo roentgenogram and careful industrial history- especially as to siHco and asbestos exposure- is needed in order to adequately assay this - X-ray film. V f v <. i r * >v % V-  ."A `l i . DEPARTMENT OF Experimental medicine v -i ^SEOftSE yy., * ,' 1 i. * ' J*i ^ Bo. ifl-v Same .. . Natl. G:-psmn Co. Millington, K.J. Interpretation of single roentgenogr*. of chest taken on 9-15-53 compared -with taken on No abnormality seen \ j Nani a. 35376 Interpretation oi Single takes on 2/3/72 Q, p^^IV-hgton. N. J. Heading Date 2/15/72 roentgenogram of cheat No abnormality of the lungs is seen. Bilateral cancified pleura plaques on the diaphragm are noted. GZORGX w. WRIGHT. U. D. Saint Lake'* Hoapltal 11311 Shaker Booleverd Cleveland. Ohio 44104 V % it NT4 ' N- 55376 lalerpratation o! single taken on 10-30-70 ^Plant: KilC^gtOn# N. J. Raading Data Xl**9*70 roantgonogram of chait Mo abnormality seen within the lungs. There are bilateral calcified pleura plaques on the diaphragms. ir" GEORGE W. WRIGHT, M. D. Saint LoJta'a Hoapltal 11311 Skakar Boolavard Claraland, Ohio 44104 \ v v JOC?.*'!)4. if) % $ Ndm* No. f 3f376 Intarpratatioa of tingle takao on 8-30-68 a o plaat: Millington, New Jersey Raadiag Date 9-11 "'68 toontgoaogtam i haat No significant abnormality seen. See previous reports regarding the pleura plaque calcifications. j GEORGS W. WRIGHT, M. D. Salat Loka'a Hoapital 11311 Shakar Boolavard Oaralaad, Okie 44104 * i * \ _r * a-.- % > KK'p.noo Nam* No. 53376 Intoiprotation of single faVoa on 4*6-66 Plant: Millington, H.J Hooding Date 4*20*66 roentgonograa of choat No significant abnbruality teen la the lungs and a caparison Of this fill to other* Of 1953, 1955, 1957, I960, and 1963 showt.no appreciable change la the loaf narking*. '* '** n In the current flla there are small calcific deposits on the diaphragmatic surface of each lung field* In retrospect, these can be seen as early as 1955 but have increased in else* Tfe4se fare father commonly eeea in persoas ho have boon exposed to "tale** or other i forms of asbestos but may originate froa other causes* GIOHQX W. WRIGHT. U. D. 8aiat Loka'i HocpiUl 11311 Sfcakor Boolooard CUr*U*i Ohio 44104 fCK 13001 - A- o Name O^ Plant: Millington, New jereey No- 11-6C - Interpretation of aingie Reading Date : 3/30/60 roentgenogram of cheat taken on 3/22/60 compared with taken on No iigtuficant abnormality *oen. GEORGE W. WRIGHT, M. D. Saint Lnka'a Hospital 11321 Shakar Boulevard Clavelaad 4, Ohio #-> , ** 7 ' tV* ' j. . t <9. * : ^ S "301.3 Name: Plant: Millington, U. (BQC) No. V57/B Reading DateA7/S7 Interpretation of Alagl* roentgenogram of chest taken on ?AVS7 compared with taken on Bo Igniflmat obnomall^ ooon. GEOBGE W. WRIGHT, M. 0. Saint Luke's Hospital 11311 Shaker Boulevard Cleveland 4, Ohio *9 v * a ** * VWiitatoWii * itnk tt*4 witi miw witoM TKn blink 10 be filled out tad lent to the Company on the day the injured employe recwvei list treatment. Stitenent of DrRichard A, Raffman, M.P., F.A.C.S i e of Injured?.. Mime Of Employer? \ National -Cfrpsuffi Coup any ........... --j3ge?__ 2___ -.-Pete of Injury?-- J2u Fine lid reodered hy> .Tchn Qi-ryiKak M. TV-----.. ..Subsequent aid? ..Richard. ftnan, M.D. l F.fl P -- CODE: O--office. V--bouse visit. H hospital visit. N--night visit X---X-ray. S-^peratioo. 19 gQ Jan. Feb MurApr. May June July Aug. Sept. Oct. Not. Dee. -- 1 I- 3 4 S 6 7 8 9 10 n 12 13 14 IS 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 rv s OP ! * 0 Fmt AidConsultationO &ne each 410.00 Ofict Visit* three $7.00 .. e Visits ,pitil Visit* "... .-fight Visits "... Operations one $%Q0.00 XQQ? X-ray one $10.00 . .. Other Charge* must be itemised and explained fully Drugs $1.00 _____ *10 00 Diagnosis Metallic foreign body embedded 21 00 in muscles of left foreana. 100 00 10 00 1 00 Explain is detail any special treatment if any. giving reasons for same and of what they consisted Total Expense for Medical Aid *1U2 00 Consultation & examination, x-ray, drug*;, excision of steel foreign body from Describe treatment .Jigft..fjpreana...d2fcgsings.. ch^ged..xftaoy.al..of.. sutures............. ---....................................... fcesult-GoodI-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- Patient refused treatment " ~ - --------- -- --------- 19 Is patient capable of doing same work as before injury?.-------------- -------------------- K not, why?------------------------------------------ ---------- Patient pronounced able to resume wort u of____________________________ --..... ......................IP Patient discharged as cured Beferred_To_Jch.n__CHrobsX.Xor further treatment. Any permanent injury? Oeseribe fHy-lS_,,,S.qa._5n------------------------------------------------------------------------------------- Dated at Madison, Rev Jersey (Ow> ' ______Aay of. Dr. chard k Street and Number X rS u O'J,s s> : . STANDARD FORM FOR SURGEON'S REPORT Approved by I. A. I. A. B. C. / National 'Jy-psirr. Company *\ 1 in pi on , Em :y* s. n y State'* Nnmber For! mu. Carrier*# File ... _ (Tbe (pace# above not to be filled in by Employer) The nf The AcciJenf '.`-J-1 1 ' 'ii : Mr. 'T'ol 1 n 1. Name of Injured Peraoth 2. Addre#: No. tod St-__I fit* 0r T*w#? --.9tate? 3. Nan* and Addre*# of RpUvr -Mational Gypsum romnang.n Mil,import , Nr. .Ter?a" 4. Dat of Accident:. ^^^.9 - Hnr 2 -15 P^f Date disability began.. S. State in patient'# ova word* where aod bow accident gemmA- I_VaS dri_yin_g_ S ,_ch 1 -6 , of metal, when a piece of steel flev off and landed in ttt/ left fr-rearr." Tht 7 iu^v 6. Gjt# accurate deacriptioo of nature and extent of Injory aod atate your objective boding*: "STcTecescf ti---* nnffi embedded in the muscles of the left forearm. _____________________ 7. Will the injury reault io () Permeseot defect?--XiL----------ll ao, thmi> .Scur in.lf/M, fnrn*. (b) Facial or head dlafignrement?. No tPermaotei dli*bll(tv ocb to** of whole or part* of Hager*. tactat or bcaU dWflgurcmtet. tic.. cnu*i b* accurattlr marked on chart 1. nrrnr rid* la accideot of thl* above repori.) referred to tbe only eaoae of patient** condition?......Y..es --If not, alate contributing eautee: 9. J* patient leffering from a^ diaoaae of the bean. lung*, brain, kidneya, blood, vtaeular aytieos or any otber di**hlmg rop.lin not doe to tbit acddeDl. .Give particulars. 10. Bat patient gay pbygieal impairment doe to preriont Occident or dieeeaef. Nc Give particular*:. 11. Ba* normal taeovary been delayed for any rotten?. No .Give particular*:. T reiiitnenr 12. Date of your fir*t treatment:. 6/7/6? .Wbo engaged yonr torvieM?--. 13. Describe treatmeul glean by yoot .tX3SU.i!.rac;.a--?. forrirn bodi^tfram left forearm, dressing changed. 14. Were X-Ray* takaar--IfiS-----------By whom? 3. A, Bftf foeD , Z Su_______ Vbeo?_ (Naw md tieml ., . ?. metallic foreign bodies in forearm. - ay goo* - "" " Yee lb. Tat patient treated by anyone eftaf-.,. -- Z T , " ' ~ Sr.ChrobaX National Tfvr"^.y- " By whom?---------(-M--a--m--.-------------------------------------------wba?----- ---- 17. Wat patient bogpiuliaadf. No .Name aod addre## of hospital;. 18 Date of adaaJaaioe to beiplul:- 19. It forther treatment needed?.... Yes J)l of iitebrii:.... _For baw long fJLX*iS Diaability 30. Patient able to muae regniar work on:. II. Patient able to fnsnao light work no:-- 23. If daatb ancsed give daUi-- iZllZ2. i/u&L RUAU: (Give any information el value not lndoded above). I am a dnly llamuod physician in the Bute of -- *?e------- ---- _ -------------- -------- I ... tr.du.ri I----------- Sew-Yog------------------------- Mril-J M~1 to-^w_y=Ik . : tv Date of tbi* report!- ^ -- --... - &p.ri) H Thl* report mart bo aifned personally by pbyticitm. Addr_o_e#_ 2ft Walnut fit. , ^ad-- -cn^ -Yeer___ ___ ___ 4 3006 ."i * V' TJ. s . FREDERICK 5. BARNES, M, O. mu*. AMDUCAN COU4U or tAL MKMCtMC . *1 PASSAIC AVENUC PAMAIC, N. i. 070W FHOMftt 7T7^Mt ?:. i .Pi rv- ' ; '<}. File: Znjd: SS# : Assd: 712 69 021 Fatlocal Gypsum Co. Laverack 4 Haines, Inc, 238 Main 8t. Buffalo, N.F. Gentlemen* Herewith, report of ortbo*>e(jic *exaaineion made a^this office on 3/10/70: NAME* 1 SPOUSE: Anna KarieTHltUREN: 2 !T:" 168 HT: OCC: Millwright. ; {.vT OTHER INJURIES: 1960 Herpes Easter; 'i9 spine injury; 1958 r/thuab, $1,100.,, 5 |BORN: USA AGE; ,53 MM IK. Grey EYES: Brown ured 1/ankle; 1960 cervical PRESENT HISTORY: On 6/3/89 hitting aeta a piece flev Into 1/lover arc. IEDICAL: 7/A on D/A - vent to y, exam; next day vent to Overlook Hospital, ' Summit, x-rays; % d saw Dr .'Raftnan, Madison, x-rays; 6/7/69 ada. to All Soul* Hosp hospitilixed 1 day. istovn,^ surgery by. Dr. Raffaan, `V- ; Lost 1 day frq COMPLAINTS: Pains of PHY51CAL FINDINGS: The petitio .vainly in winter* v \'&- r'\ "fr. ^ r 11 developed, veil nourished, jtdul aale. LEFT FOREARM; . / \ ... V ' * On the sadla1 aspect to the radial side' of the dorsum a'bgu Ju&ctionbf the middle'anddistal thirds, there 1 a transverse, dill ictlt to discern, operatiVe-"#car-{about *-3*cn. by 'lees^then'1;!).- There- is ao teadernes*. He. indicates that at tlaes he `has some d..i..s..c...o...m....f.o...r..t....d. `is|gilgkL to the scar. There are three, avail, healing, superficial,, lacerations or aaobrasion* of the radial aspect of the wrist, \ At the vrlst, dorsiflegion and deviation slightly incomplete, palmar flexion complete. . He coaplalns of some discomfort at the extreme of ulnar t- deviation* *-">- v' ` :?&:*. -7V, ;-vMr -W?W St- 3 motion at*'the elbow complete without discomfort* is noted to have" Mil, subcutaneous nodules scattered over tbs upper extremity. X-rays of the forearm by >;.Scopo**em 3/10/70 with a lead marker * t\l If JOnder hlsterF-r41 pibdvef steel flew off and JJnder^diagnof lm* h^y\.. . ". -Twr 4. -2- - *> v> * V=-V> 4 * FREDERICK S. BARN**, M. 0. pkllow. juimeAM eotuss or lmai. h*cin . ilMMAlCAVmUl . PAMAfC. M. J, 070 . ' PHONIi 777-SM1 embedded _in the muscles of the left forearm". He indicated x-rays by his ob 6/7 reveal the foreign bodies* A1 report from a doctor whose name I cannot decipher, dated 7/6/69 iBdicates first treatment 6/5/69 for injury of 6/3. Diagnosis "small laceration on dorsus of left arm". He indicates x-rays at Overlook Hospital reveal "deeply embedded foreign bodies". An x-ray report from the Overlook Hospital dated 6/4/69 with respect to the left fore&rn Indicates "at least two seall, aetallic-llke densities in the soft tissues of the distal 3rd of the forearm, one adjacent to the radius and the other, adjacent.t? the ulna. On tlyrt frontal view, there is an open safety-pin di the film`presumably a markr\with the .point of the pin almost in line with the metallic fragment on tbejrw.ls^ aspect of the. forearn Incidentally, in the report from Dr an/under treatment, be indicates in part "excision of steel foreign boaTBrnarom left forearm". DiaGXOSZS 1 CpyCXPSIOK; Based upon the-history and t . ro consideration the above noted medical information, the petitioner a a penetrating injury of the 1/forearm with a small, retaining, nets foreign body as a result of the June 1969 incident. Thereaftesv'THmoval he metallic, foreign body was xompllshed. fc *v Taking into considers ron Xh\ Results of examination 'together with the above noted medical infer $lon,JlJmould suggest that you consider payment to tbe petitioner pe sabillty of about 3-1/2% of the left band. V-. Tours truly. B71 4/13/76 r t,r. - y^~n- '* V* * 'y- FREDERIC* S. BARHSS, ,*/d. _ *,,n* MARKET j.500 ate 4JPK/W5 ,'Pli. FVAi.LAT.OM Cec.ftf N. rsted by \&metiaacc--------------- A(.d'Oi :e*ei_________ _______ .fir .red &rz .,rc /' Good _____ For------- Por ___ ?-JKF T 0N> ALD'C0mM P-eqvenc> m Cvc'es ;er $??< d A jdicsror. Cede 2101 ?RS0. 250 500 !l ? :-G ; 2C00 ; 00^-0 X GuCO R ii ____ li. :( !i _ .1 i l distorted sf::=;ch ?s~ts - ^fSss : ?aint. CpDb* ! i Ri r! i l i i 1 _J___ ______ i... SPCECH hCaK.no tests 1 Si T ,.t 4 ,.#T: , : Cv.... ... o,$.* p6 i o.N V %V ____ % % - %*" \ < A"* f *-) 'U 009 NATIONAL mPSIM COMPANY */ PHYSICAL EXAMINATION RECORD SALARIED PLANT. OFFICE. SALES DISTRICT ff///j */ !&** ^flOLRLY DATE. j PRE* EMPLOYMENT lI REINSTATEMENT S^RIODIC HEALTH DATE OF BIRTH //fa/& _________ ADDRESS _ t\c,E&-y> [j SINGLE S<\RRIF.D OTHER' LAST EMPLOYMENT PHEVIOt'S MEDICAL HEIGHT DISHQ JO Ml M i wLic.in /L7 vision-distant VISION-NEAR RA5SERMAN witn.W'`oui gissr< wiih.w/oul lsse* R.E. 20/ L.E. 20/ COLOR VISION: R.E. 20/ L.E. 20/ l RIVALS SIS Sl'GAR X HERNIA Hb: ^ MlN CHEST HEART confih-ration )r. BLOOD PRESSI'RE EXPANSION INCl'INAL RINGS R___________________ >7. / 3%, OPERATIVE SCARS & L >j ci female applicants 11 VH OF I.XST MEN'TII X !. PERK'D BACK AM) EX TREMITIES - edema, ampliation*, klnciional defects, deformities V NORM*!. ENLARGED RELAXED MF - - specific findings - additional NEl KOLOGICAL SKIN ERIPTION OENER AL CONDITION: gfaffoT) P") FAIR fl POOR; EXAMINEE H.AS BEEN ADVISED OF SIGNIFICANT E INDINCS J2*rf> Q NO SUMMARnY OK PERMANENT DEFECTS, IMPAIRMENTS; ^ V. NATIONAL GY PS I'M COMPANY PHYSICAL EXAMINATION RECORD DATE OF BIRTH H/12/16(AGE U9 LAST EMPLOY'ig.NT__________________________________ PLANT, OFFICE. SALES DISTRICT Mllllngton-Pony V DATE PRE-EMPLOYMENT REINSTATEMENT [X PERIODIC HE ALTH ADDRESS SINGLE KjARRIED OTHER HEIGHT V,< WEIGHT /(pO HEART DISFIGUREMENT - FACE. HEAD OR NECK JUZZtiOJij' * ~-*U*qCHEST CONFIGURATION CHEST EXPANSION ^GS ULu^y. d BLOOD PRESSURE | VISION-DISTANT C.R.E. 20/^^ U.L.E. 20/4*0 HERNIA ,, VISION-NEAR 20/ 20/ WASSERMAN <ZcJLj~ Hb: URINALYSIS SUGAR ^^SLBUMIN ABDOMEN 1L.M.P. ^ INGUINAL RINGS ^ .. R AJU*./.r , ._J. OPERATIVE SCARS . / ,, NORMAL ENLARGED RELAXED B \CK AND EXTREMITIES --EDEMA, AMPLIATIONS, FUNCTIONAL DEFECTS. DEFORMITIES <^L -p 0Qm^<A 0 JF1C FINDINGS - NECROLOGICAL SKIN ERUPTION 7U^ SUNWARD OF PERMANENT DEFECTS, IMPAIRMENTS; EXAMINEE HAS BEEN ADVISED OF SIGNIFIC ANT FINDING /Cl e-*-,,-^r^L ''O NATIONAL GYPSUM COMPANY Sales District Office Name ite Ae M Color r Arthritis * Operations Venereal Diseases Address > Pl.nt Kmingtrm, I..T. Dept. M W D* Check No. 4S- Children PHYSICAL RECORD (TO BE COMPLETED BY PuANT OR OFFICE) Epilepsy________________ ___________________ Hernia List on reverae side any hoapital admiaaioos ia past 5 year*. Tuberculosis Liquor Tobacco Drugs Other Illnesses Injuries -- description, location, % disability Compensation Received Rave you a history o{ silicosis or any other dust disease? Do you hove workman'* compensation ease pending {or either injury or illness? Have you aver been ia military serriee? Have any of your parents or brothers or sister* bad Tuberculosis. Cancer. Diabetes, Epilepsy or Insanity? Last previous employment I certify that the above answers are true, correctly recorded, and that 1 am in good health, and that I have never suffered horn Silicosis, except (history) Signature of Applicant Witness * If divorced, give date and place PHYSICAL EXAMINATION (TO BE COMPLETED BY DOCTOR) Height ------------ ------ i/;/ ;---------------TVf----f-f-e---is--A--t-_-_-_-_--_f/ (uf 6------------ Eyes: Right }________ Lsft /%)____________ Corrected; Right Pupilt Lungs ~ Heart ^ Cornea Shortness of Breath Blood Pressure ^ ^ Over Weight Norse! Weight Under Weight Left Binocular ^ Vision Cheat X*Ray Pulse Ears Throat and Tooaila Nose Hearing: Right Teeth ^ Left Abdomen Spine Hernia ^ Hemorrhoids If Extremities ^ Skin Reflexes l? Blood Teat (Note % of defects if sny exist) (Heed and sack only -- give location) Glands (_______ Mentality ^ Uriaalysia . ^ Musculature ^ Genitals y General Condition: Good Fair 7FOo you recommend applicant for work? Remarks Poor Nutrition: Good Type of Work? Fair Poor r-'vl<! ^ .-ttT APPROVED FOROLAN SAFETY SUPERVISOR PI iWT Examined by ~vr.r'w >M<maaAV to Date r*V otc (I'OrpinCClO Vlt tin NATIONAL GtPSUM COMPANY Sales District ^ (TO BE COMPLETED BY PERSONNEL DEPARTMENT) Arthritis ~__________________________ Epilepsy_______________________________________________ Hernia _ Operations __________________ _________ Liot os revetae aide any hospital ________________ adniasiona ia >m s yoa Venereal Diasases Tuberculosis Liquor ___________________________________ Tobacco___________________________________ Drugs Other Illnesses Injuries -- description, location, % disability________________________________________________________________ _ Do you have a workaeo'a compensation caae Compensation Received __________________ _________________________ pgftdiBi for either injury Of illnesa?________ Have you hiatory of eilicoaia or any other dual diaeaae? Have you ever been l& military eemee? Have any of your pareata or brotbert or aiatara bad Tubcrculoaia, Cancer, Diabetea, Epilepay or laaaaity? Last previous employment I certify that the above answers are true, correctly recorded, and that I an ia eood health, and that 1 bare never auifered froa Silicosis, except (hiatory) Signature of Applicant Witness 1 If divorced, give date and place iieight PHYSICAL EXAMINATION (TO BE COMPLETED BY DOCTOR) Weight /*r& Eyes: Right Pupils s' Xl Corrected: Right Cornea s' Lungs Heart Ears Throat and Tonsils Abdomen Spine X X -X s s' s' Shortness of Breath Blood Pressure/1^ f Nose ^ -------------------H--e--a-r-i-n-g--: -R--i-g-h--t-----~-*--Z-s--f / Hernia s Hemorrhoids y Over Veight Noma] Veight Under Weight Left Binocular Via ion Chest X-Ray ___________ Pulse 74 Teeth Left -------Xf'~/is ^ Extremities Scars Skin Reflexes Blood Test - s' s s General Condition: Good S' (Note % of defaea if any ozint) (Hoad and aack only -- givo location) Glands ,/ Musculature ^x""^ Genitals Mentality x" Urinalyais Fair Poor Nutrition: Good s Fair ____________ Poor Do you recommend applicant for work? S/ 'emarks --------/ - . Type of Work? ~ ... "Cl 114_________ APPROVED FOREMAN SAFETY SUPERVISOR PLANT MANACER --- XXAD" Examined by - THIS EMPLOYEE'S CONDITION IS KNOWN BY BIS SUPERVISOR. YES /7~ ^____________ M.1 NO .___ PsiiSSwr^jsj*' ^aig5^f>;. IP* *2?'$. ..*. - * 4P t% - PHHYSICAL EXAMINATION . Lr CLOCK NUMBER. OCTOBER 1947 NAME ADDRESS. CITY____ BLOOD TEST: y EYES:. EARS y NEGATIVE. NOSE: THROAT: HEART: BLOOD PRESSURExJJ^AO POSITIVE &o- jo URINE ANALYSIS: X-RAY: ^ REMARKS:___- Phjslels&!t 81gfutor m*?``is r.\ .nnco O.Funaro,,A D. EJwarcJ G. Allen, .M. D. ersev March 23, 1960 G. W. Wright, M. D. 11311 Shaker Boulevard Cleveland 4, Ohio Re: National Gypsum, Miiiington , N.J. Chest Xray No: 11-S0-B. Dear Dr. Wright: Examination of the thorax fails to demonstrate any evidence of an active pleural or parenchymal disease process. The cardiovascular silhouette is of normal size and contour f.or the patient's age and habitus. The visualized bony structures are unremarkable. Thank you for referring to us, Sincerely yours Edward G. Allen, M.D. EGA/ers