Document Vj9bnyEYMzXwEY4ZxKXEK8QVj

.jin no-iuj ). 5. r.-'p_' u.`i.nt ot L.'ibor of Labor Staiiaiics of.lhScOccP-*'0 ='Si!tiy ii j AcJminir.lr.-ition READ INSTRUCTIONS BEFORE COMPLETING THIS FORM IT WILL DE USED ONLY FOR ADMINISTRATIVE ________ AND STATISTICAL PURPOSES________ 1C7S CSMA NO. 103 I-CF.M :ual occupational i::junics and illnesses survey (Ccv'-ring Calendar Year fu>6) COMPLETE'THIS REPORT WHETHER OR NOT 1HEHE WERE ANY RECORDABLE OCCUPATIONAL INJURIES OR ILLNESSES. | SCH. NO CK SIC NWT SWT CO SIC EDIT~| 01 002140 0 2292 002 001 1151---------- ---------- CEHENT ASBESTOS PRODUCTS CO Approval Expires December 197*^ Report ALABAMA operations only COMPLETE AND RETURN ONLY THIS FORM WITHIN 3 WEEKS i 1 P.SPCRT LOCATION CR IDENTIFICATION RAGLAND ALABAMA LS.T CLAIR COUNTY ..w 35131 UC 050957000E 000163 J P.ETURN TO: /.li.'sc.na Lc'-sor Dop.-rtment C"3 Adnlnio'.- `ivo CuEi'ng r.'onl^rir.orv, 331 CO ?:c-:270 E3 * ASL'EWE*. T5 NC.VOSO .N TH'S REPORT Tl-.s re-.- st.. J c j iiosc establishments located in. cr 'iii f.. : P-v-N't Location or Idcntilication witch rrrcc-a tv';.'. ye.- :r:. Lng a;;-ess on IM:s lorr-.. Enter the numbx-t ol e.i'.aL :* "o-'ta (sea Cc'n/.cn :r T-t-Tt b-tst .'C'.JvJ n ms - T't. ;--------------------------- annual av:n;.ci: p.-alc-a-ent in -9:e Erv tec .-..-a.--. J-Ci - c' fhiO'S.tes v.ro wr-.fi d,,r.-; cc ."Car ,<a- 1C-TE. >: . Ji u--air.-es. "i'jC.np sccaana'. tc--.cc-a-y. etc i . . I'u:: ; -. V- Lv_~;;.t.s ct ccrtc.t.r.; yew: a.crccc cr.rtCj.Tnt. iRaund to me r . v-.V ...t c -l --r.n J2i I. TOTAL HOURS VVCtV.ED IN i?75 Enter the total nurrtir of heurr. r.'t-lJ . *-plovers du* r.g H-76. 00 NOT include any nor-.*.;*. - wen pj*d, sue*' os vacs- t ors. SCk leave, etc. Nate: If tiff-ley*. :a V. V.0d lew hrg'S Cur.r; 1576 due 10 :2/0?iS. Strikes, fires, etc.. C>;\;u; gndv* CJ>nr.m***ts 'S* :ton IX> to the nearest whe:r number) .2>7Zhq J. SUroemT ACTIVITIES PRFO,;.?.iEP for other F.ST A-'-l^HVENTS Of H COMPANY Ores tu s inti.de .iny .t-tilishmcntis) whose pr.mary function is to - ' iiport -at \* ; Lr* * o.eiu;.%c'y for other establishments of yaj- ca-pa-y? 0) QU No (2) 0 Ye* tt ,ca cat-. m : -v, i.n ?.f s.-.icv cr r.rran c-cv.ded (check as many a*:: a/!. 1*1 u f t-~r St-.-live 0`t ce Z' ! ' * [J h *.;.-*?-l o- t*.st r j * '-Uiil u [_; c - . . r - -- f.*i*v C* f. v-*; l*.d Cu'-r.g 1976 by tre t lt2b. en* ; .* t* : * ........................... -.r.. a-.c trr.ot. -eta: t?adv CLsitiHcas JCcr/ C f-. A .rji^Cr______ G. Enter in order of importance the princpal products manutactured. lines of VS J a! sacci'ic a;t:vit.es for 1976. (11 niC Pi CC. i <21 <3* (SI For each entry, a'so m-ciude me approximate percent ol tc:a 1976 annual value of product.cn. SICS. or receipts. /OO ** * VI. nECC.~-J\L INJURIES AND ILLNESSES D'd yOJ nave a-y recordable injuries or illnesses dj-mg calendar ,cs' "STo1 iChecL end t a) D No - compete Seel.on vil and Section IX. 12) SI Yes complete Sections VII, VIII and IX. VII SUPPLEMENTARY DATA ON JOB SAFETY AND HEALTH A I* ycur i .T.f f-mer-.t(s) had a Federal OSHA compliance inspection during catenda- year 1976. please enter the month ol the firsl inspection. (Leave this bo. plan.) (a) Oo you provide medical examinations lor your employees? (t) No (2) S Yes . lb) ll Yes. md.cate the type of medical examinations provided a-y of your iTpicyccs. (Check as many as apply) (1) sr (21 s (3) 0 (> (5) . is (6) Pre-p'accmcnt examinations ol new employees TV- odic general medical examinations r.- cd c medical Surveillance examinations Exam.nation ol employees returning to work after a tost t me job tolatcd injury or illness Exa--mation ot employees upon termination of employment Ctner Isofcilvt C. Do you have an established safety and health training program? iCfteck as many as apply) (D 113 No Yes - training for new employees i3> $ tis t-a.nmg sessions to) employees exposed to toxic substc'ces w--.ch exceed prescribed action levels t-!| Ws scheduled employee meetings, quarterly or more ol-.en 151 >ts - Informal, nonscheduled training by supervisors (6) 0 Yes . Otner (specciiffyv))J7~hYou<|K SoL^u Comnr',t-Hc.c. 0. Enter t-.c number ol lost woarrkday icases (not the number oft..: workday*! m your estcSi-shment(s) in 1976 which had 15 or r-ore wo-Ldavs away trpm wor iRf`er to co'umn 9a Ot the log. OSHA No. 100) BicTUrxM. THIS COPY ONLY HER 0008377 her 0008378