Document Yj8jk59g1a17p1JvDd5VQVyDV
FILE NAME Insulation Contractors & Distributors ICD
DATE 1971 DOC ICD066
DOCUMENT DESCRIPTION Govt Inspection Results
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C3 NEW YORK
MEDICAL SECTION ASSIGNMENT AND REPORT DIGEST SHEET
[J BUFFALO
Fl OCCUPATIONAL
[ ]RADIOLOGICAL
1. ASSIGNMENT NO
2. REFERENCE NOS
168-71
5. FIRM
Name
Street
Frontier Insulation 430
6. PLANT LOCATION If not as above
Address
Lisbon
Ave.
3. DATE ASSIGNED
5/21/71
City or Town Buffalo
4. DATE DUE ADMINISTRATION
6/21/71
County
7. WORKER Name
Street Address
8. ASSIGNMENT
Medical evaluation of asbestosis case
City or Town
County
9. ORIGIN [I.S.S.
W.C.B.
B.S.A.
[ } Workers & Unions
[] Professional
10. SEND REPORT TO
Dr. M.K.
11. SEND LETTER TO
[7 Other Labor Dept. Units
[_ Special Study
(_] Other
[ ]Other Govt Agencies
( _]Industry
DATE SENT
clo 5/27/11
5/27/11
12. COPY OF [ REPORT TO LETTER TO
13. ASSIGNED TO
Dr. Kooyman
5. INDUSTRY
Construction
09
8. ACTIVITY [_] Plant Investigation
Special Study
14. NO OF
Total
EMPLOYEES 16. NO VISITS THIS ASSGT
Other
Female
Male
17. DATE ASSGT COMPLETED
5/21/71
9. HEALTH FACILITIES
0. PHYSICAL HAZARDS Noise Illumination Radiation Temperature Humidity Pressure Vibration or Other
A. Type
j
B. Source
_,
f
c OperationCode No. & Name
Degree D.
____|
)
|
2
E. No.
F. No.
Exposed | Affected
} i
1. CHEMICAL HAZARDS Including Gases and Dusts
A. Agent Code No. N"ame
)
Asbestos
) Asbestos 10
- WORK SUMMARY
[
A. Workers Examined
No. of
Histones
No. of
Physicals
E. No.
F. No.
|
B. Source
c Operation Code No. & Name
D. Degree
Exposed | Affected
|
Insulation
Insulation Insulation Insulation Insulation
|| | | Nue
Insulation Insulation
3344
Neod
Neod
to
0Evere
1
Blood
No.Spec'nsSpec'ns CountsCounts
Usine
B. Laboratory Work
X Rays
No. Specins Analyses | No. Taken j No. Read
SpecinsSpecins
Other Tests
Analyses
Other
REMARKS
.
Case
Case
ge
Medical
Medical
record rMuedicaMedilcal Fie
308 4-62 MED
24. Section Review by
Date
OJKOJK
5/27/71 5/271 5/275//27/7711
25. Division Review by
Date
03K 5/27/71
26. Avegt Cik 27. Stat 28. McBee McBee
.
Division of Industrial Hygiene INVESTIGATORY ASSIGNMENT MEMO
_
viulution
viulution
Name and Address eat os viulution viulution viulution
430
Re
Medical
Assign Toy
Toy Kooyman Kooyman
Engineering
Air Pollution Field Eval
Field Exhaust Plans
Laboratories Bio Chem
Ind Tox
Textiles
huston
huston
ASSIGNMENT
AS IGNMENT
10-168-71 10-168-71 10-168-71 10-168-71 10-168-71
Kur
oy
.
5
Malye a
&
5121
1971
Origin
Prox
of
Medical Assignment Evaluation
100 86710450 86710450 86710450
Due Date Report To
6/21 6/21
luk
1971
IS luk luk --"
asbestosis asbestosis asbestosis case case case
i
From
JJKJJK
Copies To
Letter To
From
Copies To
Remarks
IH 9-67
DEPARTMENT OF LABOR - OFFICE MEMORANDUM
MO 168-71
To
Morris Kleinfeld M.D.
Director
Date 5/27/71 5/27/71
Office Administration
From Olive J. Kooyman M.D.
Office Medical Section
Subject Case Review and Medical Evaluation -
Case # 86710450 DA
Claimant
VS
Company Frontier Insulation
Co.
Exposure
Asbestos Asbestos -
Covered boders pipes Tuks etc. insidiation
Duration of Exp 1924-1966 1924-1966
Status
Partial Disability Total Disability -
Death
1467
Diagnosis
Remarks
Dabestosis
Emphysema Emphysema Emphysema
Cor pulmonalt
0.3
--
Case abstract in medical file 381 5-71
~*
.
Wo
MEDICAL SECTION ASSIGNMENT AND REPORT DIGEST SHEET
NEW YORK
[|] BUFFALO
] OCCUPATIONAL
RADIOLOGICAL
1. ASSIGNMENT NO 38-71
2. REFERENCE NOS
86710450
3. DATE ASSIGNED
5/24/71
5. FIRM
Name
Street
Frontier Insulation
Address
430 Lisbon Ave.
City or Town Buffalo
6. PLANT LOCATION If not as above
4. DATE DUE ADMINISTRATION
6/24/71
County
7. WORKER Name
Street Address
City or Town
County
8. ASSIGNMENT Abstract case record
9. ORIGIN
I.S.S.
[ ] Workers & Unions
10. SEND REPORT TO
Dr.
W.C.B.
M.K.
B.S.A.
Professional
11. SEND LETTER TO
{_] Other Labor Dept. Units
[_| Special Study
(_] Other
[7] Other Govt Agencies
(] Industry
DATE SENT
/ 6/1/7113 6/1/7113
c
6/1/7113
12. COPY OF [ REPORT TO
LETTER TO
13. ASSIGNED TO Mr. Wolf
15. INDUSTRY
09 Construction
18. ACTIVITY
Plant Investigation
Special Study
14. NO OF EMPLOYEES
Total
16. NO VISITS THIS ASSGT
t
be
{_] Other
Female
Male
17. DATE
COMPLETED
6/1/7166//1/171/67/11/71
9. HEALTH FACILITIES
20. PHYSICAL HAZARDS Noise Illumination Radiation Temperature Humidity Pressure Vibration or Other
A. Type
& i B. Source ~
C. Operation Code No. Name
craeeins
D. Degree
1
i
| i
2
{|
F No.
F. No.
Exposed Affe ece tee d
| |
|
3 1. CHEMICAL HAZARDS Including Gases and Dusts
A. Agent Code No. Name
B. Source
C. Operation Code Na & m Nae me
D. Degree
|
No. ; F. No.
Exposed | Affected
1 10 Asbestos
2
3
2W. ORK SUMMARY
{
A. Workers Examined
No. of Histories
No. of
Physicals
point | 32 speen pouting
Various as bestos bestos
Coverings
Coverings
pipe
Coverings pipe pipe
Containin;g materials / //" /"
7
kuju
/
!
Blood
No. No.
Spec'ns
Spec'ns
Counts
Usine
B. Laboratory Work
X Reys
No. Spec'ns Analyses No. Taken | No. Read
No. Specins
Other Tests
Analyses
Other
\
1. REMARKS
I:
24. Section Review by
Date
Case record is medical File
OJK
6/1/71
25. Division Review by
Date
oJK 6/1/71
26
. Cik 27 Stat 28. McBes McBes
-308 4-62 MED
6/1/71 6/1/71
ASSIGNMENT DivisDiivoinsion ooff InIndusdtrialustrialIndustrial Hygiene Hygiene
INVESTIGATORY
MEMO
ASSIGNMENT NUMBER
Mo7-38-71
Mo7-38-71 Mo7-38-71 Mo7-38-71
]
Name and Address Frontier
Re
Medical
Assign To
ius . wild
Frontier Insulation Insulation Insulation
430
Engineering Air Pollution
Field Eval
1 Exhaust Plans
Laboratories
[7] Bio Chem Ind Tox | Textiles
Lisbon
Ave. Ave. Buffal Buffal Buffal 2
5/21
5/21
1971 1971
Origin Prof.
Assignment Abstract Abstract
case
WCB 86710450 86710450
Que Date Report To
6/21 6/21 6/21 1971
Jr. Jr. Zuk Zuk
SECard record
Fl
From
OJK
Copies To
Letter To
From
Copies To
Remarks
IH 9-67
~
To
MON 38-71
DEPARTMENT OF LABOR -
Morris Kleinfeld M.D.
Director
OFFICE MEMORANDUM Date May 28 1971
Office Administration
From Morris A. Wolf R.N.
Office Medical Section
Subject
Frontier Insulation 430 Lisbon Ave.
Buffalo New York
On May 20th 1971 the undersigned visited the
concerning Compensation Division
New York
formerly
of Research and Statistics Workmen's Compensation City to obtain information an employee of the above named company
Board
The data were given to Olive J. Kooyman M.D.
Industrial Hygiene Physician II for evaluation and transmittal
MAW pc
Consultant Industrial Health Nurse Way
GA ea