Document dDOxjyEweLY8MjMb2XwGkKkyG
FILE NAME: WR Grace (WRG) DATE: 1965 DOC#: WRG311 DOCUMENT DESCRIPTION: 1965 Report of work injury
DOCTOR'S FIRST REPORT OF
i r i n o cAuoRamu D EPARTM EN T OP IN D U ST R IA L R ELA TIO N S D IV ISIO N OF LABO R ST A T IST IC S AN D RESEA RCH
WORK INJURY
*
Immediately a lt
r . O. W * U i , Sea VruMhM 1
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copy direetlyto the Dmajan of Labor Statieoet and f ifr t p PaUtm to file a report
the Dieiaxm it a 7-------- ------------*---- -- --
W titm i (407*441).) Anrarer all quetriont folly.
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'T a. INSURs*AfNC"E..............
1. EM PLO
2. Ad^iwi y. Buiii^
Angara 38 ...-,.......... ....,
4. EMPLO'
_
f. Addnea
6. Occupation
7. Dateinr I. Injured at
if. Date late wodndL
9amA Wmm*
County__h i to^wlii
9. Data of jtm t:
Hoar-- 8---A L Who engaged yoor "*>
10. Name otfag doctor* who treated employee for tfaia injury.
7. H o lt B o btEo n fn tn rn U fc4/ lS / 6 5
*
m yioii"FriU 7C T:
a . A C C ID EN T O R EXPO SU RE y Did employee aodfy employ of thie Injeryl----X S S --___' Employee't (taumeat
oic.TM ^w rT a^-. Punt did not kacm M u ll
12. N A TU R E A N D ID TERN T O F IN JU R Y O R D ISEA SE /i--1_j . -h
- T ,, ^ ,,1,, r - f 11f
Uoenfttkmti limUWMaituiifmik, mnimilIhOHT.aedtiwiei.) O lltEt* 3/7/68
* * 7noi<i*Mamt a lliAduaJp^
pfA,gagblnation of dupoaolflMUy/
sodium nitm a and/or titanium and/or iib tito a and/or vatmteuitto and/ar
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Dsoroo of axpositfot 7 roars of blonding acoutUcal aatorials-ftrnooo running
2 yoorR ^d /1/68 giving sxpdsurs to varoicuUto, C9 and ssbosto.
1). X-rayat By w ln n id d ^ d m lie e it____D m . Q ffln o ~ BA O f C h S S t { ^ 2/^7 1/1 Finding!! P acb co p ah isiab co sis and arvidonea o f Pnaum oconiosU
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20. REM ARKS (Nuttmyyte-txinintiajerinac
Lab: Hlsto^UssUbvand ooooidio^lln skin to sts. Sputum culturo, antlbityjio
onaitlvity JDtofinJtUVog^poiUooIaou smoar.
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Off m6di frtNa 3/U/C5 to pcosont^Soo abovo (17.)
Name. M l li J r g jtr tlljn
-E*S*"*--Sfe-De'l-o[rootwcrroieit-jJ '
Date of report-- 6/ 4 / 8 8
AddreaaTo^----j
(OHM0 0 2 1
. Ifat'm erM Bids if mere epnre reyarired
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