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I PLAINTIFF'S C- tJUzzJ" EXHIBIT a //-->>->/II G-300 ;' M-. -f - f /&ZZcLk. i-tri) ?/s'^ Ljcu z^<*Lj\ X jj / xc/ / // i~t) /3 4UC/C VTi ------------ . ' S ^ j/ A-* *-L^ >* T" 77T '? .:v I'j" _-! /  . .*f i r.'Jh.txmZvi'S COMPENSATION ^ \RD L tatc or rw iron* NOTICE CF AWARD IN DEATH CASES IN WHICH THERE ARE NO PERSONS ENTITLED TO COMPENSATION \ W.C.B. CASE NO. 2 CARRIER'S CASE NO. 0 CODE NO. 75905294 ' 91 4 NAME Or OECEASEO Grace Baylord . . 3. S. . DATE OF NrAaiXO 7 DATE OF RESERVED DECISION 4-28-60 , . VGarloclc Packing co. / a. Palnyra, 17 .Y. DATE OF ACCIOENT 11-2-53 oarr. ot olaim 11-2-58 DATE or THIS NOTICE 5-4-60 ny * * Eroloyars Mutual Liab. CARR 1ER lO** Gibb a S-fc*......................... . ADMINISTRATIVE FINANCE OFFICER WORKMEN'S COMPENSATION BOARD Rochester, K.Y. 80 CENTRE STREET - NEW YCRK 13.N.' cc: S. A. Corrao* cc: E. Igoa ................................ * ' *a *iheacifah'disB you ARE HEREBY NOTIFIED that x322XTJZXXX3g. on date stated above a Decision and Award * Bade and duly filed this day as follows: THE EMPLOYES AND/OR HIS INSURANCE CARRIER IS DIRECTED TO PAY AT ONCE TO: Robert Byers ___ . ^ R. D. ^1, Palmyra. II ,Y. Nan* y Address th, e sum off .* 1x00_._0_0_____ fo, r fuf neral, expenses; THE CHAIRMAN. WORKMEN'S COMPENSATION BOARD, "VOCATIONAL REHABILITATION FUND" the stsn of * 5QQQQ aation Larj ' in accordance with Sec. 15, subd. 9 of the Workmen's tcxnpen- THE CHAIRMAN, WORKMEN'S COMPENSATION BOARD, `FUND FOR REOPENED CASES" / the stan of * 1.5^0.00 in accordance with Sec. 25A of the Workrten's Compensation Law. Forward checks payable to CHAIRMAN, WORKMEN'S COMPENSATION DOAHL), to the Attention: FINANCE UNTT. SO Csntre Street, New York 13. N.Y. closed. Finding ct no dependents. DECISION: Memo attachod* C-63 (4-55) c.68 4 . 1 W ,f . J / 6 * * t -* C-63 ^-tf I, i~* C-63 _ - leaf ftwifc tr--dy l <` - . ,,.. gl.Wwtiftea yt. . ITft.*. * 210 OtmUm St. he" )OU *1 MCn4nSt. iWtiTtA 14 IM U.M St. W. WORKMEN'S COMPENSATION BOARD STATS or NSW TOOK NOTICE OF AWARD IN DEATH CASES IN WHICH THERE ARE NO PERSONS ENTITLED TO CO^ENSATION STIACUSJ 2 lit S*. Whim $t. 1 W.C.B. CASE NO. 2 CARRIER'S CASE NO. and COOE NO. 3. 7590529i 4. Graee Baylord 91 NAME OF occeaseo______________________________________________________ t:-- DATE OF ACCIOENT 11-2-58 oatE or DEATH 11-2-58 *. DATE OF HEADING 7 DATE OF RESERVED DECISION ll-28-60 8. DATE OF THIS NOTICE 5-4-60 my W>L0*R Palmyra, N.Y. CARRIER Saployera Mutual Liab, 10 -Gibba S-fc.................... ... Rochester, N.Y. ............................... ......................... ...................................a mfeiridraii'duin YOU ARE HEREBY NOTIFIED that ade and duly filed this day as follows: ADMINISTRATIVE FINANCE OFFICER WORKMEN'S CONPENSATION BOARD 80 CENTRE STREET ICW YORK 13.N.Y. ee: S. A. Corrao ee: E. E. Igoe on date stated above a Decision end Award was THE EMPLOYER AND/OR HIS INSURANCE CARRIER IS DIRECTED TO PAY AT ONCE TO: Robert Byers_____________ R. D. #1. Palmyra, N.Y. L Name y/ Address the sum of t fjOPaQO .for funeral expenses; THE CHAIRMAN, WORKMEN'S COMPENSATION BOARD, "VOCATIONAL REHABILITATION FUND'* the sum of 11 500 *00 accordance with Sec. 15, aubd. 9 of the Workmen's Compen sation Law; * ~J THE CHAIRMAN, WORKMEN'S COMPENSATION BOARD. "FUND FOR REOPENED CASES" . the siaa of i 1500*00 in accordance with Sec. 25A of the Workmen's Gapensation Law. * * Forward checka payable to CHAIRMAN. WORKMEN'S COMPENSATION BOARD, to the Attention: FINANCE UNIT. 80 C entre Street, New York 13, N.Y. ,,,,,,.closed. Finding of no dependents. UtLl JlUn* . i t j *>> ***** * r> ** Memo attached. .................. .... *a \C-6i {^55) C-68 C-68 MEMORANDUM Rot 75905294* Eatato of Oraca Bagrlord vs* Oarlock Packing tap Hut. Co* Finding of no dopondoata* Allow *400*00 fbnsral axpenaos payabla to Hobart Byors, a aon of tht dosoaood* Mho paid tha funsral bill* Carrior to pay tho usual sums roqulrad undor Booties 15*9 and Station 25-A to tho Special Funds* Caso is oloaod* Dt K/ft i*/2e/60 DOMALD i* IL.LLX RKPEIIMS EMPLOYERS ( UAL LIABILITY INSURANCE COMPANY OF Y ~ 1NSIN EMPLOYERS MUTUAL FIRE INSURANCE COMPANY^' HOME OFFICE: WAUSAU, WISCONSIN The Garlock Packing Company Palmyra, New York Attention: Personnel Department AidrmMtpitTo HKITtlt MtlM I) IUUI is ilia aratir aaiaiana a, an ran aaaai mmoti November 17, 1958 % Gentlemen: ' There is not much question but what the Compensation Board will erect a death case on the above claim. We would like to make a preliminary check on any known dependents of Mrs. Baylord. In the initial report which our adjuster secured from her, we find she is widowed, and apparently has children over the age of 21. Unless she was partially or wholly supporting aged parents, there probably will be no dependency established. We would appreciate anything from your personnel files which you may have in regard to the dependency factor, we further suggest you forward us a photocopy of the W-4 form from your files. Yours very truly. CWBollman - EC 1 Claim Manager .................................... .............................................. ............................. MIAMI 4 MHOHA*TOW MIMO S 1M HUM k w. STIACUH 1 *v o*. mu<4 W. C. B. Case No. state or new .you WORKMEN'S COMPENSATION BOARD NOTICE OF DECISION IN DEATH CASE Carrier Case No. Nam* of Decedent T9905294 91 ____________ BRACT livt nan________________ ESTATE Qf RRACt 9AYL0RP R.B. fl FALRYRA, N. V. Employer: , OARLOCK FACKIM CO. PALMYRA, N. V. RORERT BYERS R.*. ft CAST PALMYRA, N. Y. You are hereby notified that at a bearing held before the Workmen'* Compematlon Board oa ............ .......a dediion and award of compensation was made In the above ease as follow*: ' Rm AMim laUtimkif DmkrI Bwtfc fwiin Rato per Wwuk Acciocrr roti * ARP CAUSAL Rffi ATI OR ESTA IU SHED F >R CAUI ALLY relate* beat 4. CONTI RUED. id the employer and insurance carrier are hereby directed in accordance with the provisions of the orkmes's Compensation Law, to pay such award to the following persons: To gad funeral expenses $....................to _..... . Employer and carrier are directed to pay at one* f_______ ___ for .weeks at %............ ...... from date of death ---- ---- --------------------------.to...... .... ............ ....Jg__ _ direct to the .................................................... :------------ ------ nd thereafter (f.. ............ ......id-weekly). Balance of the award la ordered paid into the Aggregate Treat Fond as provided under Section 17 of I the law. Present value of the award as ordered paid into the Aggregate Trust Fond as of..................... .................... -...............is I........................................... Present value dose not include funeral benefits. Check to be drawn to the order of "Stats Insurance Fund--Aggregate Trust Fund Account." The Aggregate Trust Fund is to males bi-weekly payments at the rate of |.......................... beginning with <Poath benefits to surviving widow shall be increased to 40% of decedent'* avange weakly wag* baa* VMS termination td dasth buoaflta to ehUdran. _ . . The above copy of tbs dodsion and award 1* sent yoo pursuant to lew. TAKE NOTICE that tne above award or dodsion was duly filed in the office of the Workman's Compensation Board on tbs CircXTM..... day ofccTCKR -.................. ----------Datod.---------------- ----- U...................... -- /. /JtsCnt^r^ /&ClU*<r\ Bj...... - -- ............... ....... c 67 m (kftintta C-23 0^7) ALBANY 4 1949 tionfa Ireorfwoy BINGHAMTON 231 W<aMngwn * BUFFAtO 2 210 NoWS. . NEW YORK 13 00 Cmr* Sr. o ROCHESTER 14 155 Main Si. W. SYRACUSE 2 Sum Offka tart (WarMnglon l>. WORKMEN'S COMPENSATION BOARD STATE OF NEW YORK NOTICE OF DECISION 1. w c.0 C*r no. . 2. URRIIR C**c NO. AND Coor NO 3. DaTT or AC'Tiorsr >e .ejuer 7570969* 4. 3at( or Hi*.1.0 ' Mo 22779 j 91 6. Datc ur Rcec^vco f. bosij* TTT 6. D*r o. tm>* Nonet 12-10-58 12-15-58 *y Ci.'t<VA*T flrne Brrlord Sataf . P. D. #1 . .......2*leyarr..H.Y.................. {MPkOrfR * Oarlock Packing co .Pa3JBfa,-*rT.......... TO THE CLAIMANT: . 1. Any CL-mptriration due will be eenl to you by "V check l.y the employer or his. insurance carrier. 2. Keep a cartful record of the p-yents received in or;i*r that you isa> have evidence of pay ment or non-payment in ra*e of dispute. 3. Do not pay iru-ncy to anyone representing you. The fee. If any, for such representation is determined by the Board .<- Referee and will be deducted from your award and paid by the employer or his Insurance carrier to your rrpresent-.tive ur attorney. C in tooricm.tn'r compensation cases, uo compen sation aha!) be allowed for the first seven days of diaabibty. However, If the Injury results in disability of more than thirty-five days, com- pens*tior. shall be allowed from the first day of disability. C0F5T TO: lAiier hearing on dsn- slcic.i L.Ci'.i- f.;iluui::.' 0Q Workmen's Cnmprr**(ion Law Award wns c:ad>' and duly filed this cl..;, -.m. J.:r i ""] Volunlaer Firemen's Law* 3EC1S10H: Pm. . iiT^.r1ti ^wA.p..ll.w2wSa. U cam wu "continued* asd eou'iauing payment wm directed. H shall be made *l the abov* rate for thr period stated and shell hi* eontfanod thervafte' u iUi thr employer vt currier has medical or payroll evident of a chance of condition and give* notice thereof to Ih* Clujnin, Wvkmrr/i ComonniitMn Bmird, q&Jhi othtoiK provided in the dwciwon. A further bearing will be hebi In a "convnuwd'' care to drtermin*.* the extrot of further disibility. If any. * la. Volunteer Firenze.* BencfU caws, the liable political mbdMtiM is deemed Os be the "EMPLOYER" of the volunteer fireman. //<+ fOsisi**-- U CJraifTfian C-23 C-23 C-23 C-23 C-23 WORKMEN'S COMPENSATION BOARD f e----- w <> . (MufHn M \- ATTSHDINfl PHYSICIAN'S UPORT ; to aumdmo mtsciam await aa Mb im mahaaU ha MM Inaia". kM* aw* a*aia a*hla 1* 4aya Ar Mi ' MM li Mai HNAl TOC aa Mb lam aaa lapart aa4 aaik II FINAL - . Ma Ma ri*aarf aHfiaal a> aaM fayart M (1) I avanad aa4 Ma a 4aa4 aaay a*b CD Ma MMANCICAMUI.il f -. M*ar *T (a Maar lypa * "** f*~l Ma yaa M taariar MM la a aarioaaa'a a baparb a Mlanab W 9 4aya ar laa laky a af Ma MM al aay pwAaaa aaparia. V kaaMM b akUa A Wan, Ma WOMCMBf* COMfMAnON MtUS at Ma Ate al Ma MaaM la aUM Ma < (MAT .m is fIMAI w^essft WjCiwsi^grilSSr ^r- a.:P>aM AMbMarfc^ar.aatf lai AHiaa.Wbata AwNaat ar la|ary OaanW ..... Garlock Packing Co. l iMnncD wbon * * - Mnnn ' Grace Barlord . j rw Garlock Packing Company f llliaa t ir ' H. ,D. #1 Palmrra, New York Palmyra, New Toxic 7. MMikANCI eAtta I. HOSHUL <v*r) BDURn MUTOAX. UABIUIT OnfiaANCX _ f COMPANY or Mbcchun ` j?-.wThoinp9on Mem'l Hosp. ^ 110 GOBS STUXT BOaOSIZB 4, KKV YOWC 0' i . . XanandaignaJ New Tork ' ' KSM**fWfW Blm |aMA- WJfeJf' it* MW*W v40 |>4si^n oripMd Iwwli d*r 9 ftfadhp Ann, dU* at iMnOTKl -*M---- MMa MMT i^TV V- AWl-l V-1^-1M- IIP. M_PJPP. TA-- tIaMN-^a.Vv- vMM._OaTal0. PTPMV --A M-PV MAM Pa-i-m-- Aa> 52 YtirJ. aMlaa. <M4a4a AnnAi. aljiAa laffcaa, arf|.Ml aaapMaM md aay Mama W aaMia Aaaa A ov**-* Patient's wndltlon dete iorated rapidly. Emergency hospitalization 11-2-58. ^:'' Patient deceased suddenly 11-2-58 at 8:50 PM See #16 TW aaa aay MaaMMy ar AyAai 4ahd^___yM N7 < YtpoM.- |& NMara al ' If'****1 * l'* terminated: , I a* b aaM laf Ma .ygg '1 * I -dnath- (a) Wbaa AhiyaJ flji Ma'kaaa yaHaalt---------g-16-57. -m _ _____1 CD >aa aa 11-2-58 _M H* fakaar.haia 4bMaga4 T'gg a aa. gba -- ` IT--?--S8 . I aat, aAaala 4a H k Min ayaglaa JUL .'lAI ; 1L Data yaa MU yakaaa aaa ar M ha aUa la M aaaa kb awal --at never M M paPaM aarUagf____ 02______ (A) Ipadfy aaM haMMaaa I aayi _M A aay aMar waMt_____MUL I coMPuri nun n-u op pent on this um paw cm pwiow awn wwicw maw this inpoimationi | 11-14-57 ' 11a ` State *M patmfijpmm In--d Ann nmUmn h|r '` - ---------- --aim---- --^1-- ` 0 UN jU ---------- ` 1* * ~v '' n. I af b|ary aal a* parti al ha4y laaU. T . - w,. .. HU MMa b tar a Aaaaa, ffcai (I) CD Data ; I ab'far haw laagf_ ' !'a')y;(i'JH f- r u.r ift "t. jJ "JVT T>'V 1 - N h Maia aay Marry ar < a*- . T^t -* - --IU * U. hi) U. Wa f pmAmmif wmim 1 NhMN *N4 iiii"i< it- -W IA p.a-I,aa, wi W haaa lar (ada W jm ilNii Many 4 adW 4ns Inn pm _I y, h.ydliat. '__*__*__f___If_*_________________________________ __i_d_k___________ ____ **. haaa aMmaaal Miraii --AntfiPB? findlngnt Pnlmonftrr embolism from thrombus of right ------ flhrlim due to gtABiw freai rni pnlwonalB aecondarr to awrwrw rmamionBrw f^brosla;. 4a yrWh laB baawN4|a af'iihaarnSi^lijU'nitl Ha Wirto.ay caaaaaM MLeNwf twf NdYWINwHMdmflt,o , C a <^hh* IUU wJ . I aMa that l aaa 1. : a phyNalaa 4aty Sh.- .1' >4 ;4*a.^ laaaaal I la prMHaa a41riat la Mia Itaia f Hmw. Tar*. * ' .11 ! ivV, |i- r * * r~ - WjCAMM. I i',,i WXA AaM 205201___________Mcwri... -91ft R.8t Charlotte Atc.. DOW1U> C-4 Hovamber k. 1958 P&lgyTB, Sw York C-4 C-4 C-4 H-1U-5S Hosp* Copy - Varlfax of or^g. to Kp. Pierce* SJW C-4 C-11 (S-33) . WORKMEN'S COMPENSATION BOARD STATE OF NEW YORK - EMPLOYER'S REI . OF INJURED EM PLOYEE'S CHANGE IN EMPLOYMENT STATUS RESULTING FROM INJURY Tins report k to be filed findljr with the Chairmen, Workmen's Owaprantioa Board at address shown on reverse side as soon as the employment stains cf an injured employes, as reported on Form C-2.S, Form C-2, or on a pterions Form C*ll, k changed. Change as employment stains indndee return to work, of work, or decrease of regular home of work and rreess or redaction of wages. Copy also should be sent to year msmewce carrier.11 W.CA. Cam Na. ' Ciiimi'i Ceae No. ud Coda No. 1 Dot* of Accident Nam AMrva* I. Employer 2. bamM* Cirmr THE GAHLCCK acme CCKPANT PALKTBA, NSW YORK Bmloyors Mutual Liability Insurance Conpany of Wisconsin 10 Gibbs Strest " Roehostsr 4, Nsv York 3--IaJatwI Paavos KBS. G3ACE BilLCBD #8-638 !L 0. H, PADCBA, JUT-TORE 4. Date of most recent Employer's Report filed: (Check 'V form and give date filed.) dorked 3-4:30 shift OC-2S a C-2_JII=2Z=5Z__________________________________ jjFC-H_&y=SB____________ 5. Date Disability P*y"* 6--8--58 . . Hour of DayB tflO . AMP.M. 6. Nature of Tnjtirj- nf rnl-*rarr fibrosis of lmuta with shortness of breath. 7. Date of first return to work following injury:-----------------------8. (a) Change of employment status resulting from above injury: Employment Sutoa Howb per D*y Dan per Week Eifihfi Prior to bprr Quafri to (b) Date of this change in employment status i (e) Remarks:------------------------------------------ Oecopetioo 9. Loss of time resulting from above injury since first return to work: From (Mom Dey, Yeer) To (Mo., Day, Yaar) Rmsa 10. Is injured still under the care of a physician?---------------------If so, give name of physician - 11. Has injured died?--Tea____ If so, state date of death: 11--2--58l Name and address of nearest relative known:--Bnharfc 2. Bywra (son) R. D- Palrnrra, N.T. Date of this Report_H/TVfnihrr -3, -L95fi Firm TP?: GASLOCK '".CTrO CST AMT Signed by.___ ______ D. P. FRASER, ?1CS VRSSII^NT C-11 C-11 C-11 C-11 aa-3izT GORDON D. CURRIE, M.D. 797 Elmwood Avenue Rochester, 20, New York August IS, 1958 C,, Employers Mutuals of Wausau 10 Gibbs Street ^kjchester 4, New York Attention: Kr. C. V. Boll man Gentlemen: Re: Grace Baylord vs: Garlock racking Co. #A40-22779 This is a report of the examination made on the above-named claimant on July 29, 1958 at your request In ny office. As you are aware, this claimant has a history of working on a machine which makes asbestos yarn. f or over 20 years she has been employed by Garlock Packing Company in this capacity. A diagnosis of asbestosis has been established on this patient, and, as I understand it from your letter, this diagnosis is not disputed. Following the establishment of asbestosis, the claimant re turned to work at Garlock Packing Company b:t was put in a department which was apparently free from dust. In June of this year, she developed an uo'-er respiratory tract infection and was tinder the care of Dr. William Braell of Palmyra, New York. Associated with this, she became very short of breath and had cough. Following the respiratory infection, she continued to suffer from extreme dyspnea, wheezing, and an inability tc perform any exercise without the most marked respriatory difficulty. FAST HISTORY: TheClaimant has had no serious illnesses other than the oresent difficulty, and no operations. A complete review of systnes was carried out and was essentially negative in all respects. The family history was non-contributoiy. OCCUPATIONAL HISTORY: As mentioned above, she has worked for Garlock Packing Company for over 20 years. PHYSIC.-! ZXA2-3NATICN: Temoeratvre 98 Pulse 120 Rgspirations 36 Blood pressure 140/90 Height 5'Ai" Weight 147s pounds The claimant is an obviously sick white woman in respiratory distress. Her respirations are rapid and wheezing in character; on the slightest exertion she beccmes extremely dystaeic. Skin: flight cyanosis of the nail beds. Head: Normocephalic. No sinus tenderness. .St s.t / C. / // \ Be: Grace Baylord Page #2 Aueust 1958 PHYSICAL EXAMINATION (continued): . Byes: Pupils equal, react to light and accommodation. EOM normal. Fundoscopic examination negative. Bars, nose, throat: Negative. Mouth: Edentulous Neck: Supple. Trachea in the midline. Thyroid not enlarr~* Some cervical vein engorgement in the recumbent position. Aioraxs ahows see* slight increase in the AP diameter. Breasts! Negative Lungs: There was dullness at both bases on percussion! On auscul tation there were bronchovesicular breath so'-nds at the aoices further devm both lung fields, the breath so nds became bron chial in character; at the base of both lungs, extending half way up, coarse rales were audible bilaterally. Heart: Appeared not to be enlarged. The rate was rapid. Sounds were of good quality. There were no munmirs. Adbomen: Soft. The liver and spleen were not felt. No rasses, tenderness or rigidity. Pelvic & rectal examinations: Not performed. - Spine: Negative. Extremities: Showed th presence of finger clubbing bilaterally. There was no pitting edema. Neurological examination: Negative. LABATCHT DATA: Urine showed a trace of albumin, no sugar; microscopic examination showed no white cells or red cells. Sedimentation rate elevated, AOnrr.. per hour. Hematocrit slightly elevated, 46. Fluoroscopy and x-rav of the chest were obtained at the off- c3 of Dr. Ide and associates. Their retort follows: "chest examination. Fluoroscopy and film examination of the chest reveals prominence of both hilar regions, fullness of the soft tissues in the right uprer medias tinum and diffuse linear and fine nodular change throughout the lung parenchyma bilaterally exterdir.e from the above downward. In the bases there is sme softer superimposed patchy density ilaterally and some oblite ration of the pleural costophrenic angles. The heart is mildly enlarged in its transverse diameter. No specific chamber enlargement is noted. Conclusion: There is radiographic evidence of a fairly diffuse and rather extensive nodular fibrosis throughout the lun-'s. There is some superimposed subacute to chronic inflammatory change in the bases. The heart is mildly enlarged and there are some mild congestive changes in ' the hilar regions. I suspect that there is a right upper mediastinal lymph node producing the enlargement fie: Grace Baylord Pa<*e 3 ' et 18, 1958 LABORATORY DATA (continued): x-ray of the cheat(eontinued): "of the sahdow here. With the clinical history of exposure, I would accept this as a penunoconiesia:. . if fairly specific type." ' . (Signed) Charles 2. Sherwood, Y.D. The x-raya from Mount Morris Tuberculosis hospital were received and were reviewed. electrocardiogram showed a rate of 120, a PR interval normal, QRS comnlesea were all normal. All the waves were essen tially within normal limits. The tracing showed only a sinus tachycardia. OjINICH: It is my opinion that this J2 year old claimant is suffering from severe pulmonary asbestosis with marked lowering of her : pulmonary reserve as a consequence of her disease. Secondary to the pulmonary difficulty, I believe that s^e is beginning to show evidence of cor pulmonale and, indeed, is probably in a early cardiac failure at this time. . ' The claimant is at this tine totally disabled and it would be my opinion that the would probably remain so, unless some benefit could be achieved by means of theuse of digitalis and di-ireties. With the use of these drugs, the element of cardiac failure may be removed and some of the congestive changes noted in the x-ray may disappear. If, however, after tre="tnent of her cardiac faildre, the claimant still remains as dyspneic as she is at -resent, then her disability will probably be permanent. 30 far as t*e pulmonary disease is concerned, all one can do is administer bronchodilators and expectorants. The relief obtained from these drugs, however, is purely symptomatic and down not prevent progress of the chronic pulmonary disease. Yours very truly, (sitmed) GORDON D. CITCI2, ".D. OJ 205A63 CDC:ee Grig, to ..CB 3cc envl. cc Dr.Braell end. - Garolek Pecking Company Palmyra, Hew Tort <2?- Hlas Once Baylord 2. T. 0. #1 Palayra, law Tork 8a: Oarlock Packing Co . JA0-22779 July 2, 1958 Saar Madaa: ' At Sr. Snail1 a suggestion. we ar| plaaaod to adrlaa that wo hare made arrangements for you to ba esamined by ona of our consultant's hara In Soehaater. Va regret, howarar, that wo hare boon unabla to aka an apoointment until ip-Vour waaka away. Vlll you feakindly raport to tha office of Sr. Gordon Currie, 797 Xlmwood drenua, Hoeheater, Sew Tork, at 3:15 P.M. July 29. This la on a Tuesday. Vo will talaburae you for your trarsl azpansa on thla trip, should thla date donfllct with any other plana, kindly adrlaa promptly In order that a new appointment can be amide. Tours reyy truly CVBollaan - 8C1 Claim Manager Kedienl Jens 26, 1958 Hr. Piereei Hr. ** Soith He - Grace Baylord $8-638 - Sing Oept. - 8-4 * 30 shift Shortness of breath d'je to aabestoeis C-2 Hoport of claia Bade 11-27-57 Lost tire began 6-9-58 8 AH. Grace Baylord will receive leave of abeon e with par for tine lost in thin ease Sila Jane '**clfrank : Ci' / i **> WORKMEN'S COMPENSATION BOARD Stefe mi Haw T.rt ATTENDING PHYSICIAN'S MPOKT O ATTtNDtNO WlflCtAH feayarb # 4m far* AmU U tbd aOMa ft U*n after yaw Artf r--<Uf to wrtim'i ifwyiortlw SM r -iHrm mm'i baardl M. nail MUa !f day* after Sr* Iraatwsaf, ad a* Pra* bparti m teterU af 23 day* r baa dartrp kwW**Iic liisnaai. A* *** w W(Wntf b balm^ FINAL ttrocr aa Ibb tom mmm ba IW nf^lw to lb* May to aay yrwaai rwparta. N Iraa>-- b wasted arttbto 4$ Immn, to* npaH om4 Mab t . fUm tU aftt**d ariylsto to racb tape* dbr*y to* fl) CHAIRMAN. WOttMfN*S CONKNSATION tOAXO * aU #*ca to *- rfbfricf to to kb lb *f*d ad to* a rapy art'll Q) ba INSUCAMCt CAItlU. V bm, w tW EMPLOYES. rtNTb 4mm lypa tap** Q dHWf PtSJMlMAXY Q S-OAT KEPOCT Q PCOOKSS CFPOCf Q FINAL KfFOCT 1. W.C.1 Cara Naabat pi ba*w) 3m Cat'toi Car* kaAw aad Coda 1 Oat* al ttridia ar t|rry aad TUas A Adlan Wtol AndrfiM w tofary Qainid 3. iNjuno RttON 4. Iiwortt awmi -RajrlordO&rlosk Pnoklng Co-span/ . C^arloo!: fsoMn^ Oo. A44n Psl.-jjrn, He 7ork I *** ^ ____ L32._ INSUtANCC CAtClft a. hospital pi #r) OBp. '(at. LIa. Ins. Oo. 10 31bbs Street BoahajitTf ht Mmn Tor1 *ff imKpI ibiM Hbf fmfmrr aainW *Wa partanatf auie*d baaawr ^ m Vala4r liMta, i' i FWflOTft nz!Ms toy, law, *to#f ar afaic.a sM eVa It aNt far VabHaar ftoa*'i ***! #*d r*f*r *7* toai f AmmiI (aNitoa fiwWt tfayMn't bf**ir* ftod*fv cav>totaii aJ pap **# to caadtbaa pats !tf rprr*> Palnowary fibrosis rtw-todye paaa^>~A lats~fr^ Asbsater -- Inarmelwg------- (a) la IWra aa* a*y dUabXHy v pbyikto -f** -" -h acb ditobi*iry ar dtowf a rs*N to to* praam Infvry ar dlnaaa?___ _________ (b) Nay tojsey mtot to paaasM taW as bxd dbSytmwt ar alba* pamaaaat d*l*l .... JffLto H |.% drsrrlba- - ------ - - Palaonaiy lapalrasut-------------------- lb Ummm to ------------------------- --------------- M Wba 4*4 ywa (1) Id baat patisaf? -- lb) Haa paiiaas bats XaAafftd toa taa*awHY . ... If UtlVnAlfn -- _ Maipili'fT__________ ___________ _ k) h tow* ar rtariaa. bs^bsl. ar isbabito^iaa baa(--at ----- _ _ . (7) to f*at parte:aT_._JS/l2/5a------------------------------------- fiaa da*i ------ __ . .... _____ If M, adnat 4 aaHaa ad HiwiT .. -- . .... ----------------------------------- || so^ aHna aaaars J sacb - --_ M. Da*a ya totofc yttoat Ml ar rtO W abto la m** kb aw#al wasbf. \gvjo (e) la aaltoat --Alngl. |7Q (d) b*>^f ak Kai'Part V aayt.. -- \ r\*%A____fb) 4m pay a*bar va:bt -- -- _________ _________ .......-- _ . -- .. ^ fcoMnm itim$ .ii o twtn oh tun um pti of runom u>on hich tt this iMFotMAnow? | n/i r-,/^T | O. 0a^iba arts'* m4 aafat vt tojary mmd ayacjly aX pmn a# bedy toaabadi (a) Ws*a Xsapa toaaT. _________________ __ (b) Wat faatoal aacaaaciamT . ._ . _______ . - K aa, lar baa Wuyt . ..... .. ..... Id If daia b far a dbaaaa, fto: (I) Appiatlan data al taia W ratotad *y&ftaau_ .......... ..... __-- -- _ _____ ___ _______ ____________ CP) Data dbatotly b*fa-- j ---------- - - - _ (3) Pafeanr'a awpaiiaaal to*aryi-------- ---------------- ------ ... --_____ (b) taaaaa far *aad--_ _ _ fc) Old yaa abtato fcldary aad adital data fiaa prsaadlaf ^b|d(iaaf _- IA. talar tot* addlaiaaal tofanaabaa a* *riaaric ------ - - ------ ------------ _ _ - ` "- - - If aat a**aeb aalaa*l af -- I rt*b Hal Mia ladlajt aad aplslaai fivaa to fba faraaatay aaadlcel rtfarf ara faQ aad fraa fa Hr baaf af af fatablfr, lafaraiaflaa ad baWaf, aad aiada IH fall haa**todya af tba frrrfilaaa af Wc. 114 af tba Warbaar t CaafHiillai taw aad Sac. IS af Ha Valaafaar Ptaa'i laaatl law. I tfafa Hal I aa a pfcytfelaa daly llcaaaad ta pracNtr arflcbr la Ha Stata af Naw Tarfc. C441 ......... '.**! WORKMEN'S COMPENSATION BOARD . SMi of Now Trfc ATTINDIN* PHYSICIAN'S KKPOtf to att**xmo mrncMtt MFIN-AL YJ 4mf Aar In* I I to aatoaaa't aatonartoba aaaa ar a aaMaa fepattt ml Manah of S r lai 4*4*9 mi * Mag l mmj prmtkmm nparfe I mmm( b Mk 4* Wan. to. Ma naart ato aak R HNAL M. to. toato artokto af aart naan toator (I) CHAOMUH WOttMST* CCMMNUI10N HMD to *a aOaa a# *a < toaWtoadto - - .to to a **aaA aaar ** CD *a totoWAWd CAWS. I Man. ar to. CMHOtB. T to toaa to* al O fllllUlfT Q 1MAY 1900 gj NDQtoB WOO Q FINAL L WXJ. Caaa Naakar % Cmttf Cmm Htmkm md CO*x,' A Data afAaAtoat ar WaryanA Sna 4,iMrmi WWa AmUmI ar laHr O--ttW Skaaaa) ' ' r` *' 1 * Qf faun) ' '* - --' i - ' - 1 - <3*rX*ck Packing Co. i. msvwa> PCBOM * a. sifiom Nm ' Craca Baylorl Oarlock"Packing Coapany ' AAtoan i E.P. #1 PALKTBA, TN TOBX \ ... Plyrmf Vtw York * ` A** Jl_____ ' - 7. MUIANCI CAttIB t. HOSPITAL Ctm*r) ' xxrLOTZKS mutual UABurt mubamck * COMPANY OP WISCONSIN . . UGtBBSSXUET lOCHBm A NET YOKK ...... j ... * 1 , 1 ap N vito Ratotof aaAfaaA innaato Arr ai a Vtotoa Awto toaa at IMftOTII ato to nato tor V* ~ -- ' . VaLFX 1 > > ato **r toaa#. A < j 1...... ........... Pnltoomry flbroaladua to pnaoocoBlol* from aibeato*. Increasing dyspnea and j,;; ! i' | oppar raiplratoryinfection.^ I (a) to *an aaa aar AtoMkr.ar tofadf__1*1 M % hliry tMh la paimmn taM at U ~. Pu^ggaTT .Upalraeflt______L Its. Maton al a.ato.to , Hft________ L >tok ato tototof ar Mato a fan* af to pnaaaa k|ar ar toaaaaaf- I ft ' to i-m... ; M Wbta M pm (!) fc* M pMfaaft. ! (b) Ha patfml haw* Wv4 <m '-- mtenoton i/4 Y* Mm apantfa S/.16/J7---. _nfi_ A la* Inal fa J12_ : *% i Maati 11. Dan paa tola* paMan aaa ar ato ka afcla to (a) taaan. Ua anal --to* ttndateiulned n.' a. --, ato, Ml. W fc Mtoaa aarUat------&fi|A) lpato aato latoRiai. top______________________________________ jcOMPHTI TOMS Itoll 0 jUITlt OM THU UNI DAT! OP fttTlOUI MPOItT WHICH OATI THU IMFOtMATlONi | 'S U. tw*,b patoart aaa aarto ka* atotoat ar j^r --A. .^V . , y\/\UtVt" -- ** Oaaatoa aaaan ato aanaa af lafarr ato natoy * to* * Mr fa) M Mtotobfnato* CO Ban AhaAAtor ka Wto, m M to ton aay kb*ry ar i -r'ai?.:- ;; U. to yaar a*toaa .aaa ar la|ay'faiafl i f.*l lai to* < ** 9n ftoaaf a A. to| aator toa aara af aaatoar ffc)tofnT. .. ...j * r. -- :| 1 J.- *........... ........ .... .................. . M an tor kaa Ua*f_ . A toto.ali a i.P""777"i' ... . ...,,,, lJW|lto.Saaa.aato to M r-a ahaato ktoar M atotol toaa fnaa , I >L--p.r .-.1 fAruvr ?.CITt l4'. Oto^fan .aMtoaakJffaaaatoa* . n nil ' r-"1 ~ ..... ` 1 ' ` ' - ry t-i--*i -ot?r . ..Maak< ___, J** ***r|' a** rfMaai ff-aa b ftorlar***toa antotoal iapart ar* M aato toa* fa Ik* baat af ar fcatwtof|. bftrsaMaa toto VNM. ato toMaartto Ml Mwto4* af tka arato.la.a af im. 114 Mlia WarWa Catoa.aaallaa Uw af kiui to Vatoalaar ftoatoaa't laato lara. I atat* IWIaaa plpatoWa totp lim.l to praattaa atottoa tofhaltato af Naw Tart. f - WJ'-| e-Q j, * *to,to*t -t. '<*!' fto.;i 4 t * IMai*'*'* .' V **'?+'*' II* <*1 If*! H fpff* t I tol^Mfl *" I--* ,kf| MfCH lUI.* Mf'fO'ftl !' >`A * Nfin-l*i 'to* Cato t lr T'.'_L-- g `J - V -! -"i n. n- r~ r-- ^ fglynAli) VllUtoB J. UfaMll. K.H. f WaCalL 205201______________ 216 l. Charlotf At*. Palsrrw, It* Tort C-4 C-4 C-4 C-4 6*26*58 H6*p. Copy - Ysrlfpx of orig, to Mr. Plerc* SJY C-4 /c-rf mif-foft C, J -dn-m WORKMIN'S COMPENSATION BOARD "r rv (aiO . Met* f Maw ft ATTKNDIN9 PHYSICIAN'S RIPORT TO ATnNDtMO PKYtKMM ki**w* aa *fc Iww MnMM tm MaM aMMa M haaat aftar ym tnt naMar ami it M a itwr'l tn i -r Ml an* nMa aMMa U ^qiWHrlnl IMMAa^a h|na kfa* at Mania M a Map ar ha Ma anl| atttwatt Aa ana aa aanwaat la - r * RMAt IBOP aa *b tana aabW aafaaMM at Ha Mat at aar pnMan rapaa*. If attnm h naHtnM a*hia 4* Mb. a mTiL MM wMal M aaak Mart MkaaMr M 0) CMAWUK WOBCMBTS COMRNUTMN aaMMa M*aaM aarr *H GO Ha MMAMCI CMB Maa. ar Ha MFUVB. QHaw TB* ta Haa *fa * Marti MI MUttMR Q lMkMT BO [J at Ha fMt la *Udi Ha < Q FIKAl BOH L WjU. Can Mialtr. ,4 a Cantar Can Maalw.aaM CaMa> t Bata at MMaWar lafarr aaM 1M , f Mkaaaa) ' ' ham) WW Aa^4mI r lijwy Ovtamd . ------------- - 5a MJUVD rmon * *. mnorm 7. MUtAMCB CAJdua t. HOtraM ... Olaar) " 0rea Bavlord . Id. * " . 11 ", * Oarlock Packlnc Concary XMPLOm MUTUAL LlAULRT DfSUmAKCX OOUTAffT or WXBCOftSOf . . .* V i - -Mi; HtH** F ifcp dfjr, --- - j 0rloek Packing Comnany 1 MMMrn .1 * E D *1. ?l*yra E.T. ^* am _52____ r'. \ i Bftlnyra. M.T. "* * aaMSTiLErr Boaosm < kit ro*x ' : j ` Mtr fa Mr aa a VaJaataw Fhtaaa. M at tMW0T far V< ~ `` Vat. FA .I IB 'T' n.B.T, ha a twprrtwil Hit pattant la atlll aarkadly dvtpnale tTtn rm mild aTarttnn `wfV- *' f<>"'",< l,n* i imanmnrm'iaaia from Htbogtot-l i (a) It than aaa nr ta>% at th)tlatl f a. h at MMf ar filit a'aat at t> pnMt 4ay ar MMnt_ Mar la|aty la Paranra.it < npa < raa.t Jif pal angary fWwctlnw. .I AA. NaMaa at iit. (a) WM MM raa 0) H* aaa fn.wt- 00 Mn pafea ha tMfat fraa aa . . . nndetaralnad S-16-S? " _3fl_ 0Q M aa iQiti__6--2B--SB________ laaataaMa__}If a* . Maat. M la irtara i taMafL _Efi_ ?- 3- St <rno IL Ona raa Mlak MM an a aM ka aUa ta (a) aaaaa Ua aaM wwtCn&a tcmlnoflCM 4a aar aHw *wtt- w b mm aaUM------ Hfi__ *" r"r-r Yotl at areaant | cottfun itims it.it on pent ott thu um pati of numoat urorr which maw thu iwiotaunoHi | v It. ttaaa'ia MMa aaa mMt M aatfaa ar Harr ' ' 1 U. Dm i rf md riff f pNi l Mr ImMu W M V Mata a ta a *aaaa, fM fli > at ana at . It aa ta law laaftaalUM M la Mara aar M/ a altaaa Maa at aaatMaf lafar a l * `**' ;* -t* i- i *. - * i. *.- t *i . U la faa aaWaanaa aaMtaa a I UL Wat r*Maa rraMaaMr aaMa Ma i i at 4 - aMaMai (H Baaaa ta a^^ W 0*4 M ataMa ktoy aat aaMaM Mata taa MMh| MriiaM. aa. ta> aa tha aaaa M Jtaa at . Matt.. K-t otif-foci . [JM* * ***>* t plla-- M"* h Ha tararalaa aaMlaal far art ara M aaM traa ta Ha kaat at ar taaarla M<a. Maraatlaa g* Mtat._aaMjaaMa artth tafl HawlaMta at a ar.M.I.a. attaa. 114 at Ha Warkana'i Caattatll.a law aaM Saa. U at H ^**w-JL.**r** H. n.rM__a_&__a__M__at.y _la_a__a_a_aMJ ttaa aprwaarttllaaaa aaaaMtMMaaa la HatMaaf Maw. Tar*. 1^' ** ,v.h^-4.v t a. *; 1- |^.- * Birr f* . aiitU-l*':t*4` ^:n^ j}Mr Mt n craft* ru |tft-i nc^ pc *^n ** : , * W^JLti"i*a' t'a Cata"* ------ ------- - - r- t' ind) Vllliaa J. Jraell. MS i~r ^ -r >V U ~M;Ji^aaata HnaaaTt------- ^------- WjCBa 205201 a 216 1. Oharlotta Arenua 6-20-SS C-4 C-4 C-4 Palavra. Wm. Tark C-4 C-4 y C*-P'+ fi) r b *)!">. PS'***/ Bverett Merritt Re - Grace Baylord - #8^638 Bing Pept. - 8-4:30 shift Shortness of breath due to ssbestosis C-2 Report of claim Bade 11-27-57 Lost tins began 6C9-58 8 AM. . . Please note attached report of clain. --go,??; *' 7//p 'V Conmittee - So you vish Grace ylord to reeeiTe leave of absence Bit pay for tin* 1st in this case? Slla Jane '^ulfrank ; , - ,* * . ''ir * *' Physical Examination of Employees Date Name March 17, 1950. Grace La Plant Saylord " Proposed Job Twister Oper #2 , ~ ' A*e 43 Weight 139 - ' '. ... ' Textile Dept Permanent - Rehired - Height 5 Xt 3 u " * * . . - - ------- Previous Occupation Previously worked at G P.Co., Textile lapt., Left ^ 1940. . Medical History Usual children's diseases. 1931 Ctoe child- - -- Surgical History Hone Condition of: Brain and Nervous System Heart Lungs ________Gastro-Inresrinal Kidney No * Nose Throat --------- :-------------------------------------- . Good Nonnal ' Clear Good Ho albumin ' - Clear Good ' M.D. ,, _ J- Prod. Mgr. Personnel Mer. ' , ' >.; Ear* Pya*. Clear ... Rt 20/20 Lt 20/20 As corrected by glasses COD 3 ' p3o>ioHn#r a1 0 0 ' Blood Pressure_ 130/82 Hernia ................. ,, * Ho 0 00 hanna w Odr Defers Has upper plate cc a 33 s OO O Physical Rating A B C Mental Rating ABC sOnX-On< 111 j V2 1 111 2 l/ 2 ^ 3 33 3 33 11-3-52 Checked after absence from Oct. 6, 1952, due to hone accident, injured rt shoulder. OK to return to work today. Dr. Nesbitt. ' " 3-7.5-53 "Checked after absence fxnn 3-15-53 due to grippe: OK to return to vork ----- -..........-today 6 Arl. Dr. Nesbitt. 0 > a xM30 M e*W011%JOH1y* a03> a--. H* 30 aXc- 12-30-53 Checked after absence froti &-21--53 dne to nervous breakdown. OK'd to retiup^r to work Jan 4th by Sr. Sikler aad Sr. Heebltt. Sr. Seebltt. - 2-14-55 Checked after absence from 2-7-55 due to Infected rt 3rd finger, Comp. Ceie^'*'' 0 P Co. Ok'd by ttr. Heebltt to return to work today 8 AM. Sr. Heebltt. ** oro. lam . /i/'AtjY 4 >Vi9 Sreeda^v jgha.v.tTTj T?' VVoah^p'.-* Sr. purr.'LO r ?t.7 FroftlM *. rn..\ toi'K 13 .* if. rvf7uvt.sirr .,* 51 . * *. t . . it. V.'ORKMEI JT' COMFENSA J ION BOARD 5TATr or ' if-W" YORK NOTICE or- DECISION f i w c 1 . Case No _7?W4* 4 Dai cor Hr*AfKC >ie-5t Cl-Al*4AN7 -flr9-iyl*ro a, 2. r. #1 Oarlock Faakln? .......FaJjcrwu -T. ... 4 t t *f 0 t .* '*.. AND C: >* t _ Al,0 22779 j 91 C't p* '?* *vr Oi. ** * D' r< cr a t? 1 . l re o* r*-*3 f 3-lI-58 *7 r 1 \ TO Till. Cl AIM.''-"1: ' /iny ror.-;i , ,,:k *n \ * v-::: .. * * VL i .v chwls 1 v t.' p <-n; ) . * r.r !*:. ii> . i* . t:.; C. K-1. . ..! :m! I - i ilit |mv .-fii's in <> T* r t|i;,l 1 - I'O".c . i-.!! a f I ivent (' iKin-f ;.\ v::r. ; r:-.- c <( *>, . 3. Do t>-jf ;ia-. in *i.. - 1 Ti pi . u 11.; U-C. l1 J-:(C ntltM-l* ' !.-! d ftnpl< y.-r >.: . 1". .i.'li re j -1. . 1 ; .trd r lie;'; . v.a: a /-.;! 1 ;n.s':ra*(. < j / - * !(.! i jnJ v. i'l , tf** r v \ ^nr reprr .rntR*". i *-* l..i *<*.. 1. In WOTKmi -. ' < ^rl.N- , l;i' . -,tr. 1 cr4- sali'ci 5J -til 1 * i .. -.H (i- '.i. 1 sr\i ? il^y- l disabilit . l!< ~>ii-i. <' ly hi iliviliil'ly ..1 n . : I>< .!,;i ! ll"i i; -If. . , r ir;*- " s-1 . vi ` iir ; cl <livibi!i*> COPY T.i sAftei hearing on dote slated above ti e (.11' m;' I >'i'id Aw.ir-1 s.- :in,l. Workman's Compensation Law V-Jsj.'innt 'ib- tiled tv. C under IV: .. 13- *:rf:! L-< v. * AWARDj_ THE EMPLOYER -AND, O-l TDK INM'Dancf. CAUPUT* / M* T!!:i*CJi:D 'rO 1 AY AT ON CD | for dUafcUity over *j-rno3 oi___ from ' si rrie i rerw-tk j ru--' 7H- i* ^ ? ! claimant 1 ' li 97 payturits made rc.trii'* ?*i; poriot1.) a* Ncd on w*rd payable b> ihrtk > to CLAIMANTS IIUI'UES!;*; LATIVfc OK aTU J .* J fe* to DOCTOR for lieu,..nrr :i Hcoxiur DECISION: Cose was..... *<! on. tb fe.a*l* thaia Tindings* Pcenptlcml .noadltlon n?tloa and f>irw*i ralatlon for a*b*taal* f tb lvapa.- -Z>lMlity St>t nsi *.ka. ,7 dtyg Haltlug pearled, ........................... ................................. II c-*e wu *acontinut<t`* eunUr.uir.fi p.iyni*n* w** d tcti J il sl .11 n-oU* ut c. ratr (jr the j-rr'o,! Wkd stiatl be cofitiourd 'l.*r*T.f^r until thv :ij tci>ir cj t iirjo t.* :i.*<!]*! c . i*y #!! * vi\ncc of r chnw.-. of and fittl notice thereuf !* Ill- Ckawar. Wclnicn (.Vi^oinMlion borrd. * 'Ji, * * providM in thf dw`ml. A further bearing will in a * rvntinui'U' c-ire t i-trmijic the cAirm i fitr'J-.cr osuf-iiit/, ff any. In Volunteer Firemen a Bent r:t raw.a, the Jial.le pv litldtl subdivision U deemed to N i;h* **KMri OVEIt** of the vrlurter r tiitoun. U. 0-2.3 C-23 C-23 C-23 C-23 r* -s MEDICAi. ..CORO~i ' rr- SEAS ma ZLkTLOI bashed - OATS 5-3-39 *-*-39 . / * " -wm*mr on sunn * Cold - U*B irilt : * ** , \ ' 1 r^TS X a-5-51 | 8-1`5-`;1 Heada he and lAraMrn UU 11-8-19 . 1-11-40 1 10-15-52 Retreat.ad left ear TV41 Per.uep.itef 10-15-52 mon-occ 6-ll-Ui Physical *XMla*tioa 7-ll-*l Laxative - Headache . rt-JUi ii-iq-4: Headache _ ' 12-l5-4 Cat left Index fln*er at hone 1 H-3-52 | 8 11-6-52 3-24-53 Checked after absence fromlO-16-52 due to none accident, injured rt i shoulder OK'd to return to work today DrN rer.Dep.Rep. 11-4-52 Returned to work fi uu uou*h;cc dla". "11-3-52 her.DeD.oeo. 3-23-51 tfon-oee die V11-U2 Cold--Laxative ________________________ began 3-13-53 : ' 3-17-50 Physical Examination 3-25-53 C&ecaed after abse_ce from 3-13-5 6-5-50 9-28-50 Physical Examination (Textual lmeness left hip, laxative uu OK'd to work returned 6 Ak. today 1 4-1-53___ Per.uep.kep. 3-30-53 Non-occ dis * 12-6-50 Couah and constipated UU 1-17-53J Cold LU - | 9-1-51 8 I Kervouj *tc. Per. Den. n,, o_i a-. : ' , om . - ; f ~''I;-Vi'."; ** mjumr on numm ^>: . ~ wowrr on txumm ________ 12-305; Checked after absence from 8-21-5, 8-24-55 lameness - * - . nervous breakdown OK'd Dr. Dlkler 10-17-55 Callous rt 3rd finger. and Ttril return to wcrk 1-1.-54 10-26-55 " rt 3rd,left index,cough,lame Or: 9-27-54 Cold 1-6-56 Dry skin both hands. ! n-15-5 1. Cold and general lameness rt.shoul ler*10-24-5( Per.Dep.nep.10-23-56 ' 124-55 Several abestose chmsiboth hands. ; 1-21-55 Checked ash corns both hands-general lameness Oh. , . - . tc 2-4-55 Infection pl^Vnp rr "T nTiver.TV-N 2-4-55 "edressed'right 3 finger. " 11-20-56 Checked after absence 10-?-56 due r.on-occ dis .nervous condition,UK L 1 0 return to work 11-19-56 .under ca DrDikler. n_on_5? Tnd Sol dap rep 11-00--5? !:on*occ dis ended 11-19-56,6AM 2-14-55: hetumeddto work today edrssssd rt. 1 3 finger,gnerax lameness urn j ! 2-21-55 Trimmed abbestos corns both hands t------------------ redressed ngnt Jrd finger. brN 10/30/57 H/14/57 1--25--55 THnwri ash, corns rt 3rd fin. Dr Dry sklT), slao cough. Absent from work for 3 days due * and shortness of breath. Onde W5_5 5-25-55 Asbestos corns rt bandDrH 6-17-55 ` Coin left index finger.fhrfl -:7-2-f 5 Trinmed abs. corns both hands-D N ;i return to'oTV 11 fli./57 Temp. o 8 u/27/57 Probable asbestos!s of lunw. jj ; C-4 byT>r. Braell dated 11/14/57. | Negative C-2 dated 11/27/57.". -- f MEDICAL RECORD GBACE BAUOBD dm* mjmrr on buoi 12/18/57 Talked with Dr. fi. re: frequent DATS // - 3*ST absences due to chest congestion. Dr B. tlaked with Harry Beach, Bay ' i ustin and . Van Holder about same matter. Also. Employee reassured. Sf ^T-ac-aTf f-ai-is S-a.a.-S'S fL-au ^rt. c*1,1 * " * 1. ' *( "- 4o auufrr o nun -^XJ---- / //- 3- - 0,*?' <?: fS'/'/n <L?,' y.yxV //-3-7- y. L-d-.si.. tL.I.J/,, ^ *J J-. _ ' df. sfK^UC ' - k afc-- 2^--~~r~7 `'-*-<re ^ art "rr. S-2 C5-S3) WORKMEN'S COMPENSATION BOARD STATS OP NSW TOSS EMPLOYER'S REPORT OF INJURY Send this notice dhractly to Cfcarau, WoHomd'i CompointkiB Board at address ikown on tea (10) days after accident oeegn. Copy alao should be teat to yourinsurance carrier. aide within VV.CJL CA52 WO.' 111' -- --ejamB'snn tatto-- - -uniit to.~ -------nxmjnctnricrr------- ` - - . * . .. ... - NA . (T>o opaaai abooa aot ao ho ftiioM o *r oopsoytx) . l imom __ fin? p.sBT/irar Pirvrur. m.n trr________ ___ _ mtirrm__ wcw rnnr________________________ r 1MSUXAKGS BUPLOTXrS s. & acct. no. siiFLorias mmi*L uasniTV ikhiuamcs oompant or witoortstq can - m . ________ S. XK7UUD rauow MRjkJBJg B'TLQBfln. t^n t6^2A,^ a. d. n PiowiM*..in&Li;oRK EMPLOYER ACCIDENT 4. Nature of buiineaa: (State principal product* manufactured &P5&R1 Sf^eft'itff rendered). MoeHaal'oal Paekinga S. Place where accident o>ececnurrrre_d:_ . , So accident 6.. Date wi iJW.ffAA* H-27~57o___Day of Week. -Hour of Day. -A. M. _P. M 7. (a) Date disability Ifona 10 Hour of Day. .A. M_ _P. M (b) Was injured paid in full for this day?_... 8. Name of foreman-------- Barry Panels -- Ring Rgpb*------ ^lwood Htmghhen - Text11 a 9. When did you or foreman f'irst `know of imnjjuurryy?r.--------3.1-37-5? 10. Names and addresses of witnesses INJURED PERSON iihr fc*= r" NATURE OF INJURY ' OR ` OCCUPA TIONAL ' DISEASE FATAL CASES 11. 12. (a) Marital status:. Age:------ 13. Dit?dyaowu have on file (b) Snr employment ... paaaiacertificate or permit?. 14. Occupation: (a) Job title for which ttortor ft Hrappor (b) Occupation when injured: 15. (a) How long employed by you? Refaf ad .7 yrs. agtfo) **iece 01 time worker? tImq ' : (c) Hours per day:g---------------------- !(d) Days per week: rlr- r 16. Earnings in your employ: (a) Rate per: Hour $--1,-60Day 510*80--Week $-64.00M onth $_ (b) Total earnings paid during year prior to date of accident: (include bonuses paid, value of board, lodging, etc.) $_________________ Average per week: $________ - ________ (c) Bonuses or premiums paid and included in item 16(b) above: $(d) Estimated value .... ..of board,,lodging, or .other advantages jn addition to wages:- (included in item 16(b) above) -> (e) Calendar weeks in past-52 in same kind of work as at time of injury: 17. State nature of injury and part or parts of body affected: (as "Injury to Chest," etc). --'------ Ceaplalao of ^Horinesa , of brtafch------- ;------ -- 18. Did you provide medical care?. 19. Name and address of physician l. 20. Name and address of hospital:__ ' -"If so, whe_n?. ^Consult^ own T^iyBlcian 5*16-^ J* Braellj K*Dj Palnqia> * sw Torit----------------------- 21. Probable length of disability:___ 22. (a) Has employee returned to work?_____________ __(b) If so, give date:________ (c) At what occupation?:________________________ .(d) At what weekly wa_g_ e?- NOTE: Form C-ll mutt be filed each time tbere is any change in the employment statu* os reported in item 22 above. ' 23. Has injured died?(a) If so, give date of death: (b) Name aid address of nearest 24. (a) What was employee doing when accident occurred? (Describe briefly as "loading truck," "oper ating press," "shoveling dirt," "painting with spray gun," "walking downstairs," etc.) No aoeideab - Saployoe worked in Teoctlln Dept, ms wadiine upaisAur . (bj Whefe'`di<?'acac^ent^occur? (Specify whether in street, factory yard, on loading platform, in fac- CAUSE OF ACCIDENT . -PR".., OCCUPA TIONAL DISEASE - tory, etc). bo Accident - 25: How was accident or occupational disease sustained? (Describe fully, stating whether injured person r slipped,.fell, was struck,, qtc, .and. what factors led -up. to or contributed to accident Use additional . sheets, if necessary.)--to|il nyee altogea bag ohprinters af breath whleh who boltere3-- : 26. 1 due to-working in Textile Dept, ewup. a (a) What specific machine, tool, appliance, gas, liquid, poKod or other seufibsy?aenwcere*c.)r object was most closely connected with this accident or occupational disease? '.)(b^ Tf mefhnical apparatus'otj +ehicle,'what jpart'of it?j (State^if gears,'pulley, motor, etc.). 27.,Were mechanical guards or .other safeguards- (such as goggles) provided? _______ .(a) Were they .in use at time of accident? . (b) Was machine, tool, or object defective?_ --______ If so, in what way?___________________ !______ ~ _______ Eater "k11 in this bo* U accident vu reported 00 Form C-2.1 E_ nter *ry>* thifi htrr l sw irfowt mry p*. yiocaly reported oc Form C-5 VZSiC JTAKXi SIGJfXD BTi . OAflMGK-RlOglwn 00HTAHT -5SST OATX OF 1SU UFOKTi MnwwdoB-37, .3,957. TC-2 C-21141 Do F FRAflKR^ VlC2 C-2 C-2 C-2 Stch of New ToiJc ATTENDING PHYSICIANS RSPOKT TO ATTENDING ftffSIQANi fapartv aa tWi Im iWU be flad whUn 4J Uan eftw |m Co# fwtdi* tniinM la a workwaa'* cpepmotion com or ofaHw |nw>`i braakt mm, again otfSrn 15 daya ahar fto# Imatawat, aad m Pray-- fapamat lafarWU af 22 day* r law dH*g aMttirwIno troth***!., A moo oj t -ttaatmaa! U hraiwhd FINAL REPORT aa tkla fans aW bm filed regard)*-- ad tka fifing of any pcaolaaa r*park N baohaaa# k aanpiwd wiliu* 49 tooo, Cl* . a*a w't1 and omitit It FINAL. Film #k* tlgaad original af andk rmpmrt dlrorfy witfc (1) CHAIUUM, WORKMEN'S COMPENSATION COAID at iba often a# tka dktrfcr la wfcd rW aoMot I aad Ma a kfiwd *npy arlHi i ika IKSUJUNCfi CACHES, If ban, or tka EMPtOTW. &TO -T* *a faw tfpm af r*>wk dfrHOUfi PSBJMIMAXY Q |AT REPORT Q PROGRESS REPORT Q ntUi RffOn 1. W.CA. Caw NwU (P ban) 2. Cwtfar Caw Nvafaw oad OHim Gl knawa) 3. Data af Aeddaai ar lafvry oad TWm ' A Addraw Wk*ra Aabdaal or Ifajwry Cwrr*d ............ '.......................... 3, |NJURH> person * ' * Me-- Grace B'aylord -- ........ nflnlnrP**'c'arV^ nw Add* w R. Pa D. #1 Pp 1 mTfl Kov York Affh 4. EMPLOYER 7. IKSUCANCC CARRIER Oarlock Packinn Conoanv EMPLOYERS MUTUAL LIABILITY INSURANCE COMPANY Or WISCONSIN . Pal^rmra. Kew York 10 GIBBS STREET - ROCHESTER 4, NET YORK L HOSPITAL ( any) If pafkaf' dmlmi Ikef Imfvty iemf *kk pw/amkig acaffoad faatwi'c dvijr a* a VWaafaar fiawoa, aka* ai CMflOIW fke r#jr, fawn* rtflaga ar tfirtrief ogataa# wkkk afaka k raada far YaWnar Bww,i leaafar a*d aa#w *7** kara Vol. F.fi. f, Praaaaf candWIaai fSacfada dlagar--L afjutfn fadaft w^dk* iwfkkk ead any ckaafe af aaadrtiaa ran k - probable asbestos!s of lungs. fjjdlrrs of ralmonarr ril.'ixi&ja. Complaint is of dvstmea on exertion.____________________________________________________ (a) k Mima aaw a*r MaablTity ar fliruesl MrfrcIt__JtS&__ If ae, b aacb MaabIRtr ar drfact a malt at Mm prawtf bijury ar diwaM?_____ Z2 (V) key W}vn mdt la panaenaat fecial ar kaad diafifl--n--al er atbar arnaaanat dafaef?. res TP'_u_ "Slm___o__n_ary WBiit_b__r_o___s i_s, lT*th__e__r__ei _is pr1oba*b`iAl.ity of___o__rogressjon ' . if Mr dMsrib*-. 10. Notara af Broncho dilator (a) Wkaa did yae (1) fir*i traot 5/^ M No* rclkat knna dhdtargad fi*n -w--ntf_ Jy>-_ --***---------- Knp|MliM W I* bidf# operation, katpHol, ar rabotellmian twatawat ---- (2) fa f ao, ffta d , If **tr aaSawta dawBaa af M KaL OAcaT- 4 noti-gt. prPSPnP. |f ^ (M* nahMO af cadi tca*t*ta*li_ 1L Data yea tkiak ptlint < ar win bm abta b (a) raw* (4 I* pailaef (dj Specify nark aaaal *--h55 bgfiQ _ (4^ do any aifar vorL?_ --r HWst erporurfi_________________ [confine ITUiS li-15 OS tSTER OH THIS IXKC DfTC OF rtCWOUS tCfOCT WHICH C4.YC THIS tKWRKATIOKi | IX. SMI. U MM.I-, ow* Mfti Uw MC^Mf m lahnv ,-i-T-r*i "phnft. nf hrni.h, Tv-y-ntr- rr~.iy~t - dust at v;orl:" to { w. O.MriU .. ef ta{wy l tpmtfy *11 pmM W Udf i--w. PnP-rTQf*f>T1^ r>*s^ B^ -pnha^T --prims._________________________ !) W.r. Xnjt 1.1-1 r . W W- I If aa, far far fa^L W M ****" b tm Amm, e'm 0) AkV mm W ril.ri nTf^i-- Tv*" a^o C) Data dfa -textile Dewt exposed to asbestog dust. ! u-i-- Vfarjred for ?? vrs jn W b Min ill. Mm, r MinMl pul d pimddlag Infm, m db--il. _na_ . If M< flMftlu ***1 r J|1 "* r-tupirf dwM Mm Mm api. poida,. 00.11 id andirii. "ml-dl in all nrwVig^i Htip U. w ..Him pruhMlf Mdm Mm m rf omW ' ; .tsaM'*" " -- -- ;' no ................... fe) If m, pb* MM ad addraa *f pmmii ................................ ^ 0>) Ini far faadn. CO Md M ifali Ucatf ud idbnl dm (im pniid-., dn*b>' '' ,,tf -v --attaJi ilPlMiircit af mop . emm bn addHMM idaMbi m --This rerort is submitted et Teeniest of t>- ratfrnt l.n r-tfthMfih imawaaMUty nOpmtTy . | ,t*l# ^ fiadlo j# ar.td rpltleei $Uan la fka farcfdop mar'lcel rapafi ora fall cef frea fa fka bt of cy barl*fp, HararUto Hm.m! i.**1 of ffca prrr!ii* of Lae. 114 rf ffco Worittaao'a Conyaaictira Uw aad Sac. U of Kr laftrferr a a Saoafef Lew. I tfcfa tkat | om a pkytlcJcta ftJy iiwntf to praiefico arodldto In Ho Slefa of Now. YarL W.CA.s*g c-d.---------2QS2.Q1;:---------------;__________ --5 __-_fSjfnr>AV VMT14a^ .T T-^.T). t * .- (Ofi*#d ml AffMd*v PitfikiM^ wxx am<mIi.iim KmU--I- - ' '-`' tHitm East Charlotte Arer.ue omt nAf.^___________________________________ Palmyra, Raw York ' i 1CIIIW TO AlfMMMO nnSCUM W. Ik WORKMEN'S COMPENSATION BOARD Mato of Now Ywt ATTtNDINft PHYSICIAN'S UPOKT fa a varkaaa'a < M* On atynO n4ta*l a( aata natal OMty *h 0) OUHWAW. WOKMBTt COMOSOUnON toMS al On a*n al fa* knw la atkh On < anal aaO Ma a OfaaO aapy *00 CD k* MMAHCI CAMS, ha***, ar taa CMflOTBL ina T <a taa* tym * naan Q 4IJt OHUMMUT I 1MAY I PIHAL feCfOCT U WCA Can Maakar X Cantar Can llial ir aaO CaOa Of 1 i a) 3. D*tofbbbNiiyad1ba 4a Minm Wbn bbb ar bb*7 OwwuJ . S. IMJUVD pcasoN * x wnom 7. tMSUKANCS CAJBUa Nm i Grace B?aylord !' . Garloek Packinc Company DfPLOTERS MUTUAL LIABILITY DfYUHAKCS COMPANY 07 WSCONSXN . . PaylnrklfPnrUng Crm^an?______ ; tditm R. F. D. #1 1 Pa1wnpT^f Nnv Ynt*V ` *5^ Palmyra. New York *. tooBBSSTaiOT Boomrxa 4, kit yorc X KOSmM. <0ay> ` ) If ^taaf Mat Ihf bjny mmmmi 4Si (N^ratof mdjmd imaaft ddj Vh^ir Araw^ a EM^IOIU lb toa, iflhfi ar Aab alM data b aab lar Vafeabar IbtaM'i laadhi ad aabr TT bra . i, V. Praia aaatfMa* Mb dagnrfi. bbb aafbafe ad mtf M* d aaadMaa data la npaif) i : ________probable aabeetosla of lungs. XOray findings of pulmonary fibrosis. ii I _________Complaint la of dyspnea on exertion.'' . i (a) k Ana an aay OkaUky ar WirO yen 0 aa, k aata OkaMMjr ar Mn a tank af 4a praaat hjay ar Oaaat__2L. ! <h) May Hnv na> la pana.nl fatal ar hmO taOmnaita ar a*ar aaraaaaat Oalwf______ 2220 aa. Oaanftaa i _Pulmonary Blbrosis. There la probability of progression ~ iia Hatan *1 - - - Proncho dilatory..j S/36/S7 . N aat, i M kta nu 11. Data ma Otak pnta* an ar afliln aWa ta (a) aaaana Ik aaaal aaW .hag . been(k) 0a aay ataar *nk M k aatlan aaaUaftL_SSS______ ^ r-"r --* --T aTnld dust eTpoBUTW | cowrun iron u-u on mm on this um oati or urnous pot which *at this wroanATioNi | | . -11. (Ma la patafim aak In* aacUaat ar taHr dust afe work"- *^hnrt nf hraat.h. Twnwt.y ynafa - tTrr'aiir. to nnh^atnaa . Ub 0* > aal anaa* al tafary aaO am*y * t*ta al haOy fatakata___ Pnwmnffrmlnala, pmhaKU it.fnlnfrr In Anhokt.na diafiflag of lung. ta) W * -yea- -no- . a aa far ha* la*t- ikkrai fka. O) dab f taf fdbad Tun ywttre agn__________!______________________ Teirtile'De-t. exposed to asbeetoe due?* -T-t-- m--r WnrVed for 22 tt-8 in U. ta mr apkOaa *a aUtta ar kfary Inafaal ahan On iaa| il al y.ilaO^ tana al n.WIt* analailt___ In til TTrahflhlUt.y U. Wa pakM * I) nOn fa. ana *1 aaafan yhyOOtrt_____QQ___________________ --M A ph* aanaaaO aOOnn al Qnn*at P*ialOik - ' '~ - ' taaaaa far aataai________ ____ Id 010 m ahnta tkay nO aalta Oan kan pakOt f*T*t--a ' * ** | aat, ataO katanaal al an la Tatar kn * - - ,, Thie report le eutflnltted at request of the rat5ent '-------------------te kTteMinh waifniMMUty it hmr pnln^ary efkmaf* * . k*0 aptalaaa fhnm la Ik* Oarafttaa naOltal raparO at* M aaO ta** k H* hart af ay InanlaOaa. talainaWa *0* arith tall taawlaOfa af tka araatalaaa *1 taa. 114 *4 <h* Wartaaa't Cafaaaakaa har* aaO Sa*. H aIf Othaa T"a`taa'laar Uar. I akk Mat I an a (kpOalaa Oaly OaaaaaO la (raaltaa aOIrtaa la Iballala al Naw.Tark. WJL I wxx, -2QS2Q3______________ i ............. ' : -fsifned3 VI114an J_ Until, H.B fWmtm tfiNm W bb^^ WllUl lJ ; ' too--' ~'?16-East Charlotte Arenue u/u/vr. C-4 .C-4 C-4 PelmjT*, New York X-4 C-4 1)05-3110 9-11