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3 RELEASE TO WORK 9 V0RIC RESTRICTIONS 3 CANCEL RRSiRICTIONsJ
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HE FOLLOWING RESTRICTIONS ARE RECOMMENDED: ,
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--
UCTC 21265
3 RELEASE TO WORK
'FROM: MEDICAL DIVISION UNION CARBIDE OOHP., CHEMICALS & FLASTIC8, TEXAS CITY
Jr WORK RESTRICTIONS
3 CANCEL RESTRICTIONS
ISSUED:
{j^Aj BSENCE HAS BEEN DUE TO:
EFFECTIVE DATE
9 -/3- 7 ^
| | OCCUPATIONAL REASON
NON-OCCUPATIONAL REA\SON
f~~l REASONS NOT YET ENTIRELY DETERMINED
^2
RECALL - DATE
Mian.
THE FOLLOWING RESTRICTIONS ARE RECOMMENDED:
1 | Ho lifting In axceas of
Ibo. I I Moot bo off of fbot_
i of ttae I [Cancel on
) [ Ho prolonged bending, stooping or squatting
| ] Mo ladder or scaffold uwk
| | Ho heavy push-pull with back anscles
| | Ho wit ln_
j | Mo frequent etair-cllablng
eqwsuro to
[~~| Ho arms-orerbssd work
n Ho exposure to evtrnaeo of ^ or cold
| | Ho overtlae
1 | Ho overtlae except within these restrictions
| [Other.
REMARKS:______ _
OFF WORK
CT - 1522
WORK DAYS
RELEASE to work 2Sf VTORK RESTRICTIONS
FROM:
.i n
MEDICAL DIVISION
a"*/
ti 'RE:
11
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-- ----"
CANCEL RESTRICTIONS
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ISSUED;:
|
SSSSNtSS&SS^B^BSSBiBSBaEBB
l
fHEFFECTIVE DATE
0-hon-o<xkji^
reason
REAS&NB NOT SET. ENTIRELY DETERMINED
THE FOLLOWING RESTRICTIONS ARE RECOMMENDED: V
I I lifting la excess of
lbs.rH'Mwtbc off ofr foot
I of tlae
I I Ho prolonged bonding, stooping : or squatting
Qfc ladder or acaffOU work
J I Hfr.Heavy pusbrpuU with beak ne*es
Q fe work ti_
>1 o\_ unleee extended " prior to that data
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" DATE '
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| | Ho frequent etatr-cllabl^ | | Ho eras-everbeed work
l^ki axpoaure to
Htovertlh*
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| I Ho eqenri to extiwee of heat 1--1 or eold
QgOther __
tOnjl to
mmpaMmmMmm, .
UCTC 21266 .Ul'TM.
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REMARKS: