Document qkOZbYVyvozn7mae990kErrQM

FILE NAME Insulation Contractors & Distributors ICD DATE 1975 DOC ICD065 DOCUMENT DESCRIPTION Worker's Comp Claim with Cover Letter Denying Asbestos Exposure & Liability . o . . x . se . ee , er . . Se . Hgee p + wer ye at at . s as ae . . . sagemegtes 4 > rary Ui 4 Lite i. patsty sot > : 7 wen earn , . . XTmNR - AIO snes . . orntematen oe 2 ee ABORee tee . g rms . an . FTA rae . oo yg oe . . . MENTO ce TPT Mey He . os gs, nn } . - . + NEG top kn . > may a : . * +e a wR , . so HL RE * . . er - . A 4 ? wa STOR > ae . . tenmt gare STED NE ~ x SIR Ur . ger BS : OE) Ta z * * is 4 4 meyr g MESH F Ve vice DEPARTMENT OF LABOR " INTER OFFICE MEMORANDUM 63-75 To Dr. Irvin Klein Medical Director Johns From: Mr. Fred Johns P.E. Subject Buffalo Insulation 356 Hertel Avenue Buffalo Distributors Date June 20 1975 Office Workmens Compensation Board OfficeOffice New York City Buffalo Orchard Park Claimant Orchard Park Rd West Seneca W.C.B. No. 87417957 REPORT interviewed On June 18 1975 Mr. Frank J. McAfee contract manager for the above firm to obtain the work history of the claimant above The claimant was employed by the above firm for only four days August 22nd through August 25th 1972. he During all of that time according to Mr. McAfee was assigned to the Buffalo City Court Building which was then under struction His duties consisted entirely of applying four foot con- prefabricated fiberglass insulation to lengths of piping The lengths of insulation are split longitudinally The two halves are joined around the pipe simply by removing the protective tape from the longitudinal seams which have viously been coated with a contact adhesive and pressing the halves togeptrhee-r manually He was laid off when the job was completed CONCLUSION The claimant was not exposed to asbestos during his employment with the above firm SCL Frederick C. Johns Sr. Industrial Hygiene Engineer ENGINEERING SECTION ASSIGNMENT AND REPORT DIGEST SHEET YORK BUFFALO FIELD FIELED VALUATION |_] EXHAUST PLANS i] AIR POLLUTION 1. ASSIGNMENT NO 59-74 5. FIRM , Name 2. REFERENCE NOS _ Street Address 3. DATE ASSIGNED 12/26/74 12/26/74 12/26/74 City or Town Buffalo Insulation Distributors 6. 356 Hertel Ave. Buffalo PLANT LOCATION If not above mmr \. 4. DLE ADMINISTRATION 3/26/74 ' 3/26/74 3/26/74 ~~ Erie arene ae, eee a 7. WORKER Nama Street Address City or Town 7 County B. ASSIGNMENT ~ he dust TW.C.D. ORIGIN 9. [ 1.S.S. TW.C.D. TW.C.D. B.S.A. Workers & Unimas [| Professional 10. SEND REPORT TO . 11. SEND LETTER TO OtherLabor Dept. Units Other Govt Agencies Study L| . Special __. _ X OOtthehr er Anon en . ~ Industry 7 | DATE SENT 713/74 To 12. COPY OF REPORT | LETTER TO | _ 13. ASSIGNEDTO 15. INDUSTRY 18. ACTIVITY 19. FINDINGS Plant Investigation . " . aoe f Special Study 14. NO OF | EMPLOYEES Total Female Male 16. NO VISITS THIS ASSGT 17. DATE ASSGT COMPLETED i wt a Plan Examination Other oo A. Toxic Agent $ Code No. and Name | F : B. Operation Code No. and Neme X C. Hazard D. No. of j YesYes ' No Workers ! A ie A Exposed A. Toxic Agent Code No. and Name . t B. Operation Code No. and Name C._ Hazard| :Yes No i i : ; t D. No. of Workers Exposed Ho boo BO tate eA Ho Ma H i H J * . : : ae eae, : i | } 20. FIELD DATA A. No. Air Samples B. No. Dust Counts C. No. Other Determinations D. Physical Measurements ["} Air Flow Noise Radiation (| Temp./Humidity _ET] Other 21. CONTROL SYSTEM DATA If none check here[ 12 Control by Local Exhaust ]): {| 11 Air ContaminantEmission Data (|: 13 by Dilution Ventilation a Po] Fire and Explosion oe 14 by Other ek - 15 Hood Performance Data Cj 16 Air Cleaning Equipment Performance Data 17 Unusual Control System Design 22. EXHAUST PLAN DATA New Installed before Approval No. Plans No. Fan Systems {| 18 Field Test Data 19 Other Amended 3 Approved Cj Conditionally Approved Code Rule No. Authorized Agent N No. Machines No. Persons Protected ae Disapproved ee ne 23. REMARKS MAR . 24. Unit Review Date MAMARR 1/3/2014 25. Section by 5-63 kulation kulation kulation kulation kulation kulation ENG te 26. Division Review by Date n \ 27. Asagt Clk 28. Stat Clk 29. Bee 1978 ENGINEERING SECTION ASSIGNMENT ANDRREPORT EPORT DIGEST SHEET SHEET YORK BUFFALO 7" FIELD EVALUATION EXHAUST PLANS PLANS AIR POLLUTION ASSIGNMENTNO REFERENCE NOS DATE ASSIGNED Distributors Hertel Buffalo ~63-75 87417957 4/7/75 5. FIRM Name n 1 WCB Street Buffalo Insulation Address 356 LL City or Town Ave. 356 6. PLANT LOCATION If notnot as above o_ ~ ~~ DATE DUE ADMINISTRATION 5/7/75/57/75 aes County Erie CE ere emer ss 7 7. WORKER Name oo Street Claimant James LawsonMr. ASSIGNMENT Address 1021 Orchard ; City Park Rd fo oror Town TO ee er se West Seneca 14224 Seneca ieee County It Te re DUST 9. ORIGIN to LS.S. Workers Workers Unicas 10. SEND REPORT TO W.C.B.W.C.BW. .C.B. B.S.A. B.S.A. Professional Dr. Irvin Klein WCB N.Y. SENDLETTER TO Other Labor Dept. Units Special Study Other a | ii Other Govt Agencies _ Industry ~~ ~ DATE SENT 12. COOFP[JY REPORTTO LETTERLETTERTO 13. ASSIGNEDTO 15. INDUSTRY ee a y ea, J J 212 J Sat OO a OT wien 18. ACTIVITY 19. FINDINGS Plant Investigation Special Study | eee Male i14. NOOF Total Female Male Male 16. i EMPLOYE S EMPLOYEES: | 16. NO VISITS THIS 17. nt ane en ASSGT 17. DATE ASSGT COMPLETED 125 125 6/2 6/2 125 125 Plan Examination i_} Other A. Toxic Agent Code No. and Name liberter liberter liberter liberter C. Hazard | * B. Operation C. a ' Code No. and Name | Yes No- [ i L..../. AhaMa e oe er : ae naggleic Fr ad wee 4 i- eal ' se Sa foo LE ee D. No. of Workers Exposed | _ A. Toxic Agent Code No. and Name _ -. i an pope hee epee B. Operation | Code No. and Name : | peu ee. wee eee F HazardWorkers Yes , C. Hazard | No |_ j No. of Workers Exposed oe ij I j who. i t ; | { a4 . Lo I 20. FIELD DATA A. No. Air Samples D. Physical Measurements Air Flow CONTROL SYSTEM DATA If none check hetc 12 Control by Local Exhaust _ 15 Hood Performance Data i | j B. No. Dust Counts C. No. Other Determinations Noise Radiation Temp./Humidity Temp./Humidity | 11 Air Contaminant Emission Data [7] Other F_] Fire and Explosion by Dilution Ventilation 14 by Other ; 16 Air Cleaning Equipment Performance Data | woe _ 17 Unusual Control Control System Design 7 18 Field Test Data 19 Other 22. EXHAUST PLAN DATA New P'] Amended [7] Approved Conditionally Approved Installed before Approval No. Plans No. Fan Systems Code Rule No. No. Machines Authorized Agent | ce cee No. Persons Protected 23. REMARKS 24. ae Disapproved ee ee --" Unit -- --by--, Date a ee on oe ae a ee ees TITS mmm nae mean ee eae cerns --" -- ----, 6/20/78 ~ wore tome . --" -- --by--, 1/20/71 ~ #Jole 6/20/78 #Jole eee by 26. Division Review 6/20/78 Date ~ 216 6-63 ENG om 27 Assgt Clk 28. Stat Cik 29. McBee | STATE OF NEW YORK WORKMEN'S COMPENSATION BOARD 355 355 62 REQUEST FOR INVESTIGATION AND REPORT IN OCCUPATIONAL DISEASE CASE FROM NY 1. W. C. B. CASE NO DISTRICT Buffalo 2. CARRIER CASE NO 3. CODE DATE __ 3/25/75 Disablement 4, DATE OF ACCIDENT 87417957 | NAME ene NAME 47 7 74 ADDRESS 5. CLAIMANT CLAIMANT'S x rchard West Seneca Park Road NY NY 14224 EMPLOYER STRAWB Distributors 6. REPRESENTATIVE Lipsitz & Green etal STRAWB STRAWB 876-7344 7. Buffalo Insulation 1 Niagara Square BuffaloNY Distributors 356 Hertel Ave Buffalo NY 8. CARRIER 9. PHYSICIAN 10. HOSPITAL Maryland Casualty Co. Dr. Thomas Houston Erie County Chest Clinic 10 Lafayette Square Buffalo NY 1110 Abbott Rd BuffalNoY 11. DISABILITY CLAIMED total disability 12. DIAGNOSIS ITEM 9 ON FORM 4 pulmonary fibrosis pulmonary asbestosis 13. OCCUPATION Mechanic 14. PLACE OF EMPLOYMENT 356 Hertel Ave Buffalo N. Y. 15. MATERIALS WITH WHICH CLAIMANT WORKED CT SAMPLE ATTACHED asbestos 16. OTHER MATERIALS TO WHICH CLAIMANT WAS EXPOSED dusty environment SAMPLE ATTACHED 17. BASIS OF CLAIM FOR COMPENSATION Lost time and medical expenses 18. HOW DID DISEASE BEGIN Constant cough chest tightness 19. PURPOSE OF INQUIRY x ) INVESTIGATION ( ) MEDICAL OPINION , x LABORATORY ANALYSIS 20. REMARKS To |] DIVISION OF INDUSTRIAL HYGIENE AND SAFETY STANDARDS DUST ENGINEER PLEASE FORWARD REPORT IN QUADRUPLICATE TO ([} MEDICAL DIRECTOR WORKMEN'S COMPENSATION BOARD 50 Park Place New York N.Y. 10007 SUPERVISING REFEREE WORKMEN'S COMPENSATION BOARD Place New York N.Y. 2 World Trade Center NY 10087 43 4-68