Document yZG76OVOBroGRZ4XJyLQzG9n

r Interoffice Communication To L. N. Vernon, Saddle Brook From Date W. R. Beaty, Ponca City August 6, 1974 ' Subject Health Research Group Questionnaire (From a Nader Affiliate) Attached is a copy of a letter from MCA and the questionnaire. Dr. Lembke has reviewed the attached information and feels that the infor mation requested is confidential and should not be disclosed. If the questionnaire has been received at other locations, Dr. Lembke requests that any responses be cleared through him prior to forwarding to the health research group. If you disagree with Dr. Lembke, please contact him directly in order that the proper action can be taken on this-questionnaire. w. k. .Beaty Director Engineering Research Chemicals Research Division Research and Development Department db Enc CC: KLS RGW RTF RLL P.S. This questionnaire may have gone to other chemical plants. You might wish to check with them to be sure it is properly handled. VVC 000002359 MANUFACTURING CHEMISTS ASSOCIATION \n?b CONNfXflCUr AVLNUt. N W. WASHINGTON, D. C. 20009 (202) 483-6126 July 31, 1974 C/-/CM/CAU Research AUGC t9T TO: OCCUPATIONAL HEALTH COMMITTEE Subject: Health Research Group Questionnaire Attached for your interest is a copy of a questionnaire now being distributed to plant physicians at a number of leading company plant locations, including those of several chemical companies that are MCA members, by an organization known as Health Research Group. This appears to be one of the Nader affil iates headed up by Dr. Sidney Wolfe. While we believe that the chemical industry is not the only industry receiving these in quiries, you may wish to alert your plants and their physicians to the possible receipt of these questionnaires, the nature of which appear self-evident. JGT:mpc Attachment Distribution C A. C. Clark, Secretary Occupational Health Committee VVC 000002360 MK/w/t'lf .kcii r:houl# :'onf) p .<;u -.-t, u. w. V/;i:;ij.l nr;ton , quhntionnaike to plant physicians d^The Health Research `Group is a public interest croup funded by Public ''' -Citizen, Inc.' The purpose of tints questionnaire is to gather infortaa- i^.tion for a report about the o f.ficacy of occupational health services in this country. All surveyed pi ants will be listed in the final report and non-respondents will be listed as ouch. Feel free to comment or 'add any clarification that you feci necessary in response to the questions. ..- Please return the' questionnaire by August 10, 19_7j[. (A copy of: the final .ip-report will be. mailed to cooperating physicians upon request.) ...Your.,., '^participatipn is greatly appreciated. ' T'" 'b' -1-# f ' .. _y-.^v.`Y* . "-;v. . . .* * -nil * *. * - ' '`. 'Name of physician:p*__________ ' -f. ' Title: Years of employment (by present company): "' Are you^ employed'full-time or part-time? Number of hours employed per week: ______ _ Name of company: __________________________________ Your, mailing.address: ' * . ! , i\ IJaroe sand local number of union at plant: `'VJhcre were you employed prior to your present job? Hot/ long wore yoif'employed there? 1. Please indicate your academic training and background by circling the appropriate answer or supplying the requested information. a. Date graduated from medical school: , b. Academic residency in occupational medicine: None 1 year 2 years < i' * c. "In-plant" residency in a Board approved program: Yes No ra ' f d. Certification by American Board of Preventive Medicine in Occupational Medicine: Yes No e. Please list other areas of residency training and Indicate those in which you arc Board-certified. f. Please list any other relevant training. 2. Do you thLnk that there is enough attention given to occu, pational health in medical school? 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Olll| i 1 1 i,v o: b l.iiO j. . 1 H O.'b to you w i. bit MO A. * cal pv 'il.lOiMO , i if- l n r 1 -i ny i; 111"> v n wh.i. oh p ro non oi: c 11 p , 1 11 O ! : illy . 1 1; PV.- .1*' Y< v. i I* 1 -- :t 0 II'.', 1 u >i. .i V ' i. I ! . , i. , i Ob.'l. b " lit 11- 1 , . t i ! 1 1 :! iVr tvcobhionh i1' y i 1 i n V M y 1 'hyv 1 v i * : 'i * 1^ . VVC 000002362 i/,V *. 13. Please indicate to v/iicun you ro ularly report significant . occupationally-related medical Undines `and . the numerical ordex* in onion you report then :*$y r .WC;.' f V` -' OiL-1' Mb 15 ' Patient (r>) Employees * private 'physicians Dept, of Labor ___ Employees----- :------------ ) __ Union )__ Assumingconfidentiality __ Management ) of workers' names - ' ___ Other companies------------- ) Are workers given all results of their own medical surveillance tests? - . '"'.p Yes No ^ p/.? Has there been a .voul in: reporting of collective results'- ' of medical surveillance tests to. the union in the plant? ... Yes .. T , To the workers in, the plant? * *' ...V,V* * ' Yes No No .3$ vdU *f- yj<* In the past; year what In the average number of hours per week that you spent doing the following: ,r. 44;' 17 Act .ivlty Pre-empioy.ucnt exams........................ Periodic exams (non-executive) Executive physical exams............. Back-to-work exams foilowing absence for Viealch reasons.. On-tho-;iob accidents............. . . . , Treating 1llnesscs............................ Education'll sessions for workei Personal c o u n s e 1 :i. n g........... Administrative........................ Research........................ .. ............ Business and Travel........... ^Industrial -hygiene. ..... Other............................................... Total houi-D per week employed Hours per week Is..there a joint (labor and. management), health and safety, committee in your plant? ' Yes No' If yes, do you participato in meetings of this joint -health, and safety committee? Ye No 10 If you 'are employed part-time', who is in charge when you are net present? ____________________________________________ 19 r .,1.. ,. ' : .U . ' u20 Is a nurse employed by the medical department in your plant? If.yes j what are the nursefs responsibilities? Does your plant medical program have (check ansv/ers): Ye: No -V*/ ,_>&;> ' * '* * d'Ptd ` " ' Tuberculosis sk:in testing? Prc-o/u)loginert chord; x-rays? An industrial hygienist?' __ Full time Part time A -consultant dermatologist? % ' A consultant pryohiatriat? /\t_; Biochemical Laboratory screening fox1 executive' -' ; phys.i cal exams? Biochemical lab oratory screening for non- executive physical exams? &V. .v.V-21. . V '.u, J.' . "??&' - Do you think that the site of your budget limits the effec tiveness of the medical program for workers in your plant? Yes No VVc 00000236 --over-- , l: W* ' Has there' c1' .*r been an .oecupallcrviH houilh hazard In tho plant ar which yon am ample rd? Yoo Ho If yes, please list the hazards being as specific as possible. Tor each hazard, list any adverse effects i . i i. i -he workers, i he (lake the effects were 'irsk obsov. ad, the medical surveillance procedures now' employed and the frequency ol\ their application. !'or example : HAZARD ADVERSE HEALTH EFFECTS OBSERVED MEDICAL DATE SURVEILLANCE Noise Hearing loss 196*1 Annual audiometry ; Beta-naphthylamine Bladder cancer 1957 Annual cystoscopy; urine cytology - every _ 6 months-"~.-!d,.-:'..-* ___ ; .'? . --(use additional pages if necessary) Li3t the dates of any investigations or studies that have been undertaken by`you or'your company on the hazards you have re ported in question 1122. (If a study was done, list the dates under the appropriate heading). : f. Hazard Animal studydates Human study dates vtz r RESULTS L@ u@ J UgL-Ll 1|>__0 OTJOc)() ; oo'oo'ocjuu DflTElzjLlL- WEflThep. jjata Times 09m - ;5** /.foe- -- 2$*** *<"* 7* V<+t`4.i*c' Comments c~*- **,,?{}(?-*') p*-+Jy * ...&r Bomb w I ? j 4 5 6 7 S "i 10 11 52 13 14 15 16 M IS IS 20 21 22 21 24 25 2S 2? 28 29 JO 3! 32 33 34 35 3S 3J 33 3S ' i' pLflAjf GRID ..Bem i> SBmpte$ u 1 2 1 4 5 B 7 3 9 JO H 12 13 14 15 (S 17 18 IS 20 21 22 23 24 25 Z 27 28 29 3G 31 3Z 33 34 n>HNl CiKd.L) fa * @ @ is. *TPgrQ(u)o ; ^)0^ohoo^ DflT. TIMES WEftTHER 00oo2369 COMMENTS