Accident report, August 23, 1918

(Compensation) REPORT OF ACCIDENT TO AN EMPLOYE RADIUM LUMINOUS MATERIAL CORPORATION. Name of Employer #166 Alden Street Full Address Street Orange City New Jersey. State 1. Full name of injured employe Patrick Joyce 2. Address 80 Watchung Avenue, Orange, New Jersey. 3. Age 35 4. Married Tes 5. Number of Children? 4 6. Weekly wages 7. In whose employ at time of accident RADIUM LUMINOUS MATERIAL CORP'N 8. Date and time of accident 23 day of August 19 18at 3 A M M. 9. Place of accident Tank-house of the Radium Luminous Material Corp'N 10. Cause of accident Rachet slipped and left hand got caught betwen n filter press 11. Nature and extent of injury (state definitely which fingers, hand, foot or eye is injured) Bad Bruise on left hand 12. Has the injured employe returned to work did not stop work. when! ? Yes 13. Did the injury require medical aid? 14. If so, where rendered and by whom Dr. Dowling Employee 12:30 P. M 15. By whom was the physician called? If so, when ? -- 16. Taken home or to hospital - - -- 17. Name of hospital Address ? 18. Have you advised the attending physician or the hospital that your liability for the cost of treatment is defined and limited by the Compensation Act? Yes 19. Do you carry any other Compensation or General Liability, Steam Boiler, Elevator or Workmen's Boiler Collective Insurance? August 23rd, 1918. 20. Date of this notice 21. Date of notice of accident by employe to employer August 23rd, 1918. All the statements herein are made upon information merely, and are to be deemed to have been made without prejudice. RADIUM LUMINOUS MATERIAL CORP'N Signature of Assured. Please use the other side of this sheet for any additional information. Form 1743 B