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(Compensation)
REPORT OF ACCIDENT TO AN EMPLOYE
RADIUM LUMINOUS MATERIAL CORPORATION.
Name of Employer
Full Address #166 Alden Street 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 Yes
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
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
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Document data
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Context sent to Scholar
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"ocrText": "(Compensation)\nREPORT OF ACCIDENT TO AN EMPLOYE\nRADIUM LUMINOUS MATERIAL CORPORATION.\nName of Employer\nFull Address #166 Alden Street Street Orange City New Jersey.\nState\n1. Full name of injured employe Patrick Joyce\n2. Address 80 Watchung Avenue, Orange, New Jersey.\n3. Age 35\n4. Married Yes\n5. Number of Children? 4\n6. Weekly wages\n7. In whose employ at time of accident RADIUM LUMINOUS MATERIAL CORP'N\n8. Date and time of accident 23\nday of August\n19 18at 3 A M\nM.\n9. Place of accident Tank-house of the Radium Luminous Material Corp'N\n10. Cause of accident Rachet slipped and left hand got caught betwen\nfilter press\n11. Nature and extent of injury (state definitely which fingers, hand, foot or eye is injured)\nBad Bruise on left hand\n12. Has the injured employe returned to work did not stop work. when?\nYes\n13. Did the injury require medical aid?\n14. If so, where rendered and by whom Dr. Dowling\nEmployee\n12:30 P. M\n15. By whom was the physician called?\nIf so, when\n--\n16. Taken home or to hospital\n--\n17. Name of hospital\nAddress? --\n18. Have you advised the attending physician or the hospital that your liability for the cost of treatment\nis defined and limited by the Compensation Act? Yes\n19. Do you carry any other Compensation or General Liability, Steam Boiler, Elevator or Workmen's\nBoiler\nCollective Insurance?\nAugust 23rd, 1918.\n20. Date of this notice\n21. Date of notice of accident by employe to employer August 23rd, 1918.\nAll the statements herein are made upon information merely, and are to be deemed to have been made without prejudice.\nRADIUM LUMINOUS MATERIAL CORP'N\nSignature of Assured.\nPlease use the other side of this sheet for any additional information.\nForm 1743 B"
}