Ask the Scholar
Page 1 of 2
I can add historical knowledge about this page.
Page image
OCR
(Compensation)
REPORT OF ACCIDENT TO AN EMPLOYE
Name of Employer Radim deminars Material Cerpration
Full Address 166 alden
Street 0 rangleing new Juney
State
1. Full name of injured employe sony Defrave
2.
Address 39 Cane Street Prange M.J.
3.
Age 33 4. Married
yes
5. Number of Children? 3
6. Weekly wages 11 2416
7. In whose employ at time of accident Company
8. Date and time of accident 17 day of June 1918 at 10 A. M.
9.
Place of accident Company's plant
10. Cause of accident m am vos mlooing 300 et lags F
ueda and from truck One bay fill an by and
threw him to the grand.
11. Nature and extent of injury (state definitely which fingers, hand, foot or eye is injured)
2 r states bad grain an left fort.
12. Has the injured employe returned to work no
if so, when ?
13. Did the injury require medical aid ? yes.
14. If so, where rendered and by whom an plant by Dr. Smallined of Meminal pital
15. By whom was the physician called ? Superiticatent If so, when ? 11 brafter accident
16. Taken home or to hospital Jo hespital for ray pritine of fort there to have
17. Name of hospital Memorial
Address? 0 romge M.f.
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
Collective Insurance?
steam Balir
20.
Date of this notice gune me 17-1918.
21. Date of notice of accident by employe to employer Same date
All the statements herein are made upon information merely, and are to be deemed to have been made without prejudice.
Radim Luminas math Corp
Signature of Assured.
Please use the other side of this sheet for any additional information.
Form 1743 B
Suft
Page data
- Page
- 1
- Source index
- 0
- Type
- photo
- Media ID
- fce541a2307e8141
- Size
- unknown
Document data
- ID
- 75718273
- Core
- doc
- Type
- document
DTO data
{
"id": "75718273",
"sourceUrl": "https://catalog.archives.gov/id/75718273",
"contentType": "document",
"title": "Accident report, June 17, 1918",
"citationUrl": "https://catalog.archives.gov/id/75718273",
"collections": [
"Safety Light Collection",
"Records Related to Radium Dial Painters"
],
"iiifBase": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0000018.jpg",
"thumbnailUrl": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0000018.jpg",
"largeImageUrl": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0000018.jpg",
"imageCount": 2,
"hasImages": true,
"source": "import",
"hasTranscription": false
}
Context sent to Scholar
Document identity
{
"localId": "75718273",
"label": "Accident report, June 17, 1918",
"core": "doc",
"dtoType": "document",
"citationUrl": "https://catalog.archives.gov/id/75718273"
}
Document source metadata
{
"id": "75718273",
"sourceUrl": "https://catalog.archives.gov/id/75718273",
"contentType": "document",
"title": "Accident report, June 17, 1918",
"citationUrl": "https://catalog.archives.gov/id/75718273",
"collections": [
"Safety Light Collection",
"Records Related to Radium Dial Painters"
],
"iiifBase": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0000018.jpg",
"thumbnailUrl": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0000018.jpg",
"largeImageUrl": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0000018.jpg",
"imageCount": 2,
"hasImages": true,
"source": "import",
"hasTranscription": false
}
Document source extras
{
"url": "https://catalog.archives.gov/id/75718273",
"naId": 75718273,
"levelOfDescription": "fileUnit",
"recordType": "description",
"ocrSource": "nara-archive"
}
Page context
{
"seq": 1,
"pageIndex": 0,
"type": "photo",
"url": "https://s3.amazonaws.com/NARAprodstorage/lz/electronic-records/SLC/Radium/SLC_0000018.jpg",
"mediaId": "fce541a2307e8141",
"ocrText": "(Compensation)\nREPORT OF ACCIDENT TO AN EMPLOYE\nName of Employer Radim deminars Material Cerpration\nFull Address 166 alden\nStreet 0 rangleing new Juney\nState\n1. Full name of injured employe sony Defrave\n2.\nAddress 39 Cane Street Prange M.J.\n3.\nAge 33 4. Married\nyes\n5. Number of Children? 3\n6. Weekly wages 11 2416\n7. In whose employ at time of accident Company\n8. Date and time of accident 17 day of June 1918 at 10 A. M.\n9.\nPlace of accident Company's plant\n10. Cause of accident m am vos mlooing 300 et lags F\nueda and from truck One bay fill an by and\nthrew him to the grand.\n11. Nature and extent of injury (state definitely which fingers, hand, foot or eye is injured)\n2 r states bad grain an left fort.\n12. Has the injured employe returned to work no\nif so, when ?\n13. Did the injury require medical aid ? yes.\n14. If so, where rendered and by whom an plant by Dr. Smallined of Meminal pital\n15. By whom was the physician called ? Superiticatent If so, when ? 11 brafter accident\n16. Taken home or to hospital Jo hespital for ray pritine of fort there to have\n17. Name of hospital Memorial\nAddress? 0 romge M.f.\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\nCollective Insurance?\nsteam Balir\n20.\nDate of this notice gune me 17-1918.\n21. Date of notice of accident by employe to employer Same date\nAll the statements herein are made upon information merely, and are to be deemed to have been made without prejudice.\nRadim Luminas math Corp\nSignature of Assured.\nPlease use the other side of this sheet for any additional information.\nForm 1743 B\nSuft"
}