Works Form 407 Rev. ...m......... SM-3-25·35.
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COAL T~III·—··—»_ _____- WORKS REPORT FOR TI—IE_lJ_PER10¤, FROM.!-.;_.Li;.. TO_L;LQ...
 
, . AVERAGE
[P [T5,} I 1 ACCUMULATED TOTAL
(7.1 FOR___.__. 1
PERIOD 19.:.24 PERIODS FOR,.L_.....PERIODS
1. AVERAGE NO. OF EMPLOYES {UQ] r_ [QQ giglri
` l "`r` - ’ W"?] ’ ,:}r""
2_ NO_ OF HOURS WORKED 1 ..LaU‘.¤ .I. .1./;.,., ].I.].C-..)
TEMP. DISABILITY 5» LQ; 5
NUMBER OF PERM. DISABILITY I. I; {Q
3· LOST DEATH CL O G
TIME CASES TOTAL   V  __  
TEMP. DISABILITY .`L].Z}I. .flS`»jE 7];).)
PERM. DISABILITY   ,.. (1 -
4. HOURS LOST DEATH ·· ».·· ,.
TOTAL [L5 i `2].1`}?Y 2153;
TEMP. DISABILITY   W   7  LIS, __   I, L. —VrY :`_fj(_,• QQ
PERM. DISABILITY   -- ·—
5_ COMPENSATION " ‘ ““ ' ”   "' " ' '"' ’“"_""` '   T'_`T“` "
COST DEATH — __—__ Yi) 7 V HM _ rv ;___w_viL—  
TOTAL   iii. i - 2.#i».,xi. CLI`., 1  
6. FREQUENCY RATE—NO. OF LOST-TIME
ACCIDENTS PER MILLION HOURS WORKED .7 .. ,.1 _. `,.
7%.]..,1. _" é;;x•L ";;I.. 1.
7. SEVERITY RATES—HOURS LOST PER q .~ P   ;~j ln ·; ;_
1000 HOURS WORKED »— ·   *• ··`~ ·• ·~·`·»‘
B. COST PER S100 OF PAYROLL I C "'I   LII I"i/E`  
OCCURRING IN THE PRESENT CALENDAR YEAR
BUT NOT INCLUDED IN THE ABOVE FIGURES
I ESTIMATED
DATE PROBABLE
PERIOD OF
NAME Cr5`g? ,N_?_,FRYI NATURE OF INJURY ¤¤sAB. HRS. Losr °g@"$;EN.,?§JL°N
I DAYS PENALTY AND DlSAé AND`
I ` TEMP. DISAB. PENALTY
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V ' SIGNED