Works Form 407 Rev. »·m••.••..... SM--3-25-35.
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°”’~L · ‘····   ’ WORKS REPORT FOR THE. l~» PERIOD, FROM..;LQ&;iTO 
 
  »·»¤-I- AVERAGE
- I1 O 0 1 ACCUMULATED TOTAL
·r·¢; FOR.I.;_ 1
PERIOD 19..i*. PERIODS »=OR.__._..PER¤ODs
1. AVERAGE NO. OF EMPLOYES 755 755 '/LE?}
2. NO. OF HOURS WORKED {TID].? {HG1? OlO1'7
TEMP. DISABILITY   lg rf;
NUMBER OF PERM. DISABILITY 2 2 2
3· LOST DEATH Tg; Q Q
TIME CASES TOTAL {J G G
TEMP. DISABILITY ij]/L CLE C14
PERM. DISABILITY LTTE CTL CTS
4. HOURS LOST DEATH ··- ·- •·
TOTAL ICSC I.·I.Z]CIri W DLQIEE
TEMP. DISABILITY lQ...1_.·1, LC·iJ.~J·.J lfilhd-
PERM. DISABILITY 1Yj`£....]··D IlOSQ~..-¤. ILY§.%•·}O
5. COMPENSATION  ""'1"`r; 'P'' ""”’T""”"T’ 4"”‘?ST“   OO`‘ I“”"“’_"” ‘_
CQST DEATH at   A , .L..L...L
TOTAL O ;.. . .... UQ . .   __*f I£`Z}L.-Q .
6. FREQUENCY RATE-NO. OF LOST-TIME
ACCIDENTS PER MILLION HOURS VVORKED {~·— an .~~{· nrw ·‘*;· rxfe
uL1•¢.»\.: `»·.`•L,O U·.;•L.U
1. SEVERITY RATES—HOuRS LOST PER I I, ,_¤ . . ,-,._ - .. ,.,
1000 HOURS WORKED L:•.:.; .LO•;L·-.· U .Lc•..;~.»
8. COST PER $100 OF PAYROLL 'r"•"f;""1 `;¤’;¥'-I U•‘;5‘;
UNDETERMINED PERMANENT DISABILITY CASES
OOOURRING IN THE PRESENT CALENDAR YEAR
BUT NOT INCLUDED IN THE ABOVE FIGURES
I I ESTIMATED
DATE I PROEZABLE  
PERIOD OF
NAME   |N_P_]FRy NATURE OF INJURY DISAB. HRS. LOST CggI$I;EN$€;LON
DAYS PENALTY AND D|SAé_ AND'
TEMP. DISAB. PENALTY
-_O-LXJ.{?T~_L. -._-..._._-.   .... .. _.. -..D_-._...   D.-DDLL_,,_OD DO DDDD DO DLDDLOD OOED __DD__D__-
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 .-$-..7’).—...-...7 7- .77. .7L .7..7 7 .77 L.   . . . F . _ . . -.. .-- _- ....-
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K » SIGNED