Material Information

Federal Writers' Project of the Work Projects Administration for the State of Florida
Place of Publication:
[Jacksonville, Fla
Federal Writers' Project of the Work Projects Administration for the State of Florida]
Publication Date:
Physical Description:
26 p. : ;


non-fiction ( marcgt )


A collection typewritten memoranda from the Federal Writers' Project Florida headquarters in Jacksonville. The memos were sent to local supervisors for the project regarding production of a guide to Florida to be published in the WPA's American Guide series. Also included is a safety bulletin detailing the paperwork to be filled out in the event of an accident or injury to workers on the project.
General Note:
Title supplied by cataloger.
Original Version:
Works Progress Administration Tampa office records, 1917-1943 Box 1 Folder 7
Statement of Responsibility:
Federal Writers' Project of the Work Projects Administration for the State of Florida].

Record Information

Source Institution:
University of South Florida Library
Holding Location:
University of South Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
W27-00001 ( USFLDC DOI )
w27.1 ( USFLDC Handle )

USFLDC Membership

Added automatically
Tampa WPA Office Papers

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0 245
[Bulletins /
c Federal Writers' Project of the Work Projects Administration for the State of Florida].
[Jacksonville, Fla. :
b Federal Writers' Project of the Work Projects Administration for the State of Florida],
26 p.
Title supplied by cataloger.
FFW-16A, Jan. 8, 1936. Classification of guide topics -- FFW-16A, Jan. 8, 1936. Classification of guide topics [with handwritten notes] -- FFW-17, Dec. 20, 1935. Field editorial copy, publicity, supplies -- FFW-18, Dec. 26, 1935. Field continuity : your city and county -- FFW19, Dec. 31, 1935. Supplementary instructions -- FFW-20, Jan. 3, 1936. Bibliography -- FFW-21, Jan. 6, 1936. Flow of copy -- FFW-25, Jan. 22, 1936. Corrections [to FFW-16A], publicity -- Safety bulletin no. 26, Aug. 21, 1940. Forms 351, accident reports.
A collection typewritten memoranda from the Federal Writers' Project Florida headquarters in Jacksonville. The memos were sent to local supervisors for the project regarding production of a guide to Florida to be published in the WPA's American Guide series. Also included is a safety bulletin detailing the paperwork to be filled out in the event of an accident or injury to workers on the project.
2 610
Federal Writers' Project of the Work Projects Administration for the State of Florida.
Federal Writers' Project of the Work Projects Administration for the State of Florida.
1 773
t Tampa WPA Office Papers.
4 856
u http://digital.lib.usf.edu/?w27.1




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January e 1936 CARITA DO G 0 R t t i oto:t TO: DI UBJ C I I I n ool I n ol In col he onolo eti o of Copy form (F", 2) 1 loo 1 ot.f1oea of th fo m e th d te on h1ch the 1eld orke r s igt) d his h d t on 1oh t e eld 1 reoaiv d th numb r o p es oom,pris1ng th eld Da n pl o tll nutn r1 l ymbol of th opic b ing covered pl o t he d t on hioh the copy goes to th Field le. b1ch th copy wa c ecked by your Oonaul eaign te ob of your Consult nte thi symbol be pl oed in column 7 with In column a place the hich th copy goes to the .vork Files. In col The or t h to the ate on ;hioh copy go s to the 1tor1al File. 1 0. the d te on whibh th copy i ent to the t te 0 'fioe. d 12 r heo column If tb copy sent to t he s t te cubj ot 1 incomplete place check in column 11 ( IP). le oh ,ok column .rl2 ( o c ) 1ned by loo 1 nd d1 tr1ct supervisors, nabl1ng te check of c oh orker' s productivity. e a r i n r ly teful to !iss Iatalie e ell, Field Res arch Assistnnt t i i for origin t i ng this oonv n 1 nt form oo: Gen Brandon Ass1 tnt t te ditor The eric n Quid


FLOW 0 F c 0 p y r rp .. 2 """' ) FEDERAL 'l'ffiiTERS I PROJECTS Florida ... Field Worke, Au ignment F.D. Topio Field File Consultation Work file Editorial file To State offioe EIP ECC .. reoe1ved date date date date I j .. -i 7 .j ) ... _, .. ----


R ITA DOGGETT OORS B t t D1r otor FEDERAL 1 PROJECTS Roberts uilding Jacksonville, Florid TO: DI TRIOT ND LOCAL SUPERVI ORS UBJ J : BI LIO r -ro J nuary 3rd, 1936 h followin bibliographic 1 suggestions have been very kindly ubmitted to h t t o !ice by rs. Frances Reed, State Bibliogr pher, Federal r iter rojeot Dayto Beaoh, arid re preparing in this office state b1bl1og r phy with the intention o! kin it as ne rly complete as po s1ble. If, ho e ver, we get complete eh lf li t fro all librarie in Florida there will be t r mendous mount of duplio tion. This duplication i ell worth whil if in the course of it we lo t on unusual and interesting vol I t would eem to me that much ork coUld be ved if you ould end e your bibliography of source t ri 1 used on ork you h ve done and in ddition n infer 1 list giving uthor a d title of books on F1 rid in your lib ry and likely to be in cluded i other nd 1 ger libraries. e oan check this list against our fil nd note on o rd th fact that the book on be found in your city. If by oh nee we find a book in your infer 1 li t that is not included in our index it ill be a simple matter to get infor tion from you on t1 t p rticul r title. h n our s er bibliogr phy is completed it should oont Title and ubjeot design tion but also volum loc tion. consultin the ater file ill find, not only not tion but also he loc tion of the volumes most convenient tor in not only Author Thu a student on hi subject, his use n illustration: Tod y we found a book on fos ils needed by one of our re-roh workers nd loc ted in New Smyrna twelve miles y but it also can be found in our on library within fivehundred feet of our ofrioe. T h r fore if you ill end ouroe material bibliogr phy and an author and title list of anything you find on Flori a juvenile, fiction and otherwise, o n use it to adv nt ge here. A pproved : rit Doggett Corse t te Director ene Brandon ssistant Editor The eric n Guide


r -19 eo J.be:r 31. ).935 t ict ere oe o the routines a d .. thod oribod y t e e upplem t ry lnotruo ions 1 of th orbe d t lC 1v ollOWillg correction to bull tin of Dcoe er -18: The o rds eld "1'di tori l on tinui ty 1 re .. ie d ditori l Oopy ( C) p rov d : rit. Dogg tt Corse to. e Director Gene ssiatan t t te ::di tox he eric n Guide


FEDERJ.L H.ITEhS 1 BROJ ..... C'l\S Roberts Building Jacksonville, .(i'lorida FF\l-25 January 22, 1936 ... DOGGET'l1 COftSE tate Director TO: DIST ICT LCX:: L SUPERVISOR SUBJ"ECTS: CORRECTIONS PUBLICITY CDRRLCTIOUS: Please I!'..ake the following corrections and a tionsto bulletin FF\. 16-. : 165 Cons erva ti on 340 City or T nship 341 xecutive 342 Locislative 343 Judiciary PUBLICITY; In the first bulletin eli sp& tched from this office, dated lovember 4, 1935, the following instruction appeared: "You wi 11 send to the tate Office b"lo copies of aD.. newspaper publicity articles appearingin your local papers." Please observe the follouinf emendation: send one copy instead of two. Upon receipt of this bulletin, advise us or not your local papers printed the recent articles distributed by this office recarding strange facts gathered by Guide iOrkers with the request readers contact either the local newspaper or the local Guide su should he h ve any interesting and unique in :i";is poss0ssion. If this article was printeG., please send us a copy rith the advisement requested. .1: pproved: Carita Doggett Corse State Director Gene Brandon Assisthnt State Supervisor American Guide


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oo 340 01 ty 341 eoutive 3 2 Legi sla ti ve 343 Judiciary


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-6-660 Cultur 61 ligion, outst nding churche n tie r ligious ...,.. 663 66 68 6 g 70 671 672 67 67 67 76 67? 678 7 org niz tion ci nee, in labor tori obs rv tories, ( blio d priv teJ pla et ri du trial rch organiz tions, etc. t, noted mu uo collection 1 g oolon1 tc. ivate and pu lie ooll ction o n to public, t or ho not ,., th t pl y ort lif ot the co unity. t p or for orpho.n or th eri nt 1 urpo ( y or y rt in rtists' priv te print 'r\, th social torie etc. ged tc. die ne ect or place IY


-7 -nd t,t.o r tion. a ower iver tc. tio 1 in


11 1 o 1 1 o 101 1 io 111 u 1 J 1 ( 1 A nt n p 0 d r t tur t loc 1 r1 t or h 1r


0 : -1-1 3 o 1lu nd b-oil ( nt1on1ng thei d ri tion a from g nt 11 o ton, etc. ) t t< 1 geo o ure (a rook, cav rn to. ) 1 n 1 b idge nro e t or t pr t or at la io1 1 t t1v o your vio1n1ty ( 1 ro uo flor ) ( 1 1 or t te otly) uoo e of ( ev r oheo ogicnl re in r in the Any re in about which the:r is di put oted ) in t r1 l p otili r to th p ) t no on re erv ti n )


-16 -ot 31 rli st s ttle ent in the state. 232 rliest oo un 1 11 gener 1 description. 240 (Contribution o American Folkways folklor r to th t communi y ) 241 rly fol lor 1 gends 42 Ot er olkl r (song, dances, dress, superstition, eto.) 243 Contribution to langua e (include Indi n origin As choc t 'If 1okeh11, Algonquin suoco h eto.: 1oc 1i s uch 1Bunk1 ro Bunco be_County, N o., to. ) 251 oon o develop ent 252 Industri 1 row h (inc1 d 1 bor d1sput ) 253 ooia1 dev lopment 25 loted p r o litie (include historic figur ) 261 cial group in yo vicinity 262 Raoi 1 c tur 1 heritage 2 3 Rel tton hip o oi 1 group to co nity develop ent 264 onte or ry r ciaJ. group ret ining ethn1o identity ( ot : Thi section n eds c r ful fi ld investig tion) 270 thnology (racial group herit ge & cultur ) (rel tionship to industrial developm n ) 271 pulation-ro h or decline) 310 United t tee 311 outive 312 Legislative 313 Ju ic1 ry 320 t te 321 cutive 322 Legislative 323 Judio1 ry


( 0 ): 520 530 540 bop tion connection th r det iled info tion on 1 you r oe1ve our peo1 l topic. ) tion. ( nolude q plane, c rs: el v ed, ubway. e n o r d bu ea. .r or" tc. es p r 1ng serv oe oonncoted r1 t i ht rv1oe clubs, such aa Xiwan1 Rotary --give loo tion date of eet1ng, ecial events, if y 5"4 rat rn 1 or 12 tion uch Elks oos Giv loo tion. c! meeting, and peoial events, 1 any. 535 or ational olub (fishing, y oht1ng, hunting gol eta., pr1vte d publio. ) 541 1' tlllen e tore 542 out tanding shops 543 dial' ft shop wh re loo 1 pro \lot le. (As pottery, b sk try, to. ) re for 50 1' ets


0 0 p 0 r 1-0 1 n n v crt n t l v l 0 rvic r o nt 1 -c t 0 h r t 1 Ci Y 0 h C.L


-1n r1 tmm 1 to u. 11 a h1 torte n lev to run e 1 11 ) e art, U.t t t c ) c 1 uch aq uar1 c rtea, l A


-616--A 6 1 NatUl al history 652 Scientific and technical, such as p lanetar ium 6 53 Industrial 654 Historic'al 655 Social 656 Art 65 7 B otanical gardens 658 Zoological gardens, bird sanctuaries, game refuges. I 660 CULTURAL 661 Religion, outst nding churches, seminaries, religious organizations. 662 Science, institutes,laboratories, observatories,(public nd private) planetariums industrial researct organiza t ions,eto. 663 Art,noted museums ,collections, galleries,private collections, open to public, art organizations,print shops,notable dealers i n antique s and "objects d 'art 6 6 4 H usic, musical organizations,groups,ha.lls,(as Music J,.oun tain in Conn. ) symphony orcanizations, opera companies orchestras,choral societies, chamber music groups, music libraries, publishers,recordings and records. 6 6 5 Literature-landmarks of noted literary figures, libraries, collections of' local material, other collections as rare material,etc. organizations,publishers, celebrated book se J ers. 666 Theater; theater companie s stocJc com anies, little theatre groups, legi tirnate theatres, o u t doo r dram a etc. 667 Outst .nding motion pictUle h ouses, stu ios, ":lotion picture rouJ)s ,production and exhibi t.:.on N ote: t l e"" shoul '. j cJ. onJ y theaters which shoVJ first runs, foreign, exclusiveJy news or mther unusual pictures. 668 Radio. Radio stations, radio playhouses open to public, information as to ho tickets m a y be obtained. 669 Auditoriums and stadia; special events of cultural nature, such as forums lecture series, etc. (Does not incluae sport events. 670 SOCIAL 671 Organizations that play important art in social and economic life of the community 672 Labor Unions 673 societies 674 Social service agencies 674-1 Hospitals andclinics 674-2 Penal institutions, reformatories, etc. 674 3 Asylums 671-4 Homes for orphans, for the aged,etc. 6 7 5 Soci ties for expe rimental purposes "edicine, education, etc. 676Loca l Customs 677 L ocal cuisine, cook books ,recipes. 678 Outstanding social events and holidays. 679 Folk-lore-such as haunted spots, or any object or place with legendary associations.


l ... l -


t WORK PROJECTS DIS':':KICT l:GQ 4 TAMi'A, FLORIJA DISTRICT SAFETY BULLETIN NOo 26 ---------------August 21, 1940 TOa ALL PROJECT SUIER::NTENDENTS, FOREI.,mN, AND FOREWOMEN FROM: E. H. BURTON, DIRECTOR OF OPERATIONS, WPA DISTRICT NO 4 SUBJECT, FORMS 351 (Revissd 5-1-40), ACCIDENT REPORTS IN VIEW OF THE COMPLETE AND DETA 1L.r-;D INSTRUCTIONS CONTAINED IN OPERATING FR00EDURE NO, 0 .. 13 AND IN THIS COVERING TilE PREPARATION AND SUI'MISSION OF FOID4S 351 (Revised 5-J ... tO), r:c-?ms OF WHICH IEEN FIJRN:T:Sl!ED Y OUR Pil.OJECT, THE DJ\ .i:SJ.JN CANNOT SEE ANY FURTHER NECII!fSlTY FOR DELAYED SUBMISSION OR IMPR0.f'ER PREPARATION OF THESE REPORTS e YOU ARE INSTRUCTF.D TO T:E GOVERNED ACCORDINGLY IN ORDER THAT THE NECESSD:Y or Dm'TIHTE ACTION B'l THIS OFFICE TO FURTHER INSURE PROFER SUBAISSION CF THESE REPORTS WILL NOT OCCUR, All Forms 351 (Revised 5-1 .. 40), Accident Reports, are to be preparCJd :mbrr.i tted to this office in strict accordance with the follO"';; ir.t;;. :LM)<,rud;io:rFJ e .fld in addition to that contained in Operating P.l.c'1.-::H1:1.o.' e .. 0 -13 RevitSod July 5, 1940, These reports are to be checked wit)1 :i_.np+.rur;0ions contained in both of these bulletins prior to submission to this o:'l'ice, A. The green copy only, which must be the originali of all Fonns 351 is to be submitted direct to the office of Mr. E, H. of Opera.bions0 WPA District No. 4, 1102 Wallace s. fuilding, Tampa, following the accident or B. All A.Ccidents, whether they involve an injury to a worker or nnt, must be--reported, You are to be governed by the following in connection with various types of reports: l, to workers on tho project: complete all items on l'om. 351 (RE)viscd s-r-ro) with exception of l9(a), 19(b) and 19(o), and those parts of item 31 which may not apply lf Worker was not scheduled to work on the following day In uries to workers enroute to and from workr complete Q'il itoms on Form 351 RevisE)d 5I-40) with exception /. of those parts of item 31 which may not apply if worker was not scheduled to work on the following day, On the rovorso of tho form it will also be necessary to show whether or not tho workor was traveling in the shortest and most direct routo betwoen his homo and the project, and tho oosb of transportation by public carrior if this means transportation was available to tho worker. 3, to worker: all itoms of Form 351 5-l-4o)with the exception of itoms 13 through 23, and itom 3l(a), (b), and (c). If this damage involves autumotivo equipment, or equipment suoh as tractors, oto., whether furnished by tho WPfl. or tho sponsor, the c:..ato of last WPA inspection of samo must bo shown on tho rcvorso of Form 351, togothor with full details of typo, mako, modol, license number, ownor, and motor number, (1)


I > District Safety fulletin J!?..:. 4 Accidents a n d 1n u rios involvin a ntc-r..o":-1--ro Fo.cm 36 1 Rcvi ood 5-l-40 r:rust bo persons involvod, whethe r o r not injury was sustr.2.'1.c:'.o Full inforllltion rolo.tivo to ki'ld, nodol, mnke, J.ir,-:;::1::;o number, moto r numoor, owr.or and date of last WPA ins{x:o tion of automotive involved must bo ahown on tho r ovo rso of tho report mother oquipncnt i s owned by tho WPA o r by tho sponsor. ..lso, tho WFA driver of truck o r aut omobile involved, cm10d oi tho r privo.toly or by tho govo rnmont, conploto &nd submit Stnndard Form No. 2 6, Driver's Roport of Accident. s e C\il1.1onta C\nd s iolaloss of worke r s t Form 351 {riOv! ood 5-1=46 ) nust be st.bmittcd '1For Informat i o n Fur poooe Only". Fa. tali tios of worl : o r o : reports on ForrJS 351 (Revised 5 -1=4o) with supporting infornntion required by Operating Pro couuro No. 0..1 5 LlUst bo sub-nittod cove ring o.ll fo.tnlitios of o.osigncd to tho projec t a t tho time of donth, whether deeth occurred on the p r o j ect, onrouto to o r f rom tho p roject, o r olocwhoro, oven t hough tho donth WtHl not a result of o.ccidont o r injury sustn.inod by tho worker on tho project, a.nd must b e o.coompO.niod b y two certified copies of tho doath c orti fica. to. ALL FATALITIES OF VIORI.Gi:RS MUST BE REPORTED IMMEmATELY UPON KNOWLEDGE OF SAllE BY THE UOST DIRECT COMMUNICATION TO THE OFER.\.TimTS DIVISION c O r ir;ino. l Form 351 reports roturnod f rom this offioo for oorroctions or olurif3. oo.tion of items aro not to bo onrkcd 11Supp l onont" o.s those n r o moroly corrootod reports supplemental reports on l y to chow a.ddi tio no.l informo.tion not o.vnilublo for inclusion in tl o origina.l r eports o.t tho timo thoy wor o propar od such ns sendir.g injured wor ke r to tho docto r a.t o. lo.tor da.to lost timo later occurring o.s o. result of tho injury, subse quent doa.th ns o. result of tho injury, or information not uvailo.blo a.t t ho timo of propnrntion of o rigina.l report. D Compl oto onoh i tem of tho Fern 351 report in accordo.nco with tho following: I tom #ls show "Florida". Itom :ff2 s show "District No. 4n. Itom show d to on which accidont o r injury is fir s t r opo rtod, which should bo da.to o f actunl prope.rntion of ropor t o Boar in mind that supplomonto. l reports prepared nt u lntor da.te thnn tho orig ina. l r eport will bon r a lo.tor dnto, but tho dnto o f injury o.hnys rcJ:IQins tho snmo0 If acoidont or injury is not roportod by tho worke r until a. date s ubsequent t o tho.t of o.ctunl injury, indionto so.mo in stntoocn t on tho rcvorso side o f F orm 351 ( Rovisod 5 1 40). Itom :/14: show nano of county in w ich pro j ect is locv.tod. Itom #5s show na.mo of city o r tmm in whic h o r n0a r which tl1o o.ooidont oocu rrod. !tom z show wor k p r o j e c t nUDoor o nly Itom #7: show nur.bo r of uni"to If p r o j oct has only one unit show ono on l y"; if pr.j e.1t 1u\s F'. o f unit s hich a.r e desi gna t e d by loco.tions only1 show projoc'ti u nit Itott #G: sho w ki Tl.d of projo c t such a;. : fuilding constructio n "., 11car.ua 1t.'1.Hy "storn s cto:r:. 11s o wing1 1 nga.r don < D o n o t show typo of work ti unbor. ( 2 )


) / District Safoty Bulletin Nco 2 6 !ton tf!.es sh\JW da.to on which a.ccitlent o r injury a ctually happened If is not k11own show npproxim:lte dato. Itom # 1 0 : show hou r at which accident o r injury a ctually happened If this is not known show app r oximate time !b sure to show w:t, .Jthor time shown is AM o r PM, I ton #11 : follOW' inr.tructionc outlined i n Oper n t ing Pro c edu r e N o 0 -13, Rovisod July 5 1940, sure to i n you r r opor ts'tho tr.roe ossontio.l pa.rts of' o. oorr()c t o.ncvre r i .o,, tho kind of' o.cc idcmt, t h o ng;oncy with which injurious oontn c t is l!ltldo, n n d tho actual Muso of t he accident in toms of' unsn.fo o.ct a or u nsufocontlitions, or both Item :/112: shovr in unswer to this i ton v:ha t dofini te pr:::rvento.tive x:toasures in relationship to tho uctuo.l cavs0 o f 'the accident t 'lvo bo3n to.kon to p r ovont a similnr accident in tho futurco In this c onnection, o.ttontion is directed to tho following instructions issued froi:J. tho of'f'ioo of' tho Sto. to So.f'oty Consul mnt in roforcnco to o.ns1trors to thi s i to:r:u "Rocontly n nunbor of a.ccidont reports hnvo b oon ro c oivod with the 12th question answered by such us 'cautioned the workers to be mor e careful', 'advised the workers to exercise m o r e cn r o x x x', have ronindod to bo mor o careful x x, und in a good many instances the question is a.nswored by tolling who.t should not bo dono 11 Ploaso instruct a.ll nupcrvisors nnd fo rorn.on in your rospootivo divisions to onit those stutononts entirely whon prepa ring 35l's and to nnfJW'Or it by stuting b riefly whnt 'vro.s done to prevent rocurronoo f.md not 'who.t sh ould not be dono'. In othe r words, in nnzwering question 12 f'ollovr tho outline in Opora.ting Pf'oco duro o-13 (Rov 7-5 -40 ) Section 3 pago 4 purngru ph 3 .11 Itom #13 : bo suro nrimc shmrn in this iten is in nc c o rdo.nco with signature of injured I tora #14 : show c onploto identification number of workers. Iton # 1 5 r show rosidon c o o.ddress of injured enp loyeo Item #1.6: b o suro to shoV tho ugo of injured I.f this inf'or.mo.t i on is not so st&to Item 1h7: show the nctuo.l olntsificntion of worker, su c h as carpontor, laborer, truck driver, ctco !ton show what injur ed onployoc vms actually doing a t tho time of' accidonto Itan #19: ( a), ( b), and ( o): answe r theso questions only whon accident occu rred while injured onp loyoo wns to o r f roi:J. tho projoot. Iton :/120: when seve ral pcirts of body aro injur ed list a.ll parts in o rder of se riousness of' injuryo Item 1f21: o.nswor "Yos" to this question only if first a i d wns givon a.t t:i.mo :i.r.nnodio.tely following e.otuul injury Itom =/1=22: show type of first o.id given if answer to itora #Zl is Y:>s"o If answer to ito:r.t #21 is "l'To", show "N'ono"o In this connection, you n.to n.gnin n d vised that WPA Safety Regulations proh ibit the uso of' o.ny SQpplio s not app r ovod and furnished by the WPA, ( 3 )


-) / District Snfoty Bulletin No. 26. Item #23 show the nrune of tho porson o.ssignod the responsibility of rondoring first o.id on tho project. Itom #24i show of person indicntod in itcn 4/:23. Item :f/e6t if answor is '1Yos", o.lso shO\v dnto sent to doctor"., If workor goos to own privo.to physician, shO\"t this infornn.tion on revorae oi'' Forn 351. If injured ie oftorod WPA nodico.l attention o.nd refuses sto.to:xaont to thAt off'oot, signed 'bf tho worker rust appeo.r on tho revorso of Fern 351. I ton & show na.tl.C of doctor or hospi to.l to whom injurod workor is sont. Ite:ras 1/!G7 nnd 4/-29i furnioh: the nD.nes of v.ri tnosses to tho nooidont itself. 'If thoro wore non e ; indico.to. If thoro only ono witness, so state. ,:; ., lo; !tens and :/1=30t show of witnesses opposite sigrw.turos o.ppco.t'ing in itor.1s #27 o.nd #29 rospGctivoly. ; $' Item 4/:Sl(a )t answor ''Yos" if worker was scheduled to work tho ca.londnr day following o.ecidont; answor "no" if' cv.londc\r day wo.s a non-scheduled day, n holido.y, or o. Itor. 1 #Sl(b) t answer this question only if nnsvro to iten 4{:3l(n) is 11Yos" If answer to i.tc!ln #3l(a.) is 11Yos11 this question ttust bo ansvrored. This docs not noo.n did workor roturn to his noxt shif't1 but did ho ttoturn on tho day following his injury. Iton #3l(c)a o.nswor only if itc:o #3l(b) is answered "Yos". If workor did roturn on tho following co.londar day to his rogulo.r work, answer to this question should bo ttNo11 J if' worker returned to light work ns n rosult of his injury o.nswor should bo ,Yos" Lower loft ha.nd linot tho o.otual signnturo of' tho omployM nust be obtained whero possiblo. !r vrorkor oo.nnot write, his nurk l:lUst be shown and tho aignnturos of two to his nark nust appeo.r on the form. Lower right ho.nd linoi the actual signature of tho suporvisor or forennn of tho project or unit nust bo given on the line in the lower right hnnd corner. Bo suro to indioo.te whether tho signnturo is thnt of tho projoot foronan or supervisor. Ploo.so boo.r in mind that the supervisor of tho proj oot is strictly rocporuiiblo for snfoty on his project. Use tho rovorso sid of 351 to clarify the information given in o.ny of tho itons on tho fo.oo of tno roport, being sure to identifY the nurobor of tho item to which it o.pplios. (4)


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Cras ut cursus ante, a fringilla nunc. Mauris lorem nunc, cursus sit amet enim ac, vehicula vestibulum mi. Mauris viverra nisl vel enim faucibus porta. Praesent sit amet ornare diam, non finibus nulla.


Cras efficitur magna et sapien varius, luctus ullamcorper dolor convallis. Orci varius natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Fusce sit amet justo ut erat laoreet congue sed a ante.


Phasellus ornare in augue eu imperdiet. Donec malesuada sapien ante, at vehicula orci tempor molestie. Proin vitae urna elit. Pellentesque vitae nisi et diam euismod malesuada aliquet non erat.


Nunc fringilla dolor ut dictum placerat. Proin ac neque rutrum, consectetur ligula id, laoreet ligula. Nulla lorem massa, consectetur vitae consequat in, lobortis at dolor. Nunc sed leo odio.