NYC 9/11 Public Portal Document
Regulatory Submittal Part III — Health & Safety Plan
Fiterman Hall — 30 West Broadway, New York, New York
Airtek Project 05-0867 — January 10, 2006
FIGURE .1.I tiPAGE I of 3)
•?CC Tfl VVPi 1cr IAC tA;%'V T1, %1*Ir .w
COMP:tit DATE
[Nvr.ST1CAnUN TEAM
EatPtovyr's N.aitE & ID
SE.C ;AGE ]on DEscRIPnoN
DEP.ARTOrE1-r & LucpnON
AccmxT DATE A TIME
DATE & TIME Ac c irnn, T REPoRTF13 TO SL'PFRv'tSr)R
NA1VRE OF INCIDENT
NArj'RE OF INILTi
RErr•RRtn ru M ar,ic.-uFACRJTlDOCTOR t] Yrs No
❑
EMPLOYU RETtIt" D TO WORK ❑ YES DA1E'Tr tE _ ❑ No
❑ L'ot'nDILipi.o}EEI\nR47rwSrAT1'Ata1T-:JTACHLD
VTrNESSES
❑ WITNESSESIICERVEWS'STATE.ttENT5 rrAcHED
❑ PHOTOGRAPHS OP Sm - ATTACHED
❑ DxAGRAsis oi: Sot - ;1TT.1CHaD
EQLIPSfENTRECORDS- ATTACIIED- RL'i7FtifiTl 0 '- [i ce No
AccIOr.NT.tYPtscRE L ciDh.Nr DESCRIPT1oN
19
NYC-WTC 000096641
OCR can misread numbers and units. Confirm readings against the page image before using them.