NYC 9/11 Public Portal Document
al Pay m
(Contractor's Company)
~~
sevggnt, Examining Physician: _
7
10/23/00
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od
SUSIECT: PHYSICIAN'S WRITTEN OPINION
Ne
. at
one
e with the requirements of Section(m)(4) (i) of the OSHA Asbestos Standard, 29 CES
examining physician will provide the employer with a weiter opinion which shalt cciss
oO
a
I, This is to certify, that on this date 10/23/00 _, and in accordance with the OSs: 5
Asbestos Standard, 29 CFR 1926.58, { have examined
ee Pil
whose Social Security number is! Pil nud based on my findings, eave
gelermined this individual may (Wy apse) use a respiratory device whee
performing his/her required employment SULVICES;
a. The results of this examinauon hareeetiave not ( Ardetecied any medical condi
which would place the employee at an inereased risk of material health impairment frou
exposure to asbestos, and
po 3. In accordance with OSHA requirements, have informed the above named individual @!
the results of his/her medical examination and of any medical condition that may res":
from his/her exposure to asbestos.
Vee complete medical examination report on the above wamed individual will be fonvarded vo vt
ostover pending final conclusion and interpretation of any additional medical data collected during tvs
I,
Signed: Pll
f
ee Eo The Contractor's Company will provide n copy of this Physician's Written Oiaton
to the employce within 30 days of receipt. +
NYC-WTC_000120526
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NYC-WTC_000120526Source: NYC Law Department, mirrored locally