Part 86, page 37
Document date 7 July 1972
FBI 164-81, Vault Part 86 p. 37 (DB Cooper-37881), Form, dated 7 Jul 1972 — cooper.theunsolved.net/parts/Cooper-Part-86/pages/37
Transcript
The scan is the source; the transcript is machine-generated from it.
NORTHERN VIRGINIA DOCTORS HOSPITAL EMPLOYEE ACCIDENT REPORT
NOTE: This form to be completed in duplicate and sent immediately to Administrator.
NAME OF EMPLOYEE INJURED: Coffelt, Jack DEPARTMENT: C R DATE OF INJURY: 7-7-72 DAY OF WEEK: Friday TIME: 4:30 P.M. PHYSICIAN NOTIFIED: (Name) No
WAS EMPLOYEE DOING REGULAR WORK? Yes WAS EMPLOYEE INSTRUCTED REGARDING DANGERS OF JOB BEING DONE? [guess: When] first [guess: hired], he was instructed [guess: in] to dangers
BRIEF DESCRIPTION OF INJURY: Bruised rib cage R. side wound [guess: dead/head] [guess: trap] and R. shoulder
HOW DID INJURY HAPPEN? He was helping to move [guess: bodies] + [guess: bin] on C R [guess: table] to the [guess: stretcher]
WHAT DO YOU BELIEVE CAUSED THE ACCIDENT? (DESCRIBED (a) any unsafe act of the injured employee or fellow employee (b) faulty machine or equipment (c) unsafe condition of area (d) other unsafe conditions) [guess: There were] [illegible] [guess: releasing] [guess: to a new draw sheet on it was placed under the] [illegible] [illegible] [guess: felt] [illegible] [guess: pinned on the] [guess: roller] [guess: moving] [guess: turns the] [illegible] [guess: the case] [guess: leaned] at [guess: lower] and [guess: as the] [guess: only] [guess: one] R. [guess: of the] [illegible] [guess: pulled he slipped] the [guess: construction] came away [guess: before the] [guess: replaced] the [illegible] [guess: was/met on the roller] What should be done to prevent repetition? [guess: Mike sure] [guess: floor is not slick].
HAS THIS BEEN DONE? No - [guess: impractical] IF NOT, GIVE REASON. [guess: Because it] [guess: is a] dirty case and the floors cannot be mopped [guess: until] [guess: the] [illegible] is [guess: out of the room]. [guess: Also], [guess: increase up the] [illegible] [redacted]
Date this report completed by supervisor: 7-7-72 SIGNED: [redacted] [guess: Jack B. Coffelt] b6 b7C
PHYSICIAN'S REPORT: (DESCRIBE TREATMENT AND/OR MEDICATIONS) P. X: negative
Chest: Rt shoulder & chest : negative b6 b7C
SIGNED: [redacted] M.D.
DATE OF THIS REPORT: 7-7-72 SIGNED: [redacted]
[guess: well] [guess: either] [guess: dark the] [guess: she] [guess: rubbing was] left [guess: holding] the [guess: it in] - mid-air with the 2 RN's.
DB Cooper-37881