Apple Reference & Presentation Library 6 (Internal Edition)

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/ Apple Reference & Presen…rary 6 (Internal Edition) / Apple R&P Lib Internal v6.0.iso / 1-Reference / Electronic Forms / Workers Compensation / Fremont Work Inj.⁄Ill.-Spvr. / Fremont Work Inj._Ill.-Spvr.
Unknown | 1990-11-16 | 32.7 KB
open in:
MacOS 8.1 |
Win98 |
DOS
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view as text

This file was not able to be converted.
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Confidence	Program	Detection	Match Type	Support
`100%`	file	data	default
`100%`	TrID	Adobe PhotoShop Brush	default (weak)
hex view
+--------+-------------------------+-------------------------+--------+--------+
|00000000| 00 0c 00 02 00 00 00 30 | 00 00 67 0e 00 00 01 de |.......0|..g.....|
|00000010| 00 00 3d 8e 00 00 3d 90 | 00 00 81 ac 00 00 00 00 |..=...=.|........|
|00000020| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000030| 09 90 0c 60 00 01 00 01 | 00 00 00 00 00 01 00 00 |...`....|........|
|00000040| 00 00 00 00 00 03 00 01 | 00 01 00 03 00 00 00 48 |........|.......H|
|00000050| 00 48 00 00 00 00 03 08 | 02 40 ff f8 ff ee 03 10 |.H......|.@......|
|00000060| 02 52 03 47 05 28 03 fc | 00 02 00 00 00 48 00 48 |.R.G.(..|.....H.H|
|00000070| 00 00 00 00 03 08 02 40 | 00 01 00 00 00 64 00 00 |.......@|.....d..|
|00000080| 00 01 00 01 01 01 00 00 | 00 01 27 0f 00 01 00 01 |........|..'.....|
|00000090| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 00 19 |........|........|
|000000a0| 01 90 00 00 00 00 00 70 | 00 00 00 00 00 00 00 00 |.......p|........|
|000000b0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000000c0| 00 00 00 00 01 48 00 01 | 00 06 00 06 40 38 00 00 |.....H..|....@8..|
|000000d0| 00 00 00 00 40 38 00 00 | 00 00 00 00 00 2f 00 02 |....@8..|...../..|
|000000e0| 00 01 00 00 00 00 00 04 | 01 f4 01 26 00 34 00 30 |........|...&.4.0|
|000000f0| 00 01 00 14 00 01 00 09 | 00 00 00 0d 00 00 00 15 |........|........|
|00000100| 00 03 00 0c 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000110| 00 00 00 00 00 00 00 00 | 00 03 00 03 00 00 ff ff |........|........|
|00000120| ff ff ff ff ff ff 00 02 | 00 02 00 25 ae 32 00 25 |........|...%.2.%|
|00000130| ae 38 00 20 4e d2 00 20 | 4e d2 00 00 00 00 00 00 |.8. N.. |N.......|
|00000140| 00 01 00 01 00 01 00 01 | 00 01 00 01 00 00 00 00 |........|........|
|00000150| 00 00 00 01 00 00 00 00 | 00 00 00 00 00 00 00 48 |........|.......H|
|00000160| 00 07 00 00 00 01 09 90 | 0c 60 00 20 00 48 0c 3d |........|.`. .H.=|
|00000170| 09 45 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |.E......|........|
|00000180| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000190| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000001a0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000001b0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000001c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000001d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 09 |........|........|
|000001e0| 00 00 01 68 0b 90 00 10 | 0c 48 09 44 00 01 00 00 |...h....|.H.D....|
|000001f0| 00 14 00 01 00 12 00 00 | 00 03 00 03 00 00 00 00 |........|........|
|00000200| 00 04 10 50 00 02 00 01 | 00 03 00 00 00 00 00 00 |...P....|........|
|00000210| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000220| 00 00 00 03 00 03 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000230| 01 20 01 20 00 3c 00 28 | 00 00 00 39 00 2c 00 00 |. . .<.(|...9.,..|
|00000240| 00 00 00 01 00 00 00 01 | 00 00 00 00 00 ae 00 02 |........|........|
|00000250| 0b 90 00 10 0b cc 09 45 | 01 01 80 81 00 14 00 0c |.......E|........|
|00000260| 00 00 00 00 00 03 00 02 | 00 01 00 75 50 6c 65 61 |........|...uPlea|
|00000270| 73 65 20 62 65 20 73 75 | 72 65 20 74 6f 20 70 72 |se be su|re to pr|
|00000280| 69 6e 74 20 77 69 74 68 | 20 22 50 72 69 6e 74 20 |int with| "Print |
|00000290| 77 69 74 68 20 50 61 72 | 74 20 4c 61 62 65 6c 73 |with Par|t Labels|
|000002a0| 22 20 6f 70 74 69 6f 6e | 20 73 65 6c 65 63 74 65 |" option| selecte|
|000002b0| 64 2e 20 20 46 6f 6c 64 | 20 61 6e 64 20 4d 61 69 |d.  Fold| and Mai|
|000002c0| 6c 20 74 6f 20 74 68 65 | 20 44 65 70 61 72 74 6d |l to the| Departm|
|000002d0| 65 6e 74 20 6c 69 73 74 | 65 64 20 62 65 6c 6f 77 |ent list|ed below|
|000002e0| 2e 2c 00 00 00 16 00 01 | 00 00 00 00 00 0c 00 09 |.,......|........|
|000002f0| 00 14 00 00 00 0c 00 00 | 00 00 00 00 00 4e 53 69 |........|.....NSi|
|00000300| 74 65 20 4e 75 72 73 65 | 2f 46 72 65 6d 6f 6e 74 |te Nurse|/Fremont|
|00000310| 20 45 48 26 53 20 44 65 | 70 74 2e 2c 48 75 6d 61 | EH&S De|pt.,Huma|
|00000320| 6e 20 52 65 73 6f 75 72 | 63 65 73 20 4c 69 61 69 |n Resour|ces Liai|
|00000330| 73 6f 6e 2c 20 53 75 70 | 65 72 76 69 73 6f 72 2f |son, Sup|ervisor/|
|00000340| 4d 61 6e 61 67 65 72 20 | 43 6f 70 79 00 03 00 00 |Manager |Copy....|
|00000350| 00 34 00 24 00 4c 0b d0 | 09 44 00 01 00 01 00 03 |.4.$.L..|.D......|
|00000360| 00 01 ff ff ff ff ff ff | ff ff 00 00 00 00 00 00 |........|........|
|00000370| 00 00 00 00 00 01 00 28 | 00 28 00 28 00 28 00 00 |.......(|.(.(.(..|
|00000380| 00 00 00 00 00 00 00 0d | 00 00 00 88 09 f0 00 b4 |........|........|
|00000390| 0a e0 09 24 00 00 00 02 | 00 02 00 02 00 02 00 02 |...$....|........|
|000003a0| 00 03 00 00 00 34 0a 08 | 00 b4 0a e0 09 10 00 01 |.....4..|........|
|000003b0| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 00 00 |........|........|
|000003c0| aa 55 aa 55 aa 55 aa 55 | 00 01 00 00 00 00 00 00 |.U.U.U.U|........|
|000003d0| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 00 34 |........|.......4|
|000003e0| 09 f0 00 c8 0a cc 09 24 | 00 01 00 00 00 03 00 00 |.......$|........|
|000003f0| ff ff ff ff ff ff ff ff | 00 00 00 00 00 00 00 00 |........|........|
|00000400| 00 00 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000410| 00 00 00 00 00 07 00 00 | 00 e2 00 a0 01 3c 01 04 |........|.....<..|
|00000420| 09 24 00 01 00 00 ff ff | ff ff ff ff ff ff 00 01 |.$......|........|
|00000430| 00 00 00 00 00 00 00 02 | 00 a0 01 3c 01 04 09 24 |........|...<...$|
|00000440| 00 00 00 00 00 14 00 0c | 00 00 00 00 00 01 00 01 |........|........|
|00000450| 00 02 00 8e 43 6f 6d 70 | 6c 65 74 65 20 77 69 74 |....Comp|lete wit|
|00000460| 68 69 6e 20 32 34 20 68 | 6f 75 72 73 20 6f 66 20 |hin 24 h|ours of |
|00000470| 61 20 77 6f 72 6b 20 69 | 6e 6a 75 72 79 20 2f 20 |a work i|njury / |
|00000480| 69 6c 6c 6e 65 73 73 2e | 20 20 49 6e 20 74 68 65 |illness.|  In the|
|00000490| 20 65 76 65 6e 74 20 6f | 66 20 73 65 72 69 6f 75 | event o|f seriou|
|000004a0| 73 20 69 6e 6a 75 72 79 | 20 6f 72 20 64 65 61 74 |s injury| or deat|
|000004b0| 68 20 69 6d 6d 65 64 69 | 61 74 65 6c 79 20 6e 6f |h immedi|ately no|
|000004c0| 74 69 66 79 20 41 70 70 | 6c 65 20 53 65 63 75 72 |tify App|le Secur|
|000004d0| 69 74 79 20 61 6e 64 2f | 6f 72 20 53 61 66 65 74 |ity and/|or Safet|
|000004e0| 79 2e 00 00 00 16 00 01 | 00 00 00 00 00 0c 00 09 |y.......|........|
|000004f0| 00 14 00 00 00 0c 00 00 | 00 00 00 00 00 0d 00 00 |........|........|
|00000500| 00 88 01 10 00 b0 03 24 | 09 20 00 00 00 00 00 00 |.......$|. ......|
|00000510| 00 01 00 01 00 02 00 03 | 00 00 00 34 01 2c 00 b0 |........|...4.,..|
|00000520| 03 24 09 0b 00 01 00 00 | 00 03 00 00 ff ff ff ff |.$......|........|
|00000530| ff ff ff ff 00 00 aa 55 | aa 55 aa 55 aa 55 00 01 |.......U|.U.U.U..|
|00000540| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000550| 00 03 00 00 00 34 01 10 | 00 c4 03 10 09 20 00 01 |.....4..|..... ..|
|00000560| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 00 00 |........|........|
|00000570| 00 00 00 00 00 00 00 00 | 00 01 00 00 00 00 00 00 |........|........|
|00000580| 00 00 00 00 00 00 00 00 | 00 00 00 0d 00 00 00 88 |........|........|
|00000590| 03 40 00 b0 07 0c 09 20 | 00 00 00 00 00 00 00 01 |.@..... |........|
|000005a0| 00 01 00 02 00 03 00 00 | 00 34 03 60 00 b0 07 0c |........|.4.`....|
|000005b0| 09 0b 00 01 00 00 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|000005c0| ff ff 00 00 aa 55 aa 55 | aa 55 aa 55 00 01 00 00 |.....U.U|.U.U....|
|000005d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|000005e0| 00 00 00 34 03 40 00 c4 | 06 f8 09 20 00 01 00 00 |...4.@..|... ....|
|000005f0| 00 03 00 00 ff ff ff ff | ff ff ff ff 00 00 00 00 |........|........|
|00000600| 00 00 00 00 00 00 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|00000610| 00 00 00 00 00 00 00 00 | 00 06 00 00 02 b0 03 da |........|........|
|00000620| 00 70 05 fa 00 a8 00 01 | 00 00 03 da 00 70 05 fa |.p......|.....p..|
|00000630| 00 a8 00 30 00 28 02 a0 | 00 60 00 00 00 00 02 7e |...0.(..|.`.....~|
|00000640| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000650| 02 7e ff ff ff ff 00 9b | 00 0d 11 01 a0 00 82 a1 |.~......|........|
|00000660| 00 96 00 0c 01 00 01 0e | 02 00 01 0e 00 00 00 00 |........|........|
|00000670| a1 00 9a 00 08 ff fc 00 | 00 00 4c 00 00 03 00 14 |........|..L.....|
|00000680| 04 01 0d 00 0a 28 00 50 | ff ba 14 49 4e 43 49 44 |.....(.P|...INCID|
|00000690| 45 4e 54 20 49 4e 46 4f | 52 4d 41 54 49 4f 4e 01 |ENT INFO|RMATION.|
|000006a0| 00 0a 00 00 00 00 00 9a | 00 0c 90 00 04 00 00 00 |........|........|
|000006b0| 00 00 80 00 20 00 00 00 | 00 00 80 00 20 00 1a 00 |.... ...|.... ...|
|000006c0| 00 00 9a 00 20 00 01 00 | 00 00 00 1f c0 00 00 1f |.... ...|........|
|000006d0| c0 00 00 13 00 00 00 06 | 40 00 00 1f c0 00 00 1f |........|@.......|
|000006e0| c0 00 00 10 40 00 00 00 | 00 00 00 07 00 00 00 0f |....@...|........|
|000006f0| 80 00 00 18 c0 00 00 10 | 40 00 00 18 c0 00 00 0f |........|@.......|
|00000700| 80 00 00 07 00 00 00 10 | 40 00 00 1f c0 00 00 1f |........|@.......|
|00000710| c0 00 00 10 40 00 00 00 | 00 00 00 18 00 00 00 18 |....@...|........|
|00000720| 40 00 00 1f c0 00 00 1f | c0 00 00 18 40 00 00 18 |@.......|....@...|
|00000730| 40 00 00 01 c0 00 00 07 | c0 00 00 1f 40 00 00 1f |@.......|....@...|
|00000740| 40 00 00 07 c0 00 00 01 | c0 00 00 10 40 00 00 1f |@.......|....@...|
|00000750| c0 00 00 1f c0 00 00 1e | 40 00 00 07 80 00 00 07 |........|@.......|
|00000760| 80 00 00 1e 40 00 00 1f | c0 00 00 1f c0 00 00 10 |....@...|........|
|00000770| 40 00 00 00 00 00 00 0c | 40 00 00 1e c0 00 00 13 |@.......|@.......|
|00000780| c0 00 00 13 40 00 00 1f | c0 00 00 1f c0 00 00 10 |....@...|........|
|00000790| 40 00 00 07 00 00 00 0f | 80 00 00 18 c0 00 00 10 |@.......|........|
|000007a0| 40 00 00 18 c0 00 00 0f | 80 00 00 07 00 00 00 18 |@.......|........|
|000007b0| 00 00 00 1a 00 00 00 12 | 40 00 00 1f c0 00 00 1f |........|@.......|
|000007c0| c0 00 00 10 40 00 00 10 | 00 00 00 1f c0 00 00 1f |....@...|........|
|000007d0| c0 00 00 13 00 00 00 06 | 40 00 00 1f c0 00 00 1f |........|@.......|
|000007e0| c0 00 00 10 40 00 00 10 | 40 00 00 1f c0 00 00 1f |....@...|@.......|
|000007f0| c0 00 00 10 40 00 00 00 | 00 00 00 00 00 00 00 00 |....@...|........|
|00000800| 00 00 00 18 00 00 00 18 | 40 00 00 1f c0 00 00 1f |........|@.......|
|00000810| c0 00 00 18 40 00 00 18 | 00 00 00 1f c0 00 00 1f |....@...|........|
|00000820| c0 00 00 13 00 00 00 06 | 40 00 00 1f c0 00 00 1f |........|@.......|
|00000830| c0 00 00 10 40 00 00 00 | 00 00 00 18 c0 00 00 1a |....@...|........|
|00000840| c0 00 00 12 40 00 00 1f | c0 00 00 1f c0 00 00 10 |....@...|........|
|00000850| 40 00 00 07 00 00 00 0f | 80 00 00 18 c0 00 00 10 |@.......|........|
|00000860| 40 00 00 1f c0 00 00 1f | c0 00 00 10 40 00 00 10 |@.......|....@...|
|00000870| 40 00 00 1f c0 00 00 1f | c0 00 00 10 40 00 00 18 |@.......|....@...|
|00000880| 80 00 00 18 c0 00 00 10 | 40 00 00 10 40 00 00 18 |........|@...@...|
|00000890| c0 00 00 0f 80 00 00 17 | 00 00 00 1f c0 00 00 1f |........|........|
|000008a0| c0 00 00 13 00 00 00 06 | 40 00 00 1f c0 00 00 1f |........|@.......|
|000008b0| c0 00 00 10 40 00 00 10 | 40 00 00 1f c0 00 00 1f |....@...|@.......|
|000008c0| c0 00 00 10 40 00 00 a0 | 00 97 a0 00 83 ff 00 07 |....@...|........|
|000008d0| 00 00 00 86 00 38 00 4c | 00 a4 09 44 00 01 00 00 |.....8.L|...D....|
|000008e0| ff ff ff ff ff ff ff ff | 00 01 00 00 00 00 00 00 |........|........|
|000008f0| 00 02 00 38 00 4c 00 a4 | 09 44 00 00 00 00 00 14 |...8.L..|.D......|
|00000900| 00 0e 00 01 00 00 00 03 | 00 03 00 01 00 31 46 52 |........|.....1FR|
|00000910| 45 4d 4f 4e 54 20 57 4f | 52 4b 20 49 4e 4a 55 52 |EMONT WO|RK INJUR|
|00000920| 59 20 2f 20 49 4c 4c 4e | 45 53 53 20 52 45 50 4f |Y / ILLN|ESS REPO|
|00000930| 52 54 20 2d 20 53 55 50 | 45 52 56 49 53 4f 52 01 |RT - SUP|ERVISOR.|
|00000940| 00 00 00 16 00 01 00 00 | 00 00 00 0f 00 0c 00 14 |........|........|
|00000950| 01 00 00 0e 00 00 00 00 | 00 00 00 0d 00 00 00 cc |........|........|
|00000960| 00 5c 00 94 00 d0 00 fc | 00 00 00 00 00 00 00 00 |.\......|........|
|00000970| 00 00 00 02 00 07 00 00 | 00 56 00 5c 00 94 00 d0 |........|.V.\....|
|00000980| 00 fa 00 01 00 00 ff ff | ff ff ff ff ff ff 00 01 |........|........|
|00000990| 00 00 00 00 00 00 00 02 | 00 5c 00 94 00 d0 00 fa |........|.\......|
|000009a0| 00 00 00 00 00 14 00 18 | 00 00 00 00 00 03 00 03 |........|........|
|000009b0| 00 01 00 01 f0 00 00 00 | 00 16 00 01 00 00 00 00 |........|........|
|000009c0| 00 18 00 12 00 14 00 00 | 00 18 00 00 00 00 00 00 |........|........|
|000009d0| 00 07 00 00 00 56 00 a1 | 00 df 00 ba 00 fc 00 01 |.....V..|........|
|000009e0| 00 00 ff ff ff ff ff ff | ff ff 00 01 00 00 00 00 |........|........|
|000009f0| 00 00 00 02 00 a1 00 df | 00 ba 00 fc 00 00 00 00 |........|........|
|00000a00| 00 14 00 04 00 00 00 00 | 00 03 00 03 00 01 00 01 |........|........|
|00000a10| a8 00 00 00 00 16 00 01 | 00 00 00 00 00 05 00 04 |........|........|
|00000a20| 00 14 00 00 00 04 00 00 | 00 00 00 00 00 07 00 00 |........|........|
|00000a30| 00 68 0b f4 00 4c 0c 3c | 02 38 00 01 00 01 ff ff |.h...L.<|.8......|
|00000a40| ff ff ff ff ff ff 00 01 | 00 00 00 00 00 00 00 02 |........|........|
|00000a50| 0b f4 00 4c 0c 3c 02 38 | 00 00 00 00 00 14 00 0e |...L.<.8|........|
|00000a60| 00 20 00 00 00 01 00 03 | 00 01 00 14 41 70 70 6c |. ......|....Appl|
|00000a70| 65 20 43 6f 6d 70 75 74 | 65 72 2c 20 49 6e 63 2e |e Comput|er, Inc.|
|00000a80| 00 00 00 16 00 01 00 00 | 00 00 00 0f 00 0c 00 14 |........|........|
|00000a90| 20 00 00 0e 00 00 00 00 | 00 00 00 07 00 00 00 62 | .......|.......b|
|00000aa0| 0b fc 08 1c 0c 3c 09 44 | 00 01 00 00 ff ff ff ff |.....<.D|........|
|00000ab0| ff ff ff ff 00 01 00 00 | 00 00 00 00 00 02 0b fc |........|........|
|00000ac0| 08 1c 0c 3c 09 44 00 00 | 00 00 00 14 00 0a 00 00 |...<.D..|........|
|00000ad0| 00 00 00 02 00 03 00 01 | 00 0e 52 53 4b 33 30 30 |........|..RSK300|
|00000ae0| 20 28 31 31 2f 39 30 29 | 00 00 00 16 00 01 00 00 | (11/90)|........|
|00000af0| 00 00 00 0c 00 09 00 14 | 00 00 00 0a 00 00 00 00 |........|........|
|00000b00| 00 00 00 07 00 00 00 8a | 00 d8 06 70 01 07 09 20 |........|...p... |
|00000b10| 00 01 00 00 80 00 08 00 | 80 00 08 00 00 00 00 00 |........|........|
|00000b20| 00 00 00 00 00 02 00 d8 | 06 70 01 07 09 20 00 00 |........|.p... ..|
|00000b30| 00 00 00 14 00 0c ff 00 | 00 00 00 01 00 01 00 01 |........|........|
|00000b40| 00 21 41 70 70 6c 65 20 | 43 6f 6e 66 69 64 65 6e |.!Apple |Confiden|
|00000b50| 74 69 61 6c 3a 20 20 4e | 65 65 64 20 74 6f 20 4b |tial:  N|eed to K|
|00000b60| 6e 6f 77 00 00 00 00 2a | 00 02 00 00 00 00 00 0c |now....*|........|
|00000b70| 00 09 00 14 00 00 00 0c | 00 00 00 00 00 00 00 00 |........|........|
|00000b80| 00 06 00 0c 00 09 00 14 | 02 00 00 0c 00 00 00 00 |........|........|
|00000b90| 00 00 00 06 00 00 02 d0 | 00 f0 00 70 03 2c 00 a8 |........|...p.,..|
|00000ba0| 00 01 00 00 00 f0 00 70 | 03 2c 00 a8 00 30 00 28 |.......p|.,...0.(|
|00000bb0| 02 6c 00 60 00 00 00 00 | 02 9e 00 00 00 00 00 00 |.l.`....|........|
|00000bc0| 00 00 00 00 00 00 00 00 | 00 00 02 9e ff ff ff ff |........|........|
|00000bd0| 00 8e 00 0d 11 01 a0 00 | 82 a1 00 96 00 0c 01 00 |........|........|
|00000be0| 01 0e 02 00 01 0e 00 00 | 00 00 a1 00 9a 00 08 ff |........|........|
|00000bf0| fc 00 00 00 45 00 00 03 | 00 14 04 01 0d 00 0a 28 |....E...|.......(|
|00000c00| 00 4a ff c1 14 45 4d 50 | 4c 4f 59 45 45 20 49 4e |.J...EMP|LOYEE IN|
|00000c10| 46 4f 52 4d 41 54 49 4f | 4e 01 00 0a 00 00 00 00 |FORMATIO|N.......|
|00000c20| 00 8d 00 0c 90 00 04 00 | 00 00 00 00 88 00 20 00 |........|...... .|
|00000c30| 00 00 00 00 88 00 20 00 | 05 00 00 00 8d 00 20 00 |...... .|...... .|
|00000c40| 01 00 00 00 00 10 00 00 | 00 1f c0 00 00 1f c0 00 |........|........|
|00000c50| 00 13 00 00 00 06 40 00 | 00 1f c0 00 00 1f c0 00 |......@.|........|
|00000c60| 00 10 40 00 00 00 00 00 | 00 07 00 00 00 0f 80 00 |..@.....|........|
|00000c70| 00 18 c0 00 00 10 40 00 | 00 18 c0 00 00 0f 80 00 |......@.|........|
|00000c80| 00 07 00 00 00 10 40 00 | 00 1f c0 00 00 1f c0 00 |......@.|........|
|00000c90| 00 10 40 00 00 18 00 00 | 00 18 40 00 00 1f c0 00 |..@.....|..@.....|
|00000ca0| 00 1f c0 00 00 18 40 00 | 00 18 00 00 00 00 40 00 |......@.|......@.|
|00000cb0| 00 01 c0 00 00 07 c0 00 | 00 1f 40 00 00 1f 40 00 |........|..@...@.|
|00000cc0| 00 07 c0 00 00 01 c0 00 | 00 10 40 00 00 1f c0 00 |........|..@.....|
|00000cd0| 00 1f c0 00 00 1e 40 00 | 00 07 80 00 00 07 80 00 |......@.|........|
|00000ce0| 00 1e 40 00 00 1f c0 00 | 00 1f c0 00 00 10 40 00 |..@.....|......@.|
|00000cf0| 00 0c 40 00 00 1e c0 00 | 00 13 c0 00 00 13 40 00 |..@.....|......@.|
|00000d00| 00 1f c0 00 00 1f c0 00 | 00 10 40 00 00 00 00 00 |........|..@.....|
|00000d10| 00 07 00 00 00 0f 80 00 | 00 18 c0 00 00 10 40 00 |........|......@.|
|00000d20| 00 18 c0 00 00 0f 80 00 | 00 07 00 00 00 18 00 00 |........|........|
|00000d30| 00 1a 00 00 00 12 40 00 | 00 1f c0 00 00 1f c0 00 |......@.|........|
|00000d40| 00 10 40 00 00 1f c0 00 | 00 1f c0 00 00 13 00 00 |..@.....|........|
|00000d50| 00 06 40 00 00 1f c0 00 | 00 1f c0 00 00 10 40 00 |..@.....|......@.|
|00000d60| 00 10 40 00 00 1f c0 00 | 00 1f c0 00 00 10 40 00 |..@.....|......@.|
|00000d70| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 18 c0 00 |........|........|
|00000d80| 00 1a c0 00 00 12 40 00 | 00 1f c0 00 00 1f c0 00 |......@.|........|
|00000d90| 00 10 40 00 00 00 00 00 | 00 18 c0 00 00 1a c0 00 |..@.....|........|
|00000da0| 00 12 40 00 00 1f c0 00 | 00 1f c0 00 00 10 40 00 |..@.....|......@.|
|00000db0| 00 18 00 00 00 1c 40 00 | 00 17 c0 00 00 17 c0 00 |......@.|........|
|00000dc0| 00 1c 40 00 00 18 00 00 | 00 10 00 00 00 00 00 00 |..@.....|........|
|00000dd0| 00 07 00 00 00 0f 80 00 | 00 18 c0 00 00 10 40 00 |........|......@.|
|00000de0| 00 18 c0 00 00 0f 80 00 | 00 07 00 00 00 00 00 00 |........|........|
|00000df0| 00 00 c0 00 00 00 c0 00 | 00 10 40 00 00 1f c0 00 |........|..@.....|
|00000e00| 00 1f c0 00 00 10 40 00 | 00 0c 00 00 00 1e 00 00 |......@.|........|
|00000e10| 00 12 40 00 00 1f c0 00 | 00 1f c0 00 00 10 40 00 |..@.....|......@.|
|00000e20| 00 1f c0 00 00 1f c0 00 | 00 1e 40 00 00 07 80 00 |........|..@.....|
|00000e30| 00 07 80 00 00 1e 40 00 | 00 1f c0 00 00 1f c0 00 |......@.|........|
|00000e40| 00 10 40 00 00 00 00 00 | 00 18 c0 00 00 1a c0 00 |..@.....|........|
|00000e50| 00 12 40 00 00 1f c0 00 | 00 1f c0 00 00 10 40 00 |..@.....|......@.|
|00000e60| 00 a0 00 97 a0 00 83 ff | 00 01 00 00 00 ac 01 1c |........|........|
|00000e70| 00 e4 01 64 06 34 00 01 | 00 00 00 00 00 15 00 00 |...d.4..|........|
|00000e80| 00 0c 00 00 00 03 00 02 | 00 2a 00 01 00 02 00 00 |........|.*......|
|00000e90| 00 00 00 04 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000ea0| 00 00 00 00 00 00 00 00 | 00 03 00 00 ff ff ff ff |........|........|
|00000eb0| ff ff ff ff 01 3c 00 c8 | 00 18 00 18 00 00 01 12 |.....<..|........|
|00000ec0| 00 01 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000ed0| 00 00 00 00 00 02 01 1c | 00 e4 01 65 02 20 01 01 |........|...e. ..|
|00000ee0| 81 80 00 14 00 09 00 00 | 00 00 00 01 00 02 00 01 |........|........|
|00000ef0| 00 0d 45 4d 50 4c 4f 59 | 45 45 20 4e 41 4d 45 36 |..EMPLOY|EE NAME6|
|00000f00| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|00000f10| 00 00 00 09 00 00 00 00 | 00 00 00 01 00 00 00 a8 |........|........|
|00000f20| 01 1c 06 3c 01 64 08 f2 | 00 01 00 00 00 00 00 15 |...<.d..|........|
|00000f30| 00 00 00 0c 00 00 00 03 | 00 02 00 01 00 01 00 02 |........|........|
|00000f40| 00 00 00 00 00 04 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|00000f50| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 ff ff |........|........|
|00000f60| ff ff ff ff ff ff 00 fc | 01 24 00 34 00 30 00 00 |........|.$.4.0..|
|00000f70| 01 13 00 02 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000f80| 00 00 00 00 00 00 00 02 | 01 1c 06 3c 01 65 07 38 |........|...<.e.8|
|00000f90| 01 01 81 80 00 14 00 09 | 00 00 00 00 00 01 00 02 |........|........|
|00000fa0| 00 01 00 0a 57 4f 52 4b | 20 50 48 4f 4e 45 00 00 |....WORK| PHONE..|
|00000fb0| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|00000fc0| 00 09 00 00 00 00 00 00 | 00 01 00 00 00 a8 01 64 |........|.......d|
|00000fd0| 00 e4 01 ac 05 1c 00 01 | 00 00 00 00 00 15 00 00 |........|........|
|00000fe0| 00 0c 00 00 00 03 00 02 | 00 00 00 01 00 02 00 00 |........|........|
|00000ff0| 00 00 00 04 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001000| 00 00 00 00 00 00 00 00 | 00 03 00 00 ff ff ff ff |........|........|
|00001010| ff ff ff ff 00 b8 01 24 | 00 34 00 30 00 00 01 14 |.......$|.4.0....|
|00001020| 00 03 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001030| 00 00 00 00 00 02 01 64 | 00 e4 01 ad 01 9c 01 01 |.......d|........|
|00001040| 81 80 00 14 00 09 00 00 | 00 00 00 01 00 02 00 01 |........|........|
|00001050| 00 09 4a 4f 42 20 54 49 | 54 4c 45 36 00 00 00 16 |..JOB TI|TLE6....|
|00001060| 00 01 00 00 00 00 00 0b | 00 08 00 14 00 00 00 09 |........|........|
|00001070| 00 00 00 00 00 00 00 01 | 00 00 00 a2 01 6c 05 d8 |........|.....l..|
|00001080| 01 b4 06 80 00 01 00 00 | 00 00 00 15 00 00 00 0c |........|........|
|00001090| 00 00 00 03 00 03 00 01 | 00 01 00 04 00 00 00 00 |........|........|
|000010a0| 00 04 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000010b0| 00 00 00 00 00 00 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|000010c0| ff ff 00 54 00 78 00 34 | 00 30 00 00 01 15 00 04 |...T.x.4|.0......|
|000010d0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000010e0| 00 00 00 02 01 6c 06 08 | 01 b5 06 81 01 00 81 81 |.....l..|........|
|000010f0| 00 14 00 09 00 00 00 00 | 00 03 00 03 00 01 00 04 |........|........|
|00001100| 4d 41 4c 45 00 00 00 16 | 00 01 00 00 00 00 00 0b |MALE....|........|
|00001110| 00 08 00 14 00 00 00 09 | 00 00 00 00 00 00 00 01 |........|........|
|00001120| 00 00 00 a4 01 68 06 f8 | 01 b4 07 c4 00 01 00 00 |.....h..|........|
|00001130| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 03 00 01 |........|........|
|00001140| 00 01 00 04 00 00 00 00 | 00 04 00 00 00 00 00 00 |........|........|
|00001150| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|00001160| 00 00 ff ff ff ff ff ff | ff ff 00 54 00 9c 00 34 |........|...T...4|
|00001170| 00 30 00 00 01 16 00 05 | 00 01 00 00 00 00 00 00 |.0......|........|
|00001180| 00 00 00 00 00 00 00 00 | 00 00 00 02 01 68 07 28 |........|.....h.(|
|00001190| 01 b5 07 c5 01 00 81 81 | 00 14 00 09 00 00 00 00 |........|........|
|000011a0| 00 03 00 03 00 01 00 06 | 46 45 4d 41 4c 45 00 00 |........|FEMALE..|
|000011b0| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|000011c0| 00 09 00 00 00 00 00 00 | 00 01 00 00 00 a8 01 ac |........|........|
|000011d0| 00 e4 01 f4 02 2c 00 01 | 00 00 00 00 00 15 00 00 |.....,..|........|
|000011e0| 00 0c 00 00 00 03 00 02 | 00 00 00 01 00 02 00 00 |........|........|
|000011f0| 00 00 00 04 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001200| 00 00 00 00 00 00 00 00 | 00 03 00 00 ff ff ff ff |........|........|
|00001210| ff ff ff ff 00 d0 00 b4 | 00 34 00 30 00 00 01 17 |........|.4.0....|
|00001220| 00 06 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001230| 00 00 00 00 00 02 01 ac | 00 e4 01 f5 01 b4 01 01 |........|........|
|00001240| 81 80 00 14 00 09 00 00 | 00 00 00 01 00 02 00 01 |........|........|
|00001250| 00 0a 44 49 56 49 53 49 | 4f 4e 20 23 00 00 00 16 |..DIVISI|ON #....|
|00001260| 00 01 00 00 00 00 00 0b | 00 08 00 14 00 00 00 09 |........|........|
|00001270| 00 00 00 00 00 00 00 01 | 00 00 00 aa 01 ac 02 38 |........|.......8|
|00001280| 01 fc 03 cc 00 01 00 00 | 00 00 00 15 00 00 00 0c |........|........|
|00001290| 00 00 00 03 00 02 00 00 | 00 01 00 02 00 00 00 00 |........|........|
|000012a0| 00 04 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000012b0| 00 00 00 00 00 00 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|000012c0| ff ff 01 1c 00 b4 00 34 | 00 30 00 00 01 18 00 07 |.......4|.0......|
|000012d0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000012e0| 00 00 00 02 01 ac 02 38 | 01 fd 03 54 01 01 81 80 |.......8|...T....|
|000012f0| 00 14 00 09 00 00 00 00 | 00 01 00 02 00 01 00 0c |........|........|
|00001300| 44 45 50 41 52 54 4d 45 | 4e 54 20 23 00 00 00 16 |DEPARTME|NT #....|
|00001310| 00 01 00 00 00 00 00 0b | 00 08 00 14 00 00 00 09 |........|........|
|00001320| 00 00 00 00 00 00 00 01 | 00 00 00 ac 01 b4 06 a0 |........|........|
|00001330| 01 fc 08 b4 00 01 00 00 | 00 00 00 15 00 00 00 0c |........|........|
|00001340| 00 00 00 03 00 02 00 00 | 00 01 00 02 00 00 00 00 |........|........|
|00001350| 00 04 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001360| 00 00 00 00 00 00 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|00001370| ff ff 01 2c 01 24 00 2c | 00 2c 00 00 01 19 00 09 |...,.$.,|.,......|
|00001380| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001390| 00 00 00 02 01 b4 06 a0 | 01 fd 07 cc 01 01 81 80 |........|........|
|000013a0| 00 14 00 09 00 00 00 00 | 00 01 00 02 00 01 00 0d |........|........|
|000013b0| 44 41 54 45 20 52 45 50 | 4f 52 54 45 44 36 00 00 |DATE REP|ORTED6..|
|000013c0| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|000013d0| 00 09 00 00 00 00 00 00 | 00 07 00 00 00 66 02 04 |........|.....f..|
|000013e0| 00 e4 02 2f 02 80 00 01 | 00 00 ff ff ff ff ff ff |.../....|........|
|000013f0| ff ff 00 01 00 00 00 00 | 00 00 00 02 02 04 00 e4 |........|........|
|00001400| 02 2f 02 80 00 00 00 00 | 00 14 00 09 00 00 00 00 |./......|........|
|00001410| 00 01 00 01 00 01 00 12 | 45 4d 50 4c 4f 59 4d 45 |........|EMPLOYME|
|00001420| 4e 54 20 53 54 41 54 55 | 53 3a 00 00 00 16 00 01 |NT STATU|S:......|
|00001430| 00 00 00 00 00 0b 00 08 | 00 14 00 00 00 09 00 00 |........|........|
|00001440| 00 00 00 00 00 07 00 00 | 00 72 02 3c 01 48 02 64 |........|.r.<.H.d|
|00001450| 03 c4 00 01 00 00 ff ff | ff ff ff ff ff ff 00 01 |........|........|
|00001460| 00 00 00 00 00 00 00 02 | 02 3c 01 48 02 64 03 c4 |........|.<.H.d..|
|00001470| 00 00 00 00 00 14 00 09 | 00 00 00 00 00 01 00 01 |........|........|
|00001480| 00 01 00 1e 52 45 47 55 | 4c 41 52 20 46 55 4c 4c |....REGU|LAR FULL|
|00001490| 20 54 49 4d 45 20 4f 52 | 20 50 41 52 54 20 54 49 | TIME OR| PART TI|
|000014a0| 4d 45 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |ME......|........|
|000014b0| 00 14 00 00 00 09 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|000014c0| 00 a8 02 70 00 e4 02 b8 | 03 94 00 01 00 00 00 00 |...p....|........|
|000014d0| 00 15 00 00 00 0c 00 00 | 00 03 00 02 00 00 00 01 |........|........|
|000014e0| 00 02 00 00 00 00 00 04 | 00 01 00 00 00 00 00 00 |........|........|
|000014f0| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 03 00 00 |........|........|
|00001500| ff ff ff ff ff ff ff ff | 00 f0 01 24 00 34 00 30 |........|...$.4.0|
|00001510| 00 00 01 1c 00 0b 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|00001520| 00 00 00 00 00 00 00 00 | 00 02 02 70 00 e4 02 b9 |........|...p....|
|00001530| 01 d4 01 01 81 80 00 14 | 00 09 00 00 00 00 00 01 |........|........|
|00001540| 00 02 00 01 00 0a 45 4d | 50 4c 4f 59 45 45 20 23 |......EM|PLOYEE #|
|00001550| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|00001560| 00 00 00 09 00 00 00 00 | 00 00 00 01 00 00 00 aa |........|........|
|00001570| 02 70 03 d8 02 b8 06 74 | 00 01 00 00 00 00 00 15 |.p.....t|........|
|00001580| 00 00 00 0c 00 00 00 03 | 00 02 00 00 00 01 00 02 |........|........|
|00001590| 00 00 00 00 00 04 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|000015a0| 00 00 00 00 00 00 00 00 | 00 03 00 03 00 00 ff ff |........|........|
|000015b0| ff ff ff ff ff ff 01 20 | 01 24 00 34 00 30 00 00 |....... |.$.4.0..|
|000015c0| 01 1d 00 0d 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000015d0| 00 00 00 00 00 00 00 02 | 02 70 03 d8 02 b9 04 f8 |........|.p......|
|000015e0| 01 01 81 80 00 14 00 09 | 00 00 00 00 00 01 00 02 |........|........|
|000015f0| 00 01 00 0b 41 47 45 4e | 43 59 20 4e 41 4d 45 ac |....AGEN|CY NAME.|
|00001600| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|00001610| 00 00 00 09 00 00 00 00 | 00 00 00 01 00 00 00 a8 |........|........|
|00001620| 02 24 03 d8 02 70 05 2c | 00 01 00 00 00 00 00 15 |.$...p.,|........|
|00001630| 00 00 00 0c 00 00 00 03 | 00 03 00 01 00 01 00 04 |........|........|
|00001640| 00 00 00 00 00 04 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001650| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 ff ff |........|........|
|00001660| ff ff ff ff ff ff 00 54 | 01 20 00 34 00 30 00 00 |.......T|. .4.0..|
|00001670| 01 1e 00 0c 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001680| 00 00 00 00 00 00 00 02 | 02 24 04 0c 02 71 05 2d |........|.$...q.-|
|00001690| 01 00 81 81 00 14 00 09 | 00 00 00 00 00 01 00 03 |........|........|
|000016a0| 00 01 00 09 54 45 4d 50 | 4f 52 41 52 59 36 00 00 |....TEMP|ORARY6..|
|000016b0| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|000016c0| 00 09 00 00 00 00 00 00 | 00 01 00 00 00 a4 02 24 |........|.......$|
|000016d0| 06 b8 02 70 08 0c 00 01 | 00 00 00 00 00 15 00 00 |...p....|........|
|000016e0| 00 0c 00 00 00 03 00 03 | 00 01 00 01 00 04 00 00 |........|........|
|000016f0| 00 00 00 04 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001700| 00 00 00 00 00 00 00 00 | 00 03 00 00 ff ff ff ff |........|........|
|00001710| ff ff ff ff 00 54 01 20 | 00 34 00 30 00 00 01 1f |.....T. |.4.0....|
|00001720| 00 0e 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001730| 00 00 00 00 00 02 02 24 | 06 ec 02 71 08 0d 01 00 |.......$|...q....|
|00001740| 81 81 00 14 00 09 00 00 | 00 00 00 01 00 03 00 01 |........|........|
|00001750| 00 05 4f 54 48 45 52 36 | 00 00 00 16 00 01 00 00 |..OTHER6|........|
|00001760| 00 00 00 0b 00 08 00 14 | 00 00 00 09 00 00 00 00 |........|........|
|00001770| 00 00 00 01 00 00 00 a8 | 02 70 06 b8 02 b8 08 f2 |........|.p......|
|00001780| 00 01 00 00 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00001790| 00 02 00 00 00 01 00 02 | 00 00 00 00 00 04 00 01 |........|........|
|000017a0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000017b0| 00 03 00 03 00 00 ff ff | ff ff ff ff ff ff 00 c0 |........|........|
|000017c0| 01 24 00 34 00 30 00 00 | 01 20 00 0f 00 01 00 00 |.$.4.0..|. ......|
|000017d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|000017e0| 02 70 06 b8 02 b9 07 78 | 01 01 81 80 00 14 00 09 |.p.....x|........|
|000017f0| 00 00 00 00 00 01 00 02 | 00 01 00 09 28 53 50 45 |........|....(SPE|
|00001800| 43 49 46 59 29 36 00 00 | 00 16 00 01 00 00 00 00 |CIFY)6..|........|
|00001810| 00 0b 00 08 00 14 00 00 | 00 09 00 00 00 00 00 00 |........|........|
|00001820| 00 01 00 00 00 c4 02 b8 | 00 e4 03 00 08 f2 00 01 |........|........|
|00001830| 00 00 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 02 |........|........|
|00001840| 00 00 00 01 00 02 00 00 | 00 00 00 04 00 01 00 00 |........|........|
|00001850| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|00001860| 00 03 00 00 ff ff ff ff | ff ff ff ff 03 48 01 24 |........|.....H.$|
|00001870| 00 34 00 30 00 00 01 21 | 00 10 00 01 00 00 00 00 |.4.0...!|........|
|00001880| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 02 b8 |........|........|
|00001890| 00 e4 03 01 04 2c 01 01 | 81 80 00 14 00 09 00 00 |.....,..|........|
|000018a0| 00 00 00 01 00 02 00 01 | 00 25 42 55 49 4c 44 49 |........|.%BUILDI|
|000018b0| 4e 47 20 41 44 44 52 45 | 53 53 20 57 48 45 52 45 |NG ADDRE|SS WHERE|
|000018c0| 20 45 4d 50 4c 4f 59 45 | 45 20 57 4f 52 4b 53 01 | EMPLOYE|E WORKS.|
|000018d0| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|000018e0| 00 00 00 09 00 00 00 00 | 00 00 00 01 00 00 00 ac |........|........|
|000018f0| 03 34 05 60 03 7c 08 bc | 00 01 00 00 00 00 00 15 |.4.`.|..|........|
|00001900| 00 00 00 0c 00 00 00 03 | 00 02 00 04 00 01 00 02 |........|........|
|00001910| 00 00 00 00 00 04 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|00001920| 00 00 00 00 00 00 00 00 | 00 03 00 03 00 00 ff ff |........|........|
|00001930| ff ff ff ff ff ff 01 30 | 01 26 00 34 00 30 00 00 |.......0|.&.4.0..|
|00001940| 01 24 00 12 00 01 00 00 | 00 00 00 00 00 00 00 00 |.$......|........|
|00001950| 00 00 00 00 00 00 00 02 | 03 34 05 60 03 7d 06 90 |........|.4.`.}..|
|00001960| 01 01 81 80 00 14 00 09 | 00 00 00 00 00 01 00 02 |........|........|
|00001970| 00 01 00 0e 54 49 4d 45 | 20 4f 46 20 49 4e 4a 55 |....TIME| OF INJU|
|00001980| 52 59 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |RY......|........|
|00001990| 00 14 00 00 00 09 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|000019a0| 00 ac 03 34 00 e4 03 7c | 04 40 00 01 00 00 00 00 |...4...||.@......|
|000019b0| 00 15 00 00 00 0c 00 00 | 00 03 00 02 00 00 00 01 |........|........|
|000019c0| 00 02 00 00 00 00 00 04 | 00 01 00 00 00 00 00 00 |........|........|
|000019d0| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 03 00 00 |........|........|
|000019e0| ff ff ff ff ff ff ff ff | 01 30 01 26 00 34 00 30 |........|.0.&.4.0|
|000019f0| 00 00 01 25 00 11 00 01 | 00 00 00 00 00 00 00 00 |...%....|........|
|00001a00| 00 00 00 00 00 00 00 00 | 00 02 03 34 00 e4 03 7d |........|...4...}|
|00001a10| 02 14 01 01 81 80 00 14 | 00 09 00 00 00 00 00 01 |........|........|
|00001a20| 00 02 00 01 00 0e 44 41 | 54 45 20 4f 46 20 49 4e |......DA|TE OF IN|
|00001a30| 4a 55 52 59 00 00 00 16 | 00 01 00 00 00 00 00 0b |JURY....|........|
|00001a40| 00 08 00 14 00 00 00 09 | 00 00 00 00 00 00 00 07 |........|........|
|00001a50| 00 00 00 72 03 94 00 e4 | 03 bf 03 64 00 01 00 00 |...r....|...d....|
|00001a60| ff ff ff ff ff ff ff ff | 00 01 00 00 00 00 00 00 |........|........|
|00001a70| 00 02 03 94 00 e4 03 bf | 03 64 00 00 00 00 00 14 |........|.d......|
|00001a80| 00 09 00 00 00 00 00 01 | 00 01 00 01 00 1d 57 41 |........|......WA|
|00001a90| 53 20 54 48 45 52 45 20 | 4c 4f 53 54 20 54 49 4d |S THERE |LOST TIM|
|00001aa0| 45 20 46 52 4f 4d 20 57 | 4f 52 4b 33 00 00 00 16 |E FROM W|ORK3....|
|00001ab0| 00 01 00 00 00 00 00 0b | 00 08 00 14 00 00 00 09 |........|........|
|00001ac0| 00 00 00 00 00 00 00 01 | 00 00 00 a2 03 78 03 74 |........|.....x.t|
|00001ad0| 03 bc 04 3c 00 01 00 00 | 00 00 00 15 00 00 00 0c |...<....|........|
|00001ae0| 00 00 00 03 00 03 00 01 | 00 01 00 04 00 00 00 00 |........|........|
|00001af0| 00 04 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001b00| 00 00 00 00 00 00 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|00001b10| ff ff 00 54 00 94 00 30 | 00 30 00 00 01 26 00 13 |...T...0|.0...&..|
|00001b20| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001b30| 00 00 00 02 03 78 03 a8 | 03 bd 04 3d 01 00 81 81 |.....x..|...=....|
|00001b40| 00 14 00 09 00 00 00 00 | 00 01 00 03 00 01 00 03 |........|........|
|00001b50| 59 45 53 00 00 00 00 16 | 00 01 00 00 00 00 00 0b |YES.....|........|
|00001b60| 00 08 00 14 00 00 00 09 | 00 00 00 00 00 00 00 01 |........|........|
|00001b70| 00 00 00 a0 03 78 04 44 | 03 c4 05 34 00 01 00 00 |.....x.D|...4....|
|00001b80| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 03 00 01 |........|........|
|00001b90| 00 01 00 04 00 00 00 00 | 00 00 00 01 00 00 00 00 |........|........|
|00001ba0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|00001bb0| 00 00 ff ff ff ff ff ff | ff ff 00 54 00 b8 00 34 |........|...T...4|
|00001bc0| 00 30 00 00 01 27 00 14 | 00 01 00 00 00 00 00 00 |.0...'..|........|
|00001bd0| 00 00 00 00 00 00 00 00 | 00 00 00 02 03 78 04 7c |........|.....x.||
|00001be0| 03 c5 05 35 01 00 81 81 | 00 14 00 09 00 00 00 00 |...5....|........|
|00001bf0| 00 01 00 03 00 01 00 02 | 4e 4f 00 00 00 16 00 01 |........|NO......|
|00001c00| 00 00 00 00 00 0b 00 08 | 00 14 00 00 00 09 00 00 |........|........|
|00001c10| 00 00 00 00 00 01 00 00 | 00 b4 03 78 05 60 03 bf |........|...x.`..|
|00001c20| 08 bc 00 01 00 00 00 00 | 00 15 00 00 00 0c 00 00 |........|........|
|00001c30| 00 03 00 02 00 00 00 01 | 00 02 00 00 00 00 00 04 |........|........|
|00001c40| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001c50| 00 00 00 03 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|00001c60| 01 ec 01 26 00 33 00 30 | 00 00 01 28 00 15 00 01 |...&.3.0|...(....|
|00001c70| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001c80| 00 02 03 78 05 60 03 c0 | 07 4c 01 01 81 80 00 14 |...x.`..|.L......|
|00001c90| 00 09 00 00 00 00 00 01 | 00 02 00 01 00 16 4e 55 |........|......NU|
|00001ca0| 4d 42 45 52 20 4f 46 20 | 48 4f 55 52 53 20 4d 49 |MBER OF |HOURS MI|
|00001cb0| 53 53 45 44 00 00 00 16 | 00 01 00 00 00 00 00 0b |SSED....|........|
|00001cc0| 00 08 00 14 00 00 00 09 | 00 00 00 00 00 00 00 01 |........|........|
|00001cd0| 00 00 00 b4 03 b4 00 e4 | 03 fc 04 2c 00 01 00 00 |........|...,....|
|00001ce0| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 02 00 00 |........|........|
|00001cf0| 00 01 00 02 00 00 00 00 | 00 04 00 01 00 00 00 00 |........|........|
|00001d00| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 03 00 03 |........|........|
|00001d10| 00 00 ff ff ff ff ff ff | ff ff 01 f4 01 26 00 34 |........|.....&.4|
|00001d20| 00 30 00 00 01 29 00 16 | 00 01 00 00 00 00 00 00 |.0...)..|........|
|00001d30| 00 00 00 00 00 00 00 00 | 00 00 00 02 03 b4 00 e4 |........|........|
|00001d40| 03 fd 02 d8 01 01 81 80 | 00 14 00 09 00 00 00 00 |........|........|
|00001d50| 00 01 00 02 00 01 00 15 | 44 41 54 45 20 52 45 54 |........|DATE RET|
|00001d60| 55 52 4e 45 44 20 54 4f | 20 57 4f 52 4b 36 00 00 |URNED TO| WORK6..|
|00001d70| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|00001d80| 00 09 00 00 00 00 00 00 | 00 01 00 00 00 c6 03 f4 |........|........|
|00001d90| 00 e4 04 3c 08 bc 00 01 | 00 00 00 00 00 15 00 00 |...<....|........|
|00001da0| 00 0c 00 00 00 03 00 02 | 00 00 00 01 00 02 00 00 |........|........|
|00001db0| 00 00 00 04 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001dc0| 00 00 00 00 00 00 00 03 | 00 03 00 00 ff ff ff ff |........|........|
|00001dd0| ff ff ff ff 03 7c 01 26 | 00 34 00 30 00 00 01 2a |.....|.&|.4.0...*|
|00001de0| 00 17 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001df0| 00 00 00 00 00 02 03 f4 | 00 e4 04 3d 04 60 01 01 |........|...=.`..|
|00001e00| 81 80 00 14 00 09 00 00 | 00 00 00 01 00 02 00 01 |........|........|
|00001e10| 00 28 41 44 44 52 45 53 | 53 2f 4c 4f 43 41 54 49 |.(ADDRES|S/LOCATI|
|00001e20| 4f 4e 20 57 48 45 52 45 | 20 49 4e 43 49 44 45 4e |ON WHERE| INCIDEN|
|00001e30| 54 20 4f 43 43 55 52 52 | 45 44 00 00 00 16 00 01 |T OCCURR|ED......|
|00001e40| 00 00 00 00 00 0b 00 08 | 00 14 00 00 00 09 00 00 |........|........|
|00001e50| 00 00 00 00 00 01 00 00 | 00 d6 04 3c 00 e4 04 84 |........|...<....|
|00001e60| 08 bc 00 01 00 00 00 00 | 00 15 00 00 00 0c 00 00 |........|........|
|00001e70| 00 03 00 02 00 00 00 01 | 00 02 00 00 00 00 00 04 |........|........|
|00001e80| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001e90| 00 00 00 03 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|00001ea0| 04 c0 01 26 00 34 00 30 | 00 00 01 2b 00 18 00 01 |...&.4.0|...+....|
|00001eb0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001ec0| 00 02 04 3c 00 e4 04 85 | 05 a4 01 01 81 80 00 14 |...<....|........|
|00001ed0| 00 09 00 00 00 00 00 01 | 00 02 00 01 00 37 57 48 |........|.....7WH|
|00001ee0| 41 54 20 57 41 53 20 54 | 48 45 20 45 4d 50 4c 4f |AT WAS T|HE EMPLO|
|00001ef0| 59 45 45 20 44 4f 49 4e | 47 20 57 48 45 4e 20 54 |YEE DOIN|G WHEN T|
|00001f00| 48 45 20 49 4e 43 49 44 | 45 4e 54 20 4f 43 43 55 |HE INCID|ENT OCCU|
|00001f10| 52 52 45 44 3f 14 00 00 | 00 16 00 01 00 00 00 00 |RRED?...|........|
|00001f20| 00 0b 00 08 00 14 00 00 | 00 09 00 00 00 00 00 00 |........|........|
|00001f30| 00 07 00 00 00 ba 04 98 | 00 e4 04 c0 08 00 00 01 |........|........|
|00001f40| 00 00 ff ff ff ff ff ff | ff ff 00 01 00 00 00 00 |........|........|
|00001f50| 00 00 00 02 04 98 00 e4 | 04 c0 08 00 00 00 00 00 |........|........|
|00001f60| 00 14 00 09 00 00 00 00 | 00 01 00 01 00 01 00 65 |........|.......e|
|00001f70| 44 45 53 43 52 49 42 45 | 20 54 48 45 20 45 56 45 |DESCRIBE| THE EVE|
|00001f80| 4e 54 53 20 54 48 41 54 | 20 4f 43 43 55 52 52 45 |NTS THAT| OCCURRE|
|00001f90| 44 20 44 55 52 49 4e 47 | 20 54 48 45 20 49 4e 43 |D DURING| THE INC|
|00001fa0| 49 44 45 4e 54 20 28 61 | 74 74 61 63 68 20 61 64 |IDENT (a|ttach ad|
|00001fb0| 64 69 74 69 6f 6e 61 6c | 20 64 6f 63 75 6d 65 6e |ditional| documen|
|00001fc0| 74 61 74 69 6f 6e 20 69 | 66 20 6e 65 63 65 73 73 |tation i|f necess|
|00001fd0| 61 72 79 29 3a 00 00 00 | 00 16 00 01 00 00 00 00 |ary):...|........|
|00001fe0| 00 0b 00 08 00 14 00 00 | 00 09 00 00 00 00 00 00 |........|........|
|00001ff0| 00 01 00 00 00 a4 04 c8 | 00 ec 05 70 08 bc 00 01 |........|...p....|
|00002000| 00 00 00 00 00 15 00 00 | 00 0c 00 00 00 01 00 01 |........|........|
|00002010| 00 00 00 00 00 02 00 00 | 00 00 00 04 00 01 00 00 |........|........|
|00002020| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|00002030| 00 03 00 00 ff ff ff ff | ff ff ff ff 01 f4 01 26 |........|.......&|
|00002040| 00 34 00 30 00 00 01 2c | 00 19 00 01 00 00 00 00 |.4.0...,|........|
|00002050| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 00 00 |........|........|
|00002060| 00 00 00 00 00 32 01 01 | 81 80 00 14 00 09 00 00 |.....2..|........|
|00002070| 00 00 00 01 00 02 00 02 | 00 05 46 69 65 6c 64 36 |........|..Field6|
|00002080| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|00002090| 00 00 00 09 00 00 00 00 | 00 00 00 01 00 00 00 d4 |........|........|
|000020a0| 05 70 00 e4 05 b8 08 bc | 00 01 00 00 00 00 00 15 |.p......|........|
|000020b0| 00 00 00 0c 00 00 00 03 | 00 02 00 00 00 01 00 02 |........|........|
|000020c0| 00 00 00 00 00 04 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|000020d0| 00 00 00 00 00 00 00 00 | 00 03 00 03 00 00 ff ff |........|........|
|000020e0| ff ff ff ff ff ff 03 5c | 01 26 00 34 00 30 00 00 |.......\|.&.4.0..|
|000020f0| 01 2d 00 1a 00 01 00 00 | 00 00 00 00 00 00 00 00 |.-......|........|
|00002100| 00 00 00 00 00 00 00 02 | 05 70 00 e4 05 b9 04 40 |........|.p.....@|
|00002110| 01 01 81 80 00 14 00 09 | 00 00 00 00 00 01 00 02 |........|........|
|00002120| 00 01 00 35 54 59 50 45 | 20 4f 46 20 49 4e 4a 55 |...5TYPE| OF INJU|
|00002130| 52 59 2f 49 4c 4c 4e 45 | 53 53 20 28 73 63 72 61 |RY/ILLNE|SS (scra|
|00002140| 74 63 68 2c 20 70 75 6e | 63 74 75 72 65 2c 20 63 |tch, pun|cture, c|
|00002150| 75 74 2c 20 65 74 63 2e | 29 08 00 00 00 16 00 01 |ut, etc.|).......|
|00002160| 00 00 00 00 00 0b 00 08 | 00 14 00 00 00 09 00 00 |........|........|
|00002170| 00 00 00 00 00 01 00 00 | 00 e2 05 b8 00 e4 06 00 |........|........|
|00002180| 08 bc 00 01 00 00 00 00 | 00 15 00 00 00 0c 00 00 |........|........|
|00002190| 00 03 00 02 00 00 00 01 | 00 02 00 00 00 00 00 04 |........|........|
|000021a0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000021b0| 00 00 00 03 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|000021c0| 04 54 01 26 00 34 00 30 | 00 00 01 2e 00 1b 00 01 |.T.&.4.0|........|
|000021d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000021e0| 00 02 05 b8 00 e4 06 01 | 05 38 01 01 81 80 00 14 |........|.8......|
|000021f0| 00 09 00 00 00 00 00 01 | 00 02 00 01 00 43 50 41 |........|.....CPA|
|00002200| 52 54 20 4f 46 20 42 4f | 44 59 20 49 4e 4a 55 52 |RT OF BO|DY INJUR|
|00002210| 45 44 2f 41 46 46 45 43 | 54 45 44 20 28 6c 65 66 |ED/AFFEC|TED (lef|
|00002220| 74 20 72 69 6e 67 20 66 | 69 6e 67 65 72 2c 20 72 |t ring f|inger, r|
|00002230| 69 67 68 74 20 61 6e 6b | 6c 65 2c 20 65 74 63 2e |ight ank|le, etc.|
|00002240| 29 94 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |).......|........|
|00002250| 00 14 00 00 00 09 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|00002260| 00 e6 06 00 00 e4 06 48 | 08 bc 00 01 00 00 00 00 |.......H|........|
|00002270| 00 15 00 00 00 0c 00 00 | 00 03 00 02 00 00 00 01 |........|........|
|00002280| 00 02 00 00 00 00 00 04 | 00 01 00 00 00 00 00 00 |........|........|
|00002290| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 03 00 00 |........|........|
|000022a0| ff ff ff ff ff ff ff ff | 05 c8 01 26 00 34 00 30 |........|...&.4.0|
|000022b0| 00 00 01 2f 00 1c 00 01 | 00 00 00 00 00 00 00 00 |.../....|........|
|000022c0| 00 00 00 00 00 00 00 00 | 00 02 06 00 00 e4 06 49 |........|.......I|
|000022d0| 06 ac 01 01 81 80 00 14 | 00 09 00 00 00 00 00 01 |........|........|
|000022e0| 00 02 00 01 00 47 53 50 | 45 43 49 46 59 20 50 49 |.....GSP|ECIFY PI|
|000022f0| 45 43 45 20 4f 46 20 45 | 51 55 49 50 4d 45 4e 54 |ECE OF E|QUIPMENT|
|00002300| 2c 20 53 55 42 53 54 41 | 4e 43 45 20 4f 52 20 4f |, SUBSTA|NCE OR O|
|00002310| 42 4a 45 43 54 20 43 4f | 4e 4e 45 43 54 45 44 20 |BJECT CO|NNECTED |
|00002320| 57 49 54 48 20 49 4e 43 | 49 44 45 4e 54 2c 00 00 |WITH INC|IDENT,..|
|00002330| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|00002340| 00 09 00 00 00 00 00 00 | 00 01 00 00 00 ae 06 90 |........|........|
|00002350| 00 e4 06 d8 08 bc 00 01 | 00 00 00 00 00 15 00 00 |........|........|
|00002360| 00 0c 00 00 00 03 00 02 | 00 00 00 01 00 02 00 00 |........|........|
|00002370| 00 00 00 04 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002380| 00 00 00 00 00 00 00 03 | 00 03 00 00 ff ff ff ff |........|........|
|00002390| ff ff ff ff 01 54 01 26 | 00 34 00 30 00 00 01 31 |.....T.&|.4.0...1|
|000023a0| 00 1f 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000023b0| 00 00 00 00 00 02 06 90 | 00 e4 06 d9 02 38 01 01 |........|.....8..|
|000023c0| 81 80 00 14 00 09 00 00 | 00 00 00 01 00 02 00 01 |........|........|
|000023d0| 00 10 4c 49 53 54 20 41 | 4e 59 20 57 49 54 4e 45 |..LIST A|NY WITNE|
|000023e0| 53 53 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |SS......|........|
|000023f0| 00 14 00 00 00 09 00 00 | 00 00 00 00 00 0d 00 00 |........|........|
|00002400| 00 88 07 24 00 b0 08 74 | 09 20 00 00 00 02 00 02 |...$...t|. ......|
|00002410| 00 02 00 02 00 02 00 03 | 00 00 00 34 07 3c 00 b0 |........|...4.<..|
|00002420| 08 74 09 0c 00 01 00 00 | 00 03 00 00 ff ff ff ff |.t......|........|
|00002430| ff ff ff ff 00 00 aa 55 | aa 55 aa 55 aa 55 00 01 |.......U|.U.U.U..|
|00002440| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002450| 00 03 00 00 00 34 07 24 | 00 c4 08 5c 09 20 00 01 |.....4.$|...\. ..|
|00002460| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 00 00 |........|........|
|00002470| 00 00 00 00 00 00 00 00 | 00 01 00 00 00 00 00 00 |........|........|
|00002480| 00 00 00 00 00 00 00 00 | 00 00 00 07 00 00 00 68 |........|.......h|
|00002490| 07 44 00 e4 07 6f 02 e8 | 00 01 00 00 ff ff ff ff |.D...o..|........|
|000024a0| ff ff ff ff 00 01 00 00 | 00 00 00 00 00 02 07 44 |........|.......D|
|000024b0| 00 e4 07 6f 02 e8 00 00 | 00 00 00 14 00 09 00 00 |...o....|........|
|000024c0| 00 00 00 01 00 01 00 01 | 00 14 57 41 53 20 46 49 |........|..WAS FI|
|000024d0| 52 53 54 20 41 49 44 20 | 47 49 56 45 4e 3f 00 00 |RST AID |GIVEN?..|
|000024e0| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|000024f0| 00 09 00 00 00 00 00 00 | 00 01 00 00 00 a2 07 28 |........|.......(|
|00002500| 02 b4 07 74 03 38 00 01 | 00 00 00 00 00 15 00 00 |...t.8..|........|
|00002510| 00 0c 00 00 00 03 00 03 | 00 01 00 01 00 04 00 00 |........|........|
|00002520| 00 00 00 04 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002530| 00 00 00 00 00 00 00 00 | 00 03 00 00 ff ff ff ff |........|........|
|00002540| ff ff ff ff 00 54 00 58 | 00 34 00 30 00 00 01 32 |.....T.X|.4.0...2|
|00002550| 00 20 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |. ......|........|
|00002560| 00 00 00 00 00 02 07 28 | 02 e0 07 75 03 39 01 00 |.......(|...u.9..|
|00002570| 81 81 00 14 00 09 00 00 | 00 00 00 01 00 03 00 01 |........|........|
|00002580| 00 03 59 45 53 00 00 00 | 00 16 00 01 00 00 00 00 |..YES...|........|
|00002590| 00 0b 00 08 00 14 00 00 | 00 09 00 00 00 00 00 00 |........|........|
|000025a0| 00 01 00 00 00 a0 07 2c | 03 8c 07 78 04 7c 00 01 |.......,|...x.|..|
|000025b0| 00 00 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 03 |........|........|
|000025c0| 00 01 00 01 00 04 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|000025d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000025e0| 00 03 00 00 ff ff ff ff | ff ff ff ff 00 54 00 c0 |........|.....T..|
|000025f0| 00 34 00 30 00 00 01 33 | 00 21 00 01 00 00 00 00 |.4.0...3|.!......|
|00002600| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 07 2c |........|.......,|
|00002610| 03 bc 07 79 04 7d 01 00 | 81 81 00 14 00 09 00 00 |...y.}..|........|
|00002620| 00 00 00 01 00 03 00 01 | 00 02 4e 4f 00 00 00 16 |........|..NO....|
|00002630| 00 01 00 00 00 00 00 0b | 00 08 00 14 00 00 00 09 |........|........|
|00002640| 00 00 00 00 00 00 00 07 | 00 00 00 70 07 44 05 20 |........|...p.D. |
|00002650| 07 6f 07 70 00 01 00 00 | ff ff ff ff ff ff ff ff |.o.p....|........|
|00002660| 00 01 00 00 00 00 00 00 | 00 02 07 44 05 20 07 6f |........|...D. .o|
|00002670| 07 70 00 00 00 00 00 14 | 00 09 00 00 00 00 00 01 |.p......|........|
|00002680| 00 01 00 01 00 1c 52 45 | 46 45 52 52 45 44 20 54 |......RE|FERRED T|
|00002690| 4f 20 43 4c 49 4e 49 43 | 20 4f 52 20 44 4f 43 54 |O CLINIC| OR DOCT|
|000026a0| 4f 52 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |OR......|........|
|000026b0| 00 14 00 00 00 09 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|000026c0| 00 a2 07 30 07 80 07 70 | 08 0c 00 01 00 00 00 00 |...0...p|........|
|000026d0| 00 15 00 00 00 0c 00 00 | 00 03 00 03 00 01 00 01 |........|........|
|000026e0| 00 04 00 00 00 00 00 04 | 00 00 00 00 00 00 00 00 |........|........|
|000026f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 03 00 00 |........|........|
|00002700| ff ff ff ff ff ff ff ff | 00 54 00 58 00 2c 00 2c |........|.T.X.,.,|
|00002710| 00 00 01 34 00 22 00 01 | 00 00 00 00 00 00 00 00 |...4."..|........|
|00002720| 00 00 00 00 00 00 00 00 | 00 02 07 30 07 b4 07 71 |........|...0...q|
|00002730| 08 0d 01 00 81 81 00 14 | 00 09 00 00 00 00 00 01 |........|........|
|00002740| 00 03 00 01 00 03 59 45 | 53 00 00 00 00 16 00 01 |......YE|S.......|
|00002750| 00 00 00 00 00 0b 00 08 | 00 14 00 00 00 09 00 00 |........|........|
|00002760| 00 00 00 00 00 01 00 00 | 00 a0 07 2c 08 1c 07 78 |........|...,...x|
|00002770| 09 0c 00 01 00 00 00 00 | 00 15 00 00 00 0c 00 00 |........|........|
|00002780| 00 03 00 03 00 01 00 01 | 00 04 00 00 00 00 00 00 |........|........|
|00002790| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000027a0| 00 00 00 00 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|000027b0| 00 54 00 c0 00 34 00 30 | 00 00 01 35 00 23 00 01 |.T...4.0|...5.#..|
|000027c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000027d0| 00 02 07 2c 08 4c 07 79 | 09 0d 01 00 81 81 00 14 |...,.L.y|........|
|000027e0| 00 09 00 00 00 00 00 01 | 00 03 00 01 00 02 4e 4f |........|......NO|
|000027f0| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|00002800| 00 00 00 09 00 00 00 00 | 00 00 00 07 00 00 00 74 |........|.......t|
|00002810| 07 88 00 e4 07 b3 03 58 | 00 01 00 00 ff ff ff ff |.......X|........|
|00002820| ff ff ff ff 00 01 00 00 | 00 00 00 00 00 02 07 88 |........|........|
|00002830| 00 e4 07 b3 03 58 00 00 | 00 00 00 14 00 09 00 00 |.....X..|........|
|00002840| 00 00 00 01 00 01 00 01 | 00 1f 4e 41 4d 45 20 4f |........|..NAME O|
|00002850| 46 20 43 4c 49 4e 49 43 | 20 41 4e 44 20 2f 20 4f |F CLINIC| AND / O|
|00002860| 52 20 44 4f 43 54 4f 52 | 3a c8 00 00 00 16 00 01 |R DOCTOR|:.......|
|00002870| 00 00 00 00 00 0b 00 08 | 00 14 00 00 00 09 00 00 |........|........|
|00002880| 00 00 00 00 00 01 00 00 | 00 a4 07 c4 00 ec 08 30 |........|.......0|
|00002890| 08 bc 00 01 00 00 00 00 | 00 15 00 00 00 0c 00 00 |........|........|
|000028a0| 00 01 00 01 00 00 00 00 | 00 02 00 00 00 00 00 04 |........|........|
|000028b0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000028c0| 00 00 00 03 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|000028d0| 01 f4 01 26 00 34 00 30 | 00 00 01 36 00 24 00 01 |...&.4.0|...6.$..|
|000028e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000028f0| 00 02 00 00 00 00 00 00 | 00 32 01 01 81 80 00 14 |........|.2......|
|00002900| 00 09 00 00 00 00 00 01 | 00 02 00 02 00 05 46 69 |........|......Fi|
|00002910| 65 6c 64 36 00 00 00 16 | 00 01 00 00 00 00 00 0b |eld6....|........|
|00002920| 00 08 00 14 00 00 00 09 | 00 00 00 00 00 00 00 0d |........|........|
|00002930| 00 00 00 88 08 88 00 b0 | 09 d8 09 20 00 00 00 02 |........|... ....|
|00002940| 00 02 00 02 00 02 00 02 | 00 03 00 00 00 34 08 a0 |........|.....4..|
|00002950| 00 b0 09 d8 09 0b 00 01 | 00 00 00 03 00 00 ff ff |........|........|
|00002960| ff ff ff ff ff ff 00 00 | aa 55 aa 55 aa 55 aa 55 |........|.U.U.U.U|
|00002970| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002980| 00 00 00 03 00 00 00 34 | 08 88 00 c3 09 c0 09 20 |.......4|....... |
|00002990| 00 01 00 00 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|000029a0| 00 00 00 00 00 00 00 00 | 00 00 00 01 00 00 00 00 |........|........|
|000029b0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 07 00 00 |........|........|
|000029c0| 00 90 08 a4 00 e4 08 cf | 06 00 00 01 00 00 ff ff |........|........|
|000029d0| ff ff ff ff ff ff 00 01 | 00 00 00 00 00 00 00 02 |........|........|
|000029e0| 08 a4 00 e4 08 cf 06 00 | 00 00 00 00 00 14 00 09 |........|........|
|000029f0| 00 00 00 00 00 01 00 01 | 00 01 00 3b 48 41 53 20 |........|...;HAS |
|00002a00| 54 48 49 53 20 49 4e 43 | 49 44 45 4e 54 20 42 45 |THIS INC|IDENT BE|
|00002a10| 45 4e 20 44 49 53 43 55 | 53 53 45 44 20 57 49 54 |EN DISCU|SSED WIT|
|00002a20| 48 20 54 48 45 20 45 4d | 50 4c 4f 59 45 45 20 49 |H THE EM|PLOYEE I|
|00002a30| 4e 56 4f 4c 56 45 44 09 | 00 00 00 16 00 01 00 00 |NVOLVED.|........|
|00002a40| 00 00 00 0b 00 08 00 14 | 00 00 00 09 00 00 00 00 |........|........|
|00002a50| 00 00 00 01 00 00 00 a2 | 08 94 05 d4 08 dc 06 90 |........|........|
|00002a60| 00 01 00 00 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00002a70| 00 03 00 01 00 01 00 04 | 00 00 00 00 00 00 00 01 |........|........|
|00002a80| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002a90| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 00 54 |........|.......T|
|00002aa0| 00 8c 00 34 00 30 00 00 | 01 37 00 25 00 01 00 00 |...4.0..|.7.%....|
|00002ab0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|00002ac0| 08 94 06 04 08 dd 06 91 | 01 00 81 81 00 14 00 09 |........|........|
|00002ad0| 00 00 00 00 00 01 00 03 | 00 01 00 03 59 45 53 00 |........|....YES.|
|00002ae0| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|00002af0| 00 00 00 09 00 00 00 00 | 00 00 00 01 00 00 00 a0 |........|........|
|00002b00| 08 90 06 a4 08 dc 07 94 | 00 01 00 00 00 00 00 15 |........|........|
|00002b10| 00 00 00 0c 00 00 00 03 | 00 03 00 01 00 01 00 04 |........|........|
|00002b20| 00 00 00 00 00 00 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|00002b30| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 ff ff |........|........|
|00002b40| ff ff ff ff ff ff 00 54 | 00 c0 00 34 00 30 00 00 |.......T|...4.0..|
|00002b50| 01 38 00 26 00 01 00 00 | 00 00 00 00 00 00 00 00 |.8.&....|........|
|00002b60| 00 00 00 00 00 00 00 02 | 08 90 06 d4 08 dd 07 95 |........|........|
|00002b70| 01 00 81 81 00 14 00 09 | 00 00 00 00 00 01 00 03 |........|........|
|00002b80| 00 01 00 02 4e 4f 00 00 | 00 16 00 01 00 00 00 00 |....NO..|........|
|00002b90| 00 0b 00 08 00 14 00 00 | 00 09 00 00 00 00 00 00 |........|........|
|00002ba0| 00 07 00 00 00 a0 08 e0 | 00 e4 09 0b 07 60 00 01 |........|.....`..|
|00002bb0| 00 00 ff ff ff ff ff ff | ff ff 00 01 00 00 00 00 |........|........|
|00002bc0| 00 00 00 02 08 e0 00 e4 | 09 0b 07 60 00 00 00 00 |........|...`....|
|00002bd0| 00 14 00 09 00 00 00 00 | 00 01 00 01 00 01 00 4c |........|.......L|
|00002be0| 57 48 41 54 20 53 50 45 | 43 49 46 49 43 20 41 43 |WHAT SPE|CIFIC AC|
|00002bf0| 54 49 4f 4e 53 20 48 41 | 56 45 20 59 4f 55 20 54 |TIONS HA|VE YOU T|
|00002c00| 41 4b 45 4e 20 54 4f 20 | 50 52 45 56 45 4e 54 20 |AKEN TO |PREVENT |
|00002c10| 54 48 49 53 20 49 4e 43 | 49 44 45 4e 54 20 46 52 |THIS INC|IDENT FR|
|00002c20| 4f 4d 20 52 45 43 55 52 | 52 49 4e 47 00 00 00 16 |OM RECUR|RING....|
|00002c30| 00 01 00 00 00 00 00 0b | 00 08 00 14 00 00 00 09 |........|........|
|00002c40| 00 00 00 00 00 00 00 01 | 00 00 00 a4 09 10 00 ec |........|........|
|00002c50| 09 b4 08 bc 00 01 00 00 | 00 00 00 15 00 00 00 0c |........|........|
|00002c60| 00 00 00 01 00 01 00 00 | 00 00 00 02 00 00 00 00 |........|........|
|00002c70| 00 04 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002c80| 00 00 00 00 00 03 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|00002c90| ff ff 01 f4 01 26 00 34 | 00 30 00 00 01 39 00 27 |.....&.4|.0...9.'|
|00002ca0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002cb0| 00 00 00 02 00 00 00 00 | 00 00 00 32 01 01 81 80 |........|...2....|
|00002cc0| 00 14 00 09 00 00 00 00 | 00 01 00 02 00 02 00 05 |........|........|
|00002cd0| 46 69 65 6c 64 36 00 00 | 00 16 00 01 00 00 00 00 |Field6..|........|
|00002ce0| 00 0b 00 08 00 14 00 00 | 00 09 00 00 00 00 00 00 |........|........|
|00002cf0| 00 01 00 00 00 b2 0b 3c | 00 b0 0b 84 05 f8 00 01 |.......<|........|
|00002d00| 00 00 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 02 |........|........|
|00002d10| 00 2a 00 01 00 02 00 00 | 00 00 00 04 00 01 00 00 |.*......|........|
|00002d20| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|00002d30| 00 03 00 00 ff ff ff ff | ff ff ff ff 01 f0 01 26 |........|.......&|
|00002d40| 00 34 00 30 00 00 01 3a | 00 00 00 00 00 00 00 00 |.4.0...:|........|
|00002d50| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 0b 3c |........|.......<|
|00002d60| 00 b0 0b 85 02 a0 01 01 | 81 80 00 14 00 0a 00 00 |........|........|
|00002d70| 00 00 00 01 00 02 00 01 | 00 14 53 55 50 45 52 56 |........|..SUPERV|
|00002d80| 49 53 4f 52 20 53 49 47 | 4e 41 54 55 52 45 00 00 |ISOR SIG|NATURE..|
|00002d90| 00 16 00 01 00 00 00 00 | 00 0c 00 09 00 14 00 00 |........|........|
|00002da0| 00 0a 00 00 00 00 00 00 | 00 01 00 00 00 aa 0b 3c |........|.......<|
|00002db0| 06 38 0b 84 09 20 00 01 | 00 00 00 00 00 15 00 00 |.8... ..|........|
|00002dc0| 00 0c 00 00 00 03 00 02 | 00 00 00 01 00 02 00 00 |........|........|
|00002dd0| 00 00 00 04 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002de0| 00 00 00 00 00 00 00 03 | 00 03 00 00 ff ff ff ff |........|........|
|00002df0| ff ff ff ff 01 2e 01 26 | 00 34 00 24 00 00 01 3b |.......&|.4.$...;|
|00002e00| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002e10| 00 00 00 00 00 02 0b 3c | 06 38 0b 85 07 66 01 01 |.......<|.8...f..|
|00002e20| 81 80 00 14 00 0a 00 00 | 00 00 00 01 00 02 00 01 |........|........|
|00002e30| 00 0b 44 41 54 45 20 53 | 49 47 4e 45 44 7c 00 00 |..DATE S|IGNED|..|
|00002e40| 00 16 00 01 00 00 00 00 | 00 0c 00 09 00 14 00 00 |........|........|
|00002e50| 00 0a 00 00 00 00 00 00 | 00 06 00 00 01 ae 07 00 |........|........|
|00002e60| 00 70 08 44 00 a8 00 01 | 00 00 07 00 00 70 08 44 |.p.D....|.....p.D|
|00002e70| 00 a8 00 30 00 28 01 74 | 00 60 00 00 00 00 01 7b |...0.(.t|.`.....{|
|00002e80| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002e90| 01 7b ff ff ff ff 00 50 | 00 0d 11 01 a0 00 82 a1 |.{.....P|........|
|00002ea0| 00 96 00 0c 01 00 01 0e | 02 00 01 0e 00 00 00 00 |........|........|
|00002eb0| a1 00 9a 00 08 ff fd 00 | 00 00 27 00 00 03 00 14 |........|..'.....|
|00002ec0| 04 01 0d 00 0a 28 00 2b | ff e0 09 54 52 45 41 54 |.....(.+|...TREAT|
|00002ed0| 4d 45 4e 54 01 00 0a 00 | 00 00 00 00 4f 00 0c 90 |MENT....|....O...|
|00002ee0| 00 04 00 00 00 00 00 42 | 00 20 00 00 00 00 00 42 |.......B|. .....B|
|00002ef0| 00 20 00 0d 00 00 00 4f | 00 20 00 01 00 00 00 00 |. .....O|. ......|
|00002f00| 00 00 00 00 18 00 00 00 | 18 40 00 00 1f c0 00 00 |........|.@......|
|00002f10| 1f c0 00 00 18 40 00 00 | 18 00 00 00 1f c0 00 00 |.....@..|........|
|00002f20| 1f c0 00 00 13 00 00 00 | 06 40 00 00 1f c0 00 00 |........|.@......|
|00002f30| 1f c0 00 00 10 40 00 00 | 00 00 00 00 18 c0 00 00 |.....@..|........|
|00002f40| 1a c0 00 00 12 40 00 00 | 1f c0 00 00 1f c0 00 00 |.....@..|........|
|00002f50| 10 40 00 00 10 40 00 00 | 1f c0 00 00 1f c0 00 00 |.@...@..|........|
|00002f60| 1e 40 00 00 07 80 00 00 | 07 80 00 00 1e 40 00 00 |.@......|.....@..|
|00002f70| 1f c0 00 00 1f c0 00 00 | 10 40 00 00 18 00 00 00 |........|.@......|
|00002f80| 18 40 00 00 1f c0 00 00 | 1f c0 00 00 18 40 00 00 |.@......|.....@..|
|00002f90| 18 40 00 00 01 c0 00 00 | 07 c0 00 00 1f 40 00 00 |.@......|.....@..|
|00002fa0| 1f 40 00 00 07 c0 00 00 | 01 c0 00 00 00 40 00 00 |.@......|.....@..|
|00002fb0| 00 00 00 00 18 c0 00 00 | 1a c0 00 00 12 40 00 00 |........|.....@..|
|00002fc0| 1f c0 00 00 1f c0 00 00 | 10 40 00 00 0c 40 00 00 |........|.@...@..|
|00002fd0| 1e c0 00 00 13 c0 00 00 | 13 40 00 00 1f c0 00 00 |........|.@......|
|00002fe0| 1f c0 00 00 10 40 00 00 | 00 00 00 00 18 00 00 00 |.....@..|........|
|00002ff0| 18 40 00 00 1f c0 00 00 | 1f c0 00 00 18 40 00 00 |.@......|.....@..|
|00003000| 18 00 00 00 a0 00 97 a0 | 00 83 ff 07 00 06 00 00 |........|........|
|00003010| 01 b6 08 6c 00 70 09 b8 | 00 a8 00 01 00 00 08 6c |...l.p..|.......l|
|00003020| 00 70 09 b8 00 a8 00 30 | 00 28 01 7c 00 60 00 00 |.p.....0|.(.|.`..|
|00003030| 00 00 01 84 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003040| 00 00 00 00 01 84 ff ff | ff ff 00 52 00 0d 11 01 |........|...R....|
|00003050| a0 00 82 a1 00 96 00 0c | 01 00 01 0e 02 00 01 0e |........|........|
|00003060| 00 00 00 00 a1 00 9a 00 | 08 ff fc 00 00 00 27 00 |........|......'.|
|00003070| 00 03 00 14 04 01 0d 00 | 0a 28 00 2c ff df 0a 50 |........|.(.,...P|
|00003080| 52 45 56 45 4e 54 49 4f | 4e 01 00 0a 00 00 00 00 |REVENTIO|N.......|
|00003090| 00 51 00 0c 90 00 04 00 | 00 00 00 00 44 00 20 00 |.Q......|....D. .|
|000030a0| 00 00 00 00 44 00 20 00 | 0d 00 00 00 51 00 20 00 |....D. .|....Q. .|
|000030b0| 01 00 00 00 00 10 00 00 | 00 1f c0 00 00 1f c0 00 |........|........|
|000030c0| 00 13 00 00 00 06 40 00 | 00 1f c0 00 00 1f c0 00 |......@.|........|
|000030d0| 00 10 40 00 00 07 00 00 | 00 0f 80 00 00 18 c0 00 |..@.....|........|
|000030e0| 00 10 40 00 00 18 c0 00 | 00 0f 80 00 00 07 00 00 |..@.....|........|
|000030f0| 00 10 40 00 00 1f c0 00 | 00 1f c0 00 00 10 40 00 |..@.....|......@.|
|00003100| 00 00 00 00 00 18 00 00 | 00 18 40 00 00 1f c0 00 |........|..@.....|
|00003110| 00 1f c0 00 00 18 40 00 | 00 18 00 00 00 1f c0 00 |......@.|........|
|00003120| 00 1f c0 00 00 13 00 00 | 00 06 40 00 00 1f c0 00 |........|..@.....|
|00003130| 00 1f c0 00 00 10 40 00 | 00 00 00 00 00 18 c0 00 |......@.|........|
|00003140| 00 1a c0 00 00 12 40 00 | 00 1f c0 00 00 1f c0 00 |......@.|........|
|00003150| 00 10 40 00 00 1c 00 00 | 00 1f 00 00 00 13 c0 00 |..@.....|........|
|00003160| 00 13 c0 00 00 1f 00 00 | 00 1c 00 00 00 10 00 00 |........|........|
|00003170| 00 00 00 00 00 18 c0 00 | 00 1a c0 00 00 12 40 00 |........|......@.|
|00003180| 00 1f c0 00 00 1f c0 00 | 00 10 40 00 00 0c 40 00 |........|..@...@.|
|00003190| 00 1e c0 00 00 13 c0 00 | 00 13 40 00 00 1f c0 00 |........|..@.....|
|000031a0| 00 1f c0 00 00 10 40 00 | 00 0c 00 00 00 1e 00 00 |......@.|........|
|000031b0| 00 12 40 00 00 1f c0 00 | 00 1f c0 00 00 10 40 00 |..@.....|......@.|
|000031c0| 00 a0 00 97 a0 00 83 ff | 00 07 00 00 00 72 06 64 |........|.....r.d|
|000031d0| 00 e4 06 8f 03 34 00 01 | 00 00 ff ff ff ff ff ff |.....4..|........|
|000031e0| ff ff 00 01 00 00 00 00 | 00 00 00 02 06 64 00 e4 |........|.....d..|
|000031f0| 06 8f 03 34 00 00 00 00 | 00 14 00 09 00 00 00 00 |...4....|........|
|00003200| 00 01 00 01 00 01 00 1d | 44 49 44 20 59 4f 55 20 |........|DID YOU |
|00003210| 57 49 54 4e 45 53 53 20 | 54 48 49 53 20 49 4e 43 |WITNESS |THIS INC|
|00003220| 49 44 45 4e 54 33 00 00 | 00 16 00 01 00 00 00 00 |IDENT3..|........|
|00003230| 00 0b 00 08 00 14 00 00 | 00 09 00 00 00 00 00 00 |........|........|
|00003240| 00 01 00 00 00 a2 06 50 | 03 44 06 98 03 dc 00 01 |.......P|.D......|
|00003250| 00 00 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 03 |........|........|
|00003260| 00 01 00 01 00 04 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|00003270| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003280| 00 03 00 00 ff ff ff ff | ff ff ff ff 00 54 00 68 |........|.....T.h|
|00003290| 00 34 00 30 00 00 01 3c | 00 1d 00 01 00 00 00 00 |.4.0...<|........|
|000032a0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 06 50 |........|.......P|
|000032b0| 03 74 06 99 03 dd 01 00 | 81 81 00 14 00 09 00 00 |.t......|........|
|000032c0| 00 00 00 01 00 03 00 01 | 00 03 59 45 53 00 00 00 |........|..YES...|
|000032d0| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|000032e0| 00 09 00 00 00 00 00 00 | 00 01 00 00 00 a0 06 4c |........|.......L|
|000032f0| 03 f0 06 98 04 e0 00 01 | 00 00 00 00 00 15 00 00 |........|........|
|00003300| 00 0c 00 00 00 03 00 03 | 00 01 00 01 00 04 00 00 |........|........|
|00003310| 00 00 00 00 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003320| 00 00 00 00 00 00 00 00 | 00 03 00 00 ff ff ff ff |........|........|
|00003330| ff ff ff ff 00 54 00 c0 | 00 34 00 30 00 00 01 3d |.....T..|.4.0...=|
|00003340| 00 1e 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003350| 00 00 00 00 00 02 06 4c | 04 20 06 99 04 e1 01 00 |.......L|. ......|
|00003360| 81 81 00 14 00 09 00 00 | 00 00 00 01 00 03 00 01 |........|........|
|00003370| 00 02 4e 4f 00 00 00 16 | 00 01 00 00 00 00 00 0b |..NO....|........|
|00003380| 00 08 00 14 00 00 00 09 | 00 00 00 00 00 00 00 01 |........|........|
|00003390| 00 00 00 ae 0a e8 00 b0 | 0b 30 05 f8 00 01 00 00 |........|.0......|
|000033a0| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 02 00 2a |........|.......*|
|000033b0| 00 01 00 02 00 00 00 00 | 00 04 00 01 00 00 00 00 |........|........|
|000033c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 03 00 03 |........|........|
|000033d0| 00 00 ff ff ff ff ff ff | ff ff 01 84 01 26 00 34 |........|.....&.4|
|000033e0| 00 30 00 00 01 3e 00 2c | 00 01 00 00 00 00 00 00 |.0...>.,|........|
|000033f0| 00 00 00 00 00 00 00 00 | 00 00 00 02 0a e8 00 b0 |........|........|
|00003400| 0b 31 02 34 01 01 81 80 | 00 14 00 0a 00 00 00 00 |.1.4....|........|
|00003410| 00 01 00 02 00 01 00 0f | 53 55 50 45 52 56 49 53 |........|SUPERVIS|
|00003420| 4f 52 20 4e 41 4d 45 64 | 00 00 00 16 00 01 00 00 |OR NAMEd|........|
|00003430| 00 00 00 0c 00 09 00 14 | 00 00 00 0a 00 00 00 00 |........|........|
|00003440| 00 00 00 01 00 00 00 aa | 0a e8 06 38 0b 30 09 20 |........|...8.0. |
|00003450| 00 01 00 00 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00003460| 00 02 00 01 00 01 00 02 | 00 00 00 00 00 04 00 01 |........|........|
|00003470| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003480| 00 03 00 03 00 00 ff ff | ff ff ff ff ff ff 01 24 |........|.......$|
|00003490| 01 26 00 34 00 24 00 00 | 01 3f 00 2d 00 01 00 00 |.&.4.$..|.?.-....|
|000034a0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|000034b0| 0a e8 06 38 0b 31 07 5c | 01 01 81 80 00 14 00 0a |...8.1.\|........|
|000034c0| 00 00 00 00 00 01 00 02 | 00 01 00 0b 20 57 4f 52 |........|.... WOR|
|000034d0| 4b 20 50 48 4f 4e 45 b8 | 00 00 00 16 00 01 00 00 |K PHONE.|........|
|000034e0| 00 00 00 0c 00 09 00 14 | 00 00 00 0a 00 00 00 00 |........|........|
|000034f0| 00 00 00 06 00 00 01 98 | 09 ec 00 70 0a e8 00 a8 |........|...p....|
|00003500| 00 01 00 00 09 ec 00 70 | 0a e8 00 a8 00 30 00 28 |.......p|.....0.(|
|00003510| 01 2c 00 60 00 00 00 00 | 01 66 00 00 00 00 00 00 |.,.`....|.f......|
|00003520| 00 00 00 00 00 00 00 00 | 00 00 01 66 ff ff ff ff |........|...f....|
|00003530| 00 3e 00 0d 11 01 a0 00 | 82 a1 00 96 00 0c 01 00 |.>......|........|
|00003540| 01 0e 02 00 01 0e 00 00 | 00 00 a1 00 9a 00 08 ff |........|........|
|00003550| fc 00 00 00 1d 00 00 03 | 00 14 04 01 0d 00 0a 28 |........|.......(|
|00003560| 00 22 ff e9 08 43 4f 4d | 4d 45 4e 54 53 01 00 0a |."...COM|MENTS...|
|00003570| 00 00 00 00 00 3d 00 0c | 90 00 04 00 00 00 00 00 |.....=..|........|
|00003580| 3d 00 20 00 00 00 00 00 | 3d 00 20 00 00 00 00 00 |=. .....|=. .....|
|00003590| 3d 00 20 00 01 00 00 00 | 00 1d 80 00 00 1f c0 00 |=. .....|........|
|000035a0| 00 1b 40 00 00 16 c0 00 | 00 1f c0 00 00 0d c0 00 |..@.....|........|
|000035b0| 00 18 00 00 00 18 40 00 | 00 1f c0 00 00 1f c0 00 |......@.|........|
|000035c0| 00 18 40 00 00 18 00 00 | 00 1f c0 00 00 1f c0 00 |..@.....|........|
|000035d0| 00 13 00 00 00 06 40 00 | 00 1f c0 00 00 1f c0 00 |......@.|........|
|000035e0| 00 10 40 00 00 00 00 00 | 00 18 c0 00 00 1a c0 00 |..@.....|........|
|000035f0| 00 12 40 00 00 1f c0 00 | 00 1f c0 00 00 10 40 00 |..@.....|......@.|
|00003600| 00 10 40 00 00 1f c0 00 | 00 1f c0 00 00 1e 40 00 |..@.....|......@.|
|00003610| 00 07 80 00 00 07 80 00 | 00 1e 40 00 00 1f c0 00 |........|..@.....|
|00003620| 00 1f c0 00 00 10 40 00 | 00 1f c0 00 00 1f c0 00 |......@.|........|
|00003630| 00 1e 40 00 00 07 80 00 | 00 07 80 00 00 1e 40 00 |..@.....|......@.|
|00003640| 00 1f c0 00 00 1f c0 00 | 00 10 40 00 00 00 00 00 |........|..@.....|
|00003650| 00 07 00 00 00 0f 80 00 | 00 18 c0 00 00 10 40 00 |........|......@.|
|00003660| 00 18 c0 00 00 0f 80 00 | 00 07 00 00 00 18 80 00 |........|........|
|00003670| 00 18 c0 00 00 10 40 00 | 00 10 40 00 00 18 c0 00 |......@.|..@.....|
|00003680| 00 0f 80 00 00 07 00 00 | 00 a0 00 97 a0 00 83 ff |........|........|
|00003690| 00 07 00 00 00 a4 0a 58 | 00 e4 0a 83 06 30 00 01 |.......X|.....0..|
|000036a0| 00 00 ff ff ff ff ff ff | ff ff 00 01 00 00 00 00 |........|........|
|000036b0| 00 00 00 02 0a 58 00 e4 | 0a 83 06 30 00 00 00 00 |.....X..|...0....|
|000036c0| 00 14 00 09 00 00 00 00 | 00 01 00 01 00 01 00 50 |........|.......P|
|000036d0| 53 55 50 45 52 56 49 53 | 4f 52 20 2f 20 4d 41 4e |SUPERVIS|OR / MAN|
|000036e0| 41 47 45 52 20 43 4f 4d | 4d 45 4e 54 53 20 28 72 |AGER COM|MENTS (r|
|000036f0| 65 63 6f 72 64 20 61 6e | 79 20 6f 62 73 65 72 76 |ecord an|y observ|
|00003700| 61 74 69 6f 6e 73 20 72 | 65 6c 61 74 65 64 20 74 |ations r|elated t|
|00003710| 6f 20 74 68 69 73 20 69 | 6e 63 69 64 65 6e 74 29 |o this i|ncident)|
|00003720| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|00003730| 00 00 00 09 00 00 00 00 | 00 00 00 01 00 00 00 a4 |........|........|
|00003740| 0a 84 00 ec 0a c0 08 bc | 00 01 00 00 00 00 00 15 |........|........|
|00003750| 00 00 00 0c 00 00 00 01 | 00 01 00 00 00 00 00 02 |........|........|
|00003760| 00 00 00 00 00 04 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|00003770| 00 00 00 00 00 00 00 00 | 00 03 00 03 00 00 ff ff |........|........|
|00003780| ff ff ff ff ff ff 01 f4 | 01 26 00 28 00 28 00 00 |........|.&.(.(..|
|00003790| 01 41 00 2b 00 01 00 00 | 00 00 00 00 00 00 00 00 |.A.+....|........|
|000037a0| 00 00 00 00 00 00 00 02 | 00 00 00 00 00 00 00 32 |........|.......2|
|000037b0| 01 01 81 80 00 14 00 09 | 00 00 00 00 00 01 00 02 |........|........|
|000037c0| 00 02 00 05 46 69 65 6c | 64 36 00 00 00 16 00 01 |....Fiel|d6......|
|000037d0| 00 00 00 00 00 0b 00 08 | 00 14 00 00 00 09 00 00 |........|........|
|000037e0| 00 00 00 00 00 01 00 00 | 00 a4 02 30 00 f8 02 60 |........|...0...`|
|000037f0| 01 30 00 01 00 00 00 00 | 00 15 00 00 00 0c 00 00 |.0......|........|
|00003800| 00 03 00 03 00 01 00 00 | 00 04 00 00 00 00 00 00 |........|........|
|00003810| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003820| 00 00 00 03 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|00003830| 00 14 00 14 00 1c 00 1c | 00 00 01 43 00 0a 00 01 |........|...C....|
|00003840| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003850| 00 02 00 00 00 00 00 00 | 00 32 01 00 81 81 00 14 |........|.2......|
|00003860| 00 09 00 00 00 00 00 03 | 00 03 00 02 00 05 46 69 |........|......Fi|
|00003870| 65 6c 64 36 00 00 00 16 | 00 01 00 00 00 00 00 0b |eld6....|........|
|00003880| 00 08 00 14 00 00 00 09 | 00 00 00 00 00 00 00 01 |........|........|
|00003890| 00 00 00 a8 01 ac 03 fc | 01 fc 06 84 00 01 00 00 |........|........|
|000038a0| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 02 00 00 |........|........|
|000038b0| 00 01 00 02 00 00 00 00 | 00 04 00 01 00 00 00 00 |........|........|
|000038c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|000038d0| 00 00 ff ff ff ff ff ff | ff ff 00 e0 00 b4 00 34 |........|.......4|
|000038e0| 00 30 00 00 01 44 00 08 | 00 01 00 00 00 00 00 00 |.0...D..|........|
|000038f0| 00 00 00 00 00 00 00 00 | 00 00 00 02 01 ac 03 fc |........|........|
|00003900| 01 fd 04 dc 01 01 81 80 | 00 14 00 09 00 00 00 00 |........|........|
|00003910| 00 01 00 02 00 01 00 0a | 44 45 50 54 2e 20 4e 41 |........|DEPT. NA|
|00003920| 4d 45 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |ME......|........|
|00003930| 00 14 00 00 00 09 00 00 | 00 00 00 00 00 0d 00 00 |........|........|
|00003940| 01 0e 00 d4 04 58 01 08 | 06 44 00 00 00 00 00 00 |.....X..|.D......|
|00003950| 00 00 00 00 00 02 00 06 | 00 00 00 82 00 d8 04 58 |........|.......X|
|00003960| 00 fc 04 7c 00 01 00 00 | 00 d8 04 58 00 fc 04 7c |...|....|...X...||
|00003970| 00 30 00 28 00 54 00 4c | 00 00 00 00 00 50 00 00 |.0.(.T.L|.....P..|
|00003980| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 50 |........|.......P|
|00003990| 00 fb 01 a5 01 04 01 ae | 11 01 a0 30 39 a0 00 82 |........|...09...|
|000039a0| 01 00 0a 00 00 00 00 02 | d0 02 40 90 00 02 00 fb |........|..@.....|
|000039b0| 01 a4 01 04 01 b4 00 fb | 01 a5 01 04 01 ae 00 fb |........|........|
|000039c0| 01 a5 01 04 01 ae 00 00 | 31 80 4a 40 4a 40 3f 80 |........|1.J@J@?.|
|000039d0| 0a 00 3f 80 4a 40 4a 40 | 31 80 a0 00 83 ff 00 07 |..?.J@J@|1.......|
|000039e0| 00 00 00 6c 00 d4 04 84 | 01 08 06 44 00 01 00 00 |...l....|...D....|
|000039f0| ff ff ff ff ff ff ff ff | 00 01 00 00 00 00 00 00 |........|........|
|00003a00| 00 02 00 d4 04 84 01 08 | 06 44 00 00 00 00 00 14 |........|.D......|
|00003a10| 00 0a 00 00 00 00 00 01 | 00 01 00 01 00 18 2d 20 |........|......- |
|00003a20| 55 20 66 6f 72 20 41 75 | 78 69 6c 69 61 72 79 20 |U for Au|xiliary |
|00003a30| 57 69 6e 64 6f 77 00 00 | 00 16 00 01 00 00 00 00 |Window..|........|
|00003a40| 00 0c 00 09 00 14 00 00 | 00 0a 00 00 00 00 00 00 |........|........|
|00003a50| 00 03 00 00 00 34 00 d0 | 04 48 01 04 06 44 00 01 |.....4..|.H...D..|
|00003a60| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 00 01 |........|........|
|00003a70| 00 00 00 00 00 00 00 00 | 00 01 00 00 00 00 00 00 |........|........|
|00003a80| 00 00 00 00 00 00 00 00 | 00 00 00 07 00 00 00 80 |........|........|
|00003a90| 0a 00 00 e4 0a 2c 04 6c | 00 01 00 00 ff ff ff ff |.....,.l|........|
|00003aa0| ff ff ff ff 00 01 00 00 | 00 00 00 00 00 02 0a 00 |........|........|
|00003ab0| 00 e4 0a 2c 04 6c 00 00 | 00 00 00 14 00 09 00 00 |...,.l..|........|
|00003ac0| 00 00 00 01 00 01 00 01 | 00 2c 20 45 4d 50 4c 4f |........|., EMPLO|
|00003ad0| 59 45 45 20 43 4c 41 49 | 4d 20 46 4f 52 4d 20 28 |YEE CLAI|M FORM (|
|00003ae0| 44 57 43 20 46 4f 52 4d | 20 31 29 20 50 52 4f 56 |DWC FORM| 1) PROV|
|00003af0| 49 44 45 44 20 0d 00 00 | 00 16 00 01 00 00 00 00 |IDED ...|........|
|00003b00| 00 0b 00 08 00 14 00 00 | 00 09 00 00 00 00 00 00 |........|........|
|00003b10| 00 01 00 00 00 a2 0a 04 | 04 8c 0a 50 05 10 00 01 |........|...P....|
|00003b20| 00 00 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 03 |........|........|
|00003b30| 00 01 00 01 00 04 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|00003b40| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 01 |........|........|
|00003b50| 00 03 00 00 ff ff ff ff | ff ff ff ff 00 54 00 58 |........|.....T.X|
|00003b60| 00 34 00 30 00 00 01 45 | 00 28 00 01 00 00 00 00 |.4.0...E|.(......|
|00003b70| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 0a 04 |........|........|
|00003b80| 04 b8 0a 51 05 11 01 00 | 81 81 00 14 00 09 00 00 |...Q....|........|
|00003b90| 00 00 00 01 00 03 00 01 | 00 03 59 45 53 00 00 00 |........|..YES...|
|00003ba0| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|00003bb0| 00 09 00 00 00 00 00 00 | 00 01 00 00 00 a0 0a 08 |........|........|
|00003bc0| 05 64 0a 54 06 54 00 01 | 00 00 00 00 00 15 00 00 |.d.T.T..|........|
|00003bd0| 00 0c 00 00 00 03 00 03 | 00 01 00 01 00 04 00 00 |........|........|
|00003be0| 00 00 00 00 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00003bf0| 00 00 00 00 00 00 00 01 | 00 03 00 00 ff ff ff ff |........|........|
|00003c00| ff ff ff ff 00 54 00 c0 | 00 34 00 30 00 00 01 46 |.....T..|.4.0...F|
|00003c10| 00 29 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |.)......|........|
|00003c20| 00 00 00 00 00 02 0a 08 | 05 94 0a 55 06 55 01 00 |........|...U.U..|
|00003c30| 81 81 00 14 00 09 00 00 | 00 00 00 01 00 03 00 01 |........|........|
|00003c40| 00 02 4e 4f 00 00 00 16 | 00 01 00 00 00 00 00 0b |..NO....|........|
|00003c50| 00 08 00 14 00 00 00 09 | 00 00 00 00 00 00 00 01 |........|........|
|00003c60| 00 00 00 ac 0a 00 06 1c | 0a 48 08 d8 00 01 00 00 |........|.H......|
|00003c70| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 02 00 00 |........|........|
|00003c80| 00 01 00 02 00 00 00 00 | 00 04 00 01 00 00 00 00 |........|........|
|00003c90| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 03 00 03 |........|........|
|00003ca0| 00 00 ff ff ff ff ff ff | ff ff 01 34 01 26 00 34 |........|...4.&.4|
|00003cb0| 00 30 00 00 01 47 00 2a | 00 01 00 00 00 00 00 00 |.0...G.*|........|
|00003cc0| 00 00 00 00 00 00 00 00 | 00 00 00 02 0a 00 06 1c |........|........|
|00003cd0| 0a 49 07 50 01 01 81 80 | 00 14 00 09 00 00 00 00 |.I.P....|........|
|00003ce0| 00 01 00 02 00 01 00 0d | 44 41 54 45 20 50 52 4f |........|DATE PRO|
|00003cf0| 56 49 44 45 44 36 00 00 | 00 16 00 01 00 00 00 00 |VIDED6..|........|
|00003d00| 00 0b 00 08 00 14 00 00 | 00 09 00 00 00 00 00 00 |........|........|
|00003d10| 00 07 00 00 00 76 0a 2c | 00 e4 0a 5b 03 44 00 01 |.....v.,|...[.D..|
|00003d20| 00 00 ff ff ff ff ff ff | ff ff 00 01 00 00 00 00 |........|........|
|00003d30| 00 00 00 02 0a 2c 00 e4 | 0a 5b 03 44 00 00 00 00 |.....,..|.[.D....|
|00003d40| 00 14 00 09 00 00 00 00 | 00 01 00 01 00 01 00 21 |........|.......!|
|00003d50| 54 4f 20 54 48 45 20 45 | 4d 50 4c 4f 59 45 45 20 |TO THE E|MPLOYEE |
|00003d60| 28 43 61 6c 69 66 6f 72 | 6e 69 61 20 4f 6e 6c 79 |(Califor|nia Only|
|00003d70| 29 20 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |) ......|........|
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