REGULATIONS AFFECTING SEAMEN

27

11.—State what was done for the man after the accl
dent, with name and address of attending physi
cian or hospital, if any... ee

12.—State probable period of disablement........_.
13.—Give statement, if any, made by injured person.

14.—Name of person in charge or superintending work
at time of Accident TT re
IS—Was man able to return to duty? Tf 50. When Puree
16.—Was steamer loading or discharging? From or to ]
dock orlighter Peo

17.—~What machinery or gear was in use, and was it in }
Lordocl er mo tsetse RE

18.—(a) Was the man perfectly sober?
(b) Was he careless? ———————
(c) Was any other person at fault? If so, who |
and 1 What Wav Po Re rrr em rt i

19.—Was substitute signed on? On what date ee
20.—Name of substitute ______._

Te a rr mem——

CA ——
Naxes oF WITNESSES TO ACCIDENT AND PERSONS

Acererine IN Wore

HoME ADDRESSES