Metallurgical Laboratory (Met Lab) SEC Class Screening Worksheet


1) Employee Name ______________________________________________________


2) SS#__________________________________________________________________


3) Is there proof of a diagnosis of a specified cancer?  Y/N     If yes, list cancer type and diagnosis date


__________________________________   ____________________________________


4) Does there appear to be one full year of covered employment between August 13, 1942 and June 30, 1946?  Y/N


If yes, identify employment period at Met Lab




5) If either question 3 or 4 is answered “no”, is there anything in the file to suggest that additional development might change the answers to “yes?”  Y/N


If so, what development is needed?







Coding Action Taken:

            □     Coded ISL “SEC inclusion likely” (#3 and #4 both Yes)

□     Coded ISD “SEC development may be needed” (#5 is a Yes)

□     Coded ISU “SEC inclusion unlikely” (#5 is a No)




______________________________      _______________________________________

Date                                                                Signature