Mallinckrodt Chemical Company, Detrehan Street Plant (Mallinckrodt)

1958 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 at least one full year of covered employment between January 1, 1958 and December 31, 1958? Y/N


If yes, identify employment period at Mallinckrodt




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