Argonne National Laboratory-West
SEC Class Screening Worksheet
1) Employee Name _______________________________________________________
2) Case ID#__________________________________________________________________
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 250 workdays of covered employment between April 10, 1951 and December 31, 1957? Y / N
If yes, identify employment period at the Argonne National Laboratory-West:
_______________________________________________________________________
5) For a claim with a deceased employee, is there an eligible survivor who has filed a claim? Y/N
6) If either question 3, 4, 5 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?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
ECS Action Taken on SEC Screening Navigation Panel:
□ Select “Likely” (#3, #4, and #5 are Yes)
□ Select “Unlikely” (#6 is a No)
□ Select “Development Needed” (#6 is a Yes)
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Date Signature