Hanford site, Richland, WA
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 the employee appear to have 250 workdays of Hanford employment between January 1, 1984 and December 31, 1990?
If yes, identify employment period at Hanford:
_______________________________________________________________________
5) Identify employment that is not included or is specifically excluded from the class:
Federal employment between January 1, 1984 through December 31, 1990
_____________________________________ _____________________
Time Period Number of work days
Battelle Memorial Institute between January 1, 1984 through December 31, 1990
_____________________________________ _____________________
Time Period Number of work days
Rockwell Hanford Operations between January 1, 1984 through June 28, 1987
____________________________________ _____________________
Time Period Number of work days
Boeing Computer Services Richland between January 1, 1984 through June 28, 1987
_____________________________________ _____________________
Time Period Number of work days
UNC Nuclear Industries between January 1, 1984 through June 28, 1987
_____________________________________ _____________________
Time Period Number of work days
Westinghouse Hanford Company between January 1, 1984 through December 31, 1990
_____________________________________ _____________________
Time Period Number of work days
Hanford Environmental Health Foundation between Jan. 1, 1984 through Dec. 31, 1990
_____________________________________ _____________________
Time Period Number of work day
6) Subtract all employment not qualifying for inclusion in the class (delineated in number 5) from the total period identified in #4 and calculate total number of days in the class.
______________________________________________________________________
______________________________________________________________________
7) Add any SEC periods from other classes that might apply and identify those.
______________________________________________________________________
8) 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?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
ECS Action Taken on SEC Screening Navigation Panel:
□ Select “Likely” (#3 Yes + 250 days after exclusions in #5)
□ Select “Unlikely” (#3 and/or #4 is a No and/or exclusions in #5 prevail)
□ Select “Development Needed” (#6 provides some days that may be combined with other classes per #7 and/or #8 to include the employee in the class)
______________________________ _______________________________________
Date Signature