OOPSPC50.m

OOPSPC50 ;HIRMFO/YH-REPORT OF ACCIDENT CA2 - PAGE 2 ;2/21/98

 ;;2.0;ASISTS;;Jun 03, 2002

 ;;

EN1 ;RESET PRINTRA, SET PAGE SIZE (PORTRAIT) AND PCL PICTURE FRAME 8 1/2"*11"

 W !,$CHAR(27),"E",$CHAR(27),"&l1E",$CHAR(27),"*c5952x7920Y",$CHAR(27),"%0B",$CHAR(27),"&s1#C"

 W !,"IN;SP1;IP;PW.3;SC0,22,0,29,1;"

 W !,"DT@,1;SD1,277,2,1,4,9,5,0,6,1,7,23;"

 W !,"PU.5,28.8;LBOfficial Supervisor's Report of Occupational Disease: Please complete information requested below@;"

 W !,"PU.4,28.2;FT10,10;RA21,28.6;PU.5,28.6;PD21,28.6;PU.5,28.3;LBSupervisor's Report@;PU.5,28.2;PD21,28.2;"

 W !,"SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 W !,"PU.5,27.9;LB19. Agency name, and address of reporting office (Include city, state, and zip code)@;"

 W !,"PU16.2,28.2;PD16.2,27.3;PU16.3,27.9;LBOWCP Agency Code@;"

 W !,"PU15.2,26.4;PD15.2,27.3;PU15.3,27;LBOSHA Site Code@;PU12,26.1;LBZip Code@;PU17.5,25.3;LBZip Code@;"

 W !,"PU.5,27.3;PD21,27.3;PU.5,26.4;PD21,26.4;"

 W !,"PU.5,25.6;PD21,25.6;"

 W !,"PU.5,25.3;LB20. Employee's duty station (Street address and zip code)@;"

 W !,"PU.5,24.7;PD21,24.7;"

 W !,"PU.5,24.4;LB21. Regular@;PU1.1,24.1;LBwork@;PU1.1,23.8;LBhours@;PU2.2,23.8;LBFrom@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU3.4,23.8;LB:@;"

 W !,"SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 W !,"PU4.1,24.2;EA4.3,24.4;PU4.5,24.2;LBa.m.@;PU4.1,23.8;EA4.3,24;PU4.5,23.8;LBp.m.@;PU5.8,23.8;LBTo@;"

 W !,"SD1,277,2,1,4,9,5,0,6,5,7,23;PU6.8,23.8;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 W !,"PU7.4,24.2;EA7.6,24.4;PU7.8,24.2;LBa.m.@;PU7.4,23.8;EA7.6,24;PU7.8,23.8;LBp.m.@;"

 W !,"PU8.9,24.7;PD8.9,23.4;PU9,24.4;LB22. Regular@;PU9.6,24.1;LBwork@;PU9.6,23.8;LBschedule@;"

 W !,"PU11,23.8;EA11.2,24;PU11.4,23.8;LBSun.@;PU12.3,23.8;EA12.5,24;PU12.7,23.8;LBMon.@;"

 W !,"PU13.6,23.8;EA13.8,24;PU14,23.8;LBTues.@;PU14.9,23.8;EA15.1,24;PU15.3,23.8;LBWed.@;"

 W !,"PU16.2,23.8;EA16.4,24;PU16.6,23.8;LBThurs.@;PU17.7,23.8;EA17.9,24;PU18.1,23.8;LBFri.@;"

 W !,"PU18.8,23.8;EA19,24;PU19.2,23.8;LBSat.@;"

 W !,"PU.5,23.5;PD21,23.5;PU.5,23.2;LB23. Name and address of physician first providing medical care@;"

 W !,"LB (Include city, state, zip code)@;"

 W !,"PU13.9,23.5;PD13.9,21;PU14,23.2;LB24. First date@;PU17.5,23.2;LBMo.@;PU18.4,23.2;LBDay@;PU19.3,23.2;LBYr.@;"

 W !,"PU14.5,22.9;LBmedical@;PU14.5,22.6;LBcare received@;PU13.9,22.3;PD21,22.3;"

 W !,"PU17.3,22.4;PD19.9,22.4;PU17.3,22.4;PD17.3,22.6;PU18.2,22.4;PD18.2,22.6;PU19.1,22.4;PD19.1,22.6;PU19.9,22.4;PD19.9,22.6;"

 W !,"PU14,22;LB25. Do medical reports@;PU14.5,21.7;LBshow employee is@;PU14.5,21.4;LBdisabled for work?@;"

 W !,"PU17.5,21.7;EA17.7,21.9;PU17.9,21.7;LBYes@;PU18.9,21.7;EA19.1,21.9;PU19.3,21.7;LBNo@;"

 W !,"PU.5,22.6;PD13.9,22.6;PU.5,21.8;PD13.9,21.8;PU.5,21;PD21,21;"

 W !,"PU.5,20.7;LB26. Date employee@;PU3.4,20.7;LBMo.@;PU4.3,20.7;LBDay@;PU5.3,20.7;LBYr.@;"

 W !,"PU6.2,20.7;PD6.2,19.7;PU6.3,20.7;LB27. Date and@;PU9.4,20.7;LBMo.@;PU10.2,20.7;LBDay@;PU11.2,20.7;LBYr.@;"

 W !,"PU1.1,20.4;LBfirst reported@;PU1.1,20.1;LBcondition to@;PU1.1,19.8;LBsupervisor@;"

 W !,"PU3.2,20.1;PD5.9,20.1;PU3.2,20.1;PD3.2,20.3;PU4.1,20.1;PD4.1,20.3;PU5,20.1;PD5,20.3;PU5.9,20.1;PD5.9,20.3;PU6.2,21;PD6.2,19.7;"

 W !,"PU6.9,20.4;LBhour employee@;PU6.9,20.1;LBstopped work@;"

 W !,"PU9.2,20.1;PD11.8,20.1;PU9.2,20.1;PD9.2,20.3;PU10,20.1;PD10,20.3;PU10.9,20.1;PD10.9,20.3;PU11.8,20.1;PD11.8,20.3;"

 W !,"PU12.1,20.1;LBTime@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU13.7,20.1;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 W !,"PU14.5,20.4;EA14.7,20.6;PU14.9,20.4;LBa.m.@;PU14.5,20;EA14.7,20.2;PU14.9,20;LBp.m.@;"

 W !,"PU.5,19.7;PD21,19.7;"

 W !,"PU.5,19.4;LB28. Date and@;PU3.5,19.4;LBMo.@;PU4.4,19.4;LBDay@;PU5.3,19.4;LBYr.@;PU10.1,19.7;PD10.1,18.4;PU10.2,19.4;"

 W !,"LB29. Date employee was last@;"

 W !,"PU14.2,19.4;LBMo.@;PU15,19.4;LBDay@;PU16,19.4;LBYr.@;"

 W !,"PU1,19.1;LBhour employee's@;PU1,18.8;LBpay stopped@;PU3.4,18.8;PD5.9,18.8;PU3.4,18.8;PD3.4,19;"

 W !,"PU4.2,18.8;PD4.2,19;PU5.1,18.8;PD5.1,19;PU5.9,18.8;PD5.9,19;"

 W !,"PU6.3,18.8;LBTime@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU7.7,18.8;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 W !,"PU8.5,19.1;EA8.7,19.3;PU8.9,19.1;LBa.m.@;PU8.5,18.7;EA8.7,18.9;PU8.9,18.7;LBp.m.@;"

 W !,"PU10.6,19.1;LBexposed to conditions@;PU10.6,18.8;LBalleged to have caused@;PU10.6,18.5;LBdisease or illness@;"

 W !,"PU14.1,18.8;PD16.7,18.8;PU14.1,18.8;PD14.1,19;PU14.9,18.8;PD14.9,19;PU15.8,18.8;PD15.8,19;PU16.7,18.8;PD16.7,19;PU.5,18.4;PD21,18.4;"

 W !,"PU.5,18.4;PD21,18.4;PU.5,18.1;LB30. Date@;PU2.6,18.1;LBMo.@;PU3.5,18.1;LBDay@;PU4.5,18.1;LBYr.@;"

 W !,"PU1.1,17.8;LBreturned@;PU1.1,17.5;LBto work@;PU2.5,17.5;PD5.1,17.5;PU2.5,17.5;PD2.5,17.7;"

 W !,"PU3.3,17.5;PD3.3,17.7;PU4.2,17.5;PD4.2,17.7;"

 W !,"PU5.1,17.5;PD5.1,17.7;PU5.4,17.5;LBTime@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU6.9,17.5;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 W !,"PU7.8,17.7;EA8,17.9;PU8.2,17.7;LBa.m.@;PU7.8,17.3;EA8,17.5;PU8.2,17.3;LBp.m.@;"

 W !,"PU.5,17.1;PD21,17.1;PU.5,16.8;LB31. If employee has returned to work and work assignment has changed, describe new duties@;"

 W !,"PU.5,13.7;PD21,13.7;PU.5,13.4;LB32. Employee's Retirement Coverage@;"

 W !,"PU7.2,13.4;EA7.4,13.2;PU7.8,13.2;LBCSRS@;"

 W !,"PU9.2,13.4;EA9.4,13.2;PU9.8,13.2;LBFERS@;"

 W !,"PU11.2,13.4;EA11.4,13.2;PU11.8,13.2;LBOther, (Identify)@;"

 W !,"PU.5,12.6;PD21,12.6;"

 W !,"PU.5,12.3;LB33. Was injury caused@;PU3.6,12.6;PD3.6,10.1;PU3.6,11.7;PD21,11.7;PU3.6,10.9;PD21,10.9;"

 W !,"PU3.7,12.3;LB34. Name and address of third party (Include city, state, and zip code)@;"

 W !,"PU.9,12;LBby third party?@;PU.9,11.5;EA1.1,11.7;PU1.3,11.5;LBYes@;PU2.3,11.5;EA2.5,11.7;PU2.7,11.5;LBNo@;"

 W !,"PU2.3,11.2;LBIf ""No,""@;PU2.3,10.9;LBgo to@;PU2.3,10.6;LBitem 34.@;"

 W !,"PU.5,10.1;PD21,10.1;PU.5,9.6;PD21,9.6;SD1,277,2,1,4,9,5,0,6,1,7,23;PU.5,9.7;LBSignature of Supervisor@;PU.5,9.6;RA21,10.1;"

 W !,"SD1,277,2,1,4,9,5,0,6,0,7,16901;PU.5,9.3;LB35. A supervisor who knowingly certifies to any false statement,@;"

 W !,"LB misrepresentation, concealment of fact, etc., in respect to this claim@;"

 W !,"PU1.1,8.9;LBmay also be subject to appropriate felony criminal prosecution.@;"

 W !,"PU1.1,8.4;LBI certify that the information given above and that furnished by the employee on the reverse@;"

 W !,"LB of this form is true to the best of my@;"

 W !,"PU1.1,8.1;LBknowledge with the following exception:@;"

 W !,"PU.5,6.2;PD21,6.2;PU.5,5.9;LBName of Supervisor (Type or print)@;"

 W !,"PU.5,5.4;PD21,5.4;PU.5,5.1;LB Signature of Supervisor@;PU12.4,5.1;LBDate@;"

 W !,"PU.5,4.6;PD21,4.6;PU.5,4.3;LBSupervisor's Title@;PU12.4,4.3;LBOffice phone@;"

 W !,"PU.5,3;PD21,3;PU19,2.5;SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 W !,"PU18.5,2.5;LBForm CA-2@;PU18.5,2.1;LBRev. Jan. 1997@;"

 D:IEN>0 ^OOPSPC51

 W !,$CHAR(27),"&r0F",$CHAR(27),"%0A" Q

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---OOPSPC50   6769     printed  Sep 23, 2025@19:15:25                                                                                                                                                                                                    Page 2

OOPSPC50  ;HIRMFO/YH-REPORT OF ACCIDENT CA2 - PAGE 2 ;2/21/98

 +1       ;;2.0;ASISTS;;Jun 03, 2002

 +2       ;;

EN1       ;RESET PRINTRA, SET PAGE SIZE (PORTRAIT) AND PCL PICTURE FRAME 8 1/2"*11"

 +1        WRITE !,$CHAR(27),"E",$CHAR(27),"&l1E",$CHAR(27),"*c5952x7920Y",$CHAR(27),"%0B",$CHAR(27),"&s1#C"

 +2        WRITE !,"IN;SP1;IP;PW.3;SC0,22,0,29,1;"

 +3        WRITE !,"DT@,1;SD1,277,2,1,4,9,5,0,6,1,7,23;"

 +4        WRITE !,"PU.5,28.8;LBOfficial Supervisor's Report of Occupational Disease: Please complete information requested below@;"

 +5        WRITE !,"PU.4,28.2;FT10,10;RA21,28.6;PU.5,28.6;PD21,28.6;PU.5,28.3;LBSupervisor's Report@;PU.5,28.2;PD21,28.2;"

 +6        WRITE !,"SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 +7        WRITE !,"PU.5,27.9;LB19. Agency name, and address of reporting office (Include city, state, and zip code)@;"

 +8        WRITE !,"PU16.2,28.2;PD16.2,27.3;PU16.3,27.9;LBOWCP Agency Code@;"

 +9        WRITE !,"PU15.2,26.4;PD15.2,27.3;PU15.3,27;LBOSHA Site Code@;PU12,26.1;LBZip Code@;PU17.5,25.3;LBZip Code@;"

 +10       WRITE !,"PU.5,27.3;PD21,27.3;PU.5,26.4;PD21,26.4;"

 +11       WRITE !,"PU.5,25.6;PD21,25.6;"

 +12       WRITE !,"PU.5,25.3;LB20. Employee's duty station (Street address and zip code)@;"

 +13       WRITE !,"PU.5,24.7;PD21,24.7;"

 +14       WRITE !,"PU.5,24.4;LB21. Regular@;PU1.1,24.1;LBwork@;PU1.1,23.8;LBhours@;PU2.2,23.8;LBFrom@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU3.4,23.8;LB:@;"

 +15       WRITE !,"SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 +16       WRITE !,"PU4.1,24.2;EA4.3,24.4;PU4.5,24.2;LBa.m.@;PU4.1,23.8;EA4.3,24;PU4.5,23.8;LBp.m.@;PU5.8,23.8;LBTo@;"

 +17       WRITE !,"SD1,277,2,1,4,9,5,0,6,5,7,23;PU6.8,23.8;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 +18       WRITE !,"PU7.4,24.2;EA7.6,24.4;PU7.8,24.2;LBa.m.@;PU7.4,23.8;EA7.6,24;PU7.8,23.8;LBp.m.@;"

 +19       WRITE !,"PU8.9,24.7;PD8.9,23.4;PU9,24.4;LB22. Regular@;PU9.6,24.1;LBwork@;PU9.6,23.8;LBschedule@;"

 +20       WRITE !,"PU11,23.8;EA11.2,24;PU11.4,23.8;LBSun.@;PU12.3,23.8;EA12.5,24;PU12.7,23.8;LBMon.@;"

 +21       WRITE !,"PU13.6,23.8;EA13.8,24;PU14,23.8;LBTues.@;PU14.9,23.8;EA15.1,24;PU15.3,23.8;LBWed.@;"

 +22       WRITE !,"PU16.2,23.8;EA16.4,24;PU16.6,23.8;LBThurs.@;PU17.7,23.8;EA17.9,24;PU18.1,23.8;LBFri.@;"

 +23       WRITE !,"PU18.8,23.8;EA19,24;PU19.2,23.8;LBSat.@;"

 +24       WRITE !,"PU.5,23.5;PD21,23.5;PU.5,23.2;LB23. Name and address of physician first providing medical care@;"

 +25       WRITE !,"LB (Include city, state, zip code)@;"

 +26       WRITE !,"PU13.9,23.5;PD13.9,21;PU14,23.2;LB24. First date@;PU17.5,23.2;LBMo.@;PU18.4,23.2;LBDay@;PU19.3,23.2;LBYr.@;"

 +27       WRITE !,"PU14.5,22.9;LBmedical@;PU14.5,22.6;LBcare received@;PU13.9,22.3;PD21,22.3;"

 +28       WRITE !,"PU17.3,22.4;PD19.9,22.4;PU17.3,22.4;PD17.3,22.6;PU18.2,22.4;PD18.2,22.6;PU19.1,22.4;PD19.1,22.6;PU19.9,22.4;PD19.9,22.6;"

 +29       WRITE !,"PU14,22;LB25. Do medical reports@;PU14.5,21.7;LBshow employee is@;PU14.5,21.4;LBdisabled for work?@;"

 +30       WRITE !,"PU17.5,21.7;EA17.7,21.9;PU17.9,21.7;LBYes@;PU18.9,21.7;EA19.1,21.9;PU19.3,21.7;LBNo@;"

 +31       WRITE !,"PU.5,22.6;PD13.9,22.6;PU.5,21.8;PD13.9,21.8;PU.5,21;PD21,21;"

 +32       WRITE !,"PU.5,20.7;LB26. Date employee@;PU3.4,20.7;LBMo.@;PU4.3,20.7;LBDay@;PU5.3,20.7;LBYr.@;"

 +33       WRITE !,"PU6.2,20.7;PD6.2,19.7;PU6.3,20.7;LB27. Date and@;PU9.4,20.7;LBMo.@;PU10.2,20.7;LBDay@;PU11.2,20.7;LBYr.@;"

 +34       WRITE !,"PU1.1,20.4;LBfirst reported@;PU1.1,20.1;LBcondition to@;PU1.1,19.8;LBsupervisor@;"

 +35       WRITE !,"PU3.2,20.1;PD5.9,20.1;PU3.2,20.1;PD3.2,20.3;PU4.1,20.1;PD4.1,20.3;PU5,20.1;PD5,20.3;PU5.9,20.1;PD5.9,20.3;PU6.2,21;PD6.2,19.7;"

 +36       WRITE !,"PU6.9,20.4;LBhour employee@;PU6.9,20.1;LBstopped work@;"

 +37       WRITE !,"PU9.2,20.1;PD11.8,20.1;PU9.2,20.1;PD9.2,20.3;PU10,20.1;PD10,20.3;PU10.9,20.1;PD10.9,20.3;PU11.8,20.1;PD11.8,20.3;"

 +38       WRITE !,"PU12.1,20.1;LBTime@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU13.7,20.1;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 +39       WRITE !,"PU14.5,20.4;EA14.7,20.6;PU14.9,20.4;LBa.m.@;PU14.5,20;EA14.7,20.2;PU14.9,20;LBp.m.@;"

 +40       WRITE !,"PU.5,19.7;PD21,19.7;"

 +41       WRITE !,"PU.5,19.4;LB28. Date and@;PU3.5,19.4;LBMo.@;PU4.4,19.4;LBDay@;PU5.3,19.4;LBYr.@;PU10.1,19.7;PD10.1,18.4;PU10.2,19.4;"

 +42       WRITE !,"LB29. Date employee was last@;"

 +43       WRITE !,"PU14.2,19.4;LBMo.@;PU15,19.4;LBDay@;PU16,19.4;LBYr.@;"

 +44       WRITE !,"PU1,19.1;LBhour employee's@;PU1,18.8;LBpay stopped@;PU3.4,18.8;PD5.9,18.8;PU3.4,18.8;PD3.4,19;"

 +45       WRITE !,"PU4.2,18.8;PD4.2,19;PU5.1,18.8;PD5.1,19;PU5.9,18.8;PD5.9,19;"

 +46       WRITE !,"PU6.3,18.8;LBTime@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU7.7,18.8;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 +47       WRITE !,"PU8.5,19.1;EA8.7,19.3;PU8.9,19.1;LBa.m.@;PU8.5,18.7;EA8.7,18.9;PU8.9,18.7;LBp.m.@;"

 +48       WRITE !,"PU10.6,19.1;LBexposed to conditions@;PU10.6,18.8;LBalleged to have caused@;PU10.6,18.5;LBdisease or illness@;"

 +49       WRITE !,"PU14.1,18.8;PD16.7,18.8;PU14.1,18.8;PD14.1,19;PU14.9,18.8;PD14.9,19;PU15.8,18.8;PD15.8,19;PU16.7,18.8;PD16.7,19;PU.5,18.4;PD21,18.4;"

 +50       WRITE !,"PU.5,18.4;PD21,18.4;PU.5,18.1;LB30. Date@;PU2.6,18.1;LBMo.@;PU3.5,18.1;LBDay@;PU4.5,18.1;LBYr.@;"

 +51       WRITE !,"PU1.1,17.8;LBreturned@;PU1.1,17.5;LBto work@;PU2.5,17.5;PD5.1,17.5;PU2.5,17.5;PD2.5,17.7;"

 +52       WRITE !,"PU3.3,17.5;PD3.3,17.7;PU4.2,17.5;PD4.2,17.7;"

 +53       WRITE !,"PU5.1,17.5;PD5.1,17.7;PU5.4,17.5;LBTime@;SD1,277,2,1,4,9,5,0,6,5,7,23;PU6.9,17.5;LB:@;SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 +54       WRITE !,"PU7.8,17.7;EA8,17.9;PU8.2,17.7;LBa.m.@;PU7.8,17.3;EA8,17.5;PU8.2,17.3;LBp.m.@;"

 +55       WRITE !,"PU.5,17.1;PD21,17.1;PU.5,16.8;LB31. If employee has returned to work and work assignment has changed, describe new duties@;"

 +56       WRITE !,"PU.5,13.7;PD21,13.7;PU.5,13.4;LB32. Employee's Retirement Coverage@;"

 +57       WRITE !,"PU7.2,13.4;EA7.4,13.2;PU7.8,13.2;LBCSRS@;"

 +58       WRITE !,"PU9.2,13.4;EA9.4,13.2;PU9.8,13.2;LBFERS@;"

 +59       WRITE !,"PU11.2,13.4;EA11.4,13.2;PU11.8,13.2;LBOther, (Identify)@;"

 +60       WRITE !,"PU.5,12.6;PD21,12.6;"

 +61       WRITE !,"PU.5,12.3;LB33. Was injury caused@;PU3.6,12.6;PD3.6,10.1;PU3.6,11.7;PD21,11.7;PU3.6,10.9;PD21,10.9;"

 +62       WRITE !,"PU3.7,12.3;LB34. Name and address of third party (Include city, state, and zip code)@;"

 +63       WRITE !,"PU.9,12;LBby third party?@;PU.9,11.5;EA1.1,11.7;PU1.3,11.5;LBYes@;PU2.3,11.5;EA2.5,11.7;PU2.7,11.5;LBNo@;"

 +64       WRITE !,"PU2.3,11.2;LBIf ""No,""@;PU2.3,10.9;LBgo to@;PU2.3,10.6;LBitem 34.@;"

 +65       WRITE !,"PU.5,10.1;PD21,10.1;PU.5,9.6;PD21,9.6;SD1,277,2,1,4,9,5,0,6,1,7,23;PU.5,9.7;LBSignature of Supervisor@;PU.5,9.6;RA21,10.1;"

 +66       WRITE !,"SD1,277,2,1,4,9,5,0,6,0,7,16901;PU.5,9.3;LB35. A supervisor who knowingly certifies to any false statement,@;"

 +67       WRITE !,"LB misrepresentation, concealment of fact, etc., in respect to this claim@;"

 +68       WRITE !,"PU1.1,8.9;LBmay also be subject to appropriate felony criminal prosecution.@;"

 +69       WRITE !,"PU1.1,8.4;LBI certify that the information given above and that furnished by the employee on the reverse@;"

 +70       WRITE !,"LB of this form is true to the best of my@;"

 +71       WRITE !,"PU1.1,8.1;LBknowledge with the following exception:@;"

 +72       WRITE !,"PU.5,6.2;PD21,6.2;PU.5,5.9;LBName of Supervisor (Type or print)@;"

 +73       WRITE !,"PU.5,5.4;PD21,5.4;PU.5,5.1;LB Signature of Supervisor@;PU12.4,5.1;LBDate@;"

 +74       WRITE !,"PU.5,4.6;PD21,4.6;PU.5,4.3;LBSupervisor's Title@;PU12.4,4.3;LBOffice phone@;"

 +75       WRITE !,"PU.5,3;PD21,3;PU19,2.5;SD1,277,2,1,4,9,5,0,6,0,7,16901;"

 +76       WRITE !,"PU18.5,2.5;LBForm CA-2@;PU18.5,2.1;LBRev. Jan. 1997@;"

 +77       if IEN>0

               DO ^OOPSPC51

 +78       WRITE !,$CHAR(27),"&r0F",$CHAR(27),"%0A"

           QUIT