HomeMy WebLinkAbout30940 / 80-16Sept�srber 18, 1980 # 16 RFSOLUPION
• i i•'�. iX � • '171u17hY /.: YD.
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4v'ric.nc,F,S, t��e City oc Os'nicosn, on tiie oui day of iecet*oes, I979, aciop'rQd a
Uniform Extension Policy for e�loyees o£ the police and fire departnents; and
WHEREAS, the follaaing police departrrent and fire depart�r�nt pessonnel have
tret the rec�urements of said Uniform Extension Policy and have requested a onr
year exteiLSion of their er�loynent:
RICHARD PFIILLIPS - 7th Request - Police Depart�nt
Date of Birth: Noeelnber 2, 1919
Original Retirerrent Date Was: L�cPmber 31, 1974
IIt�ploy�nt Extension 1lirouc�: December 31, 1981
�'II GR2IBNER - lst E�quest - Fire Depart�rent
Date of Birth: I�cembPS 9, 1925
Original Retiretrent Date Was: i�cerrber 31, 1980
FS�loynent Eactension Throuc�i�: DecemUer 31, 1981
tiCi+d� TS�Fcr'•F'JR"c. BE IT Itc: vL'v'FD i:y 'CtlZ .^..Gi�."ZiGi1 COuZ1C:ii Gf ti:c ��,1�C]' Oi C�aiiri•�5:;
that the foregoing extensions are hereby granted.
S�E'.iTTED �Y
APPRQVED �Gy✓ / `� • ! C
- 16 -
m
August 8, 1980
Mr. Kenneth Grabner
403 Westfield
Oshkosh, Wi 5�+901
P1r. Wi11'_am Frueh
�Iember� cf Common Council
City Ha11
Oshkosh, 'w'i 5�+901
1 /
Dear Mr. Frueh and Council Members,
I hereby request an extension of employment with the Oshkosh
Fire Department beyond my normal retirement date of December
9, 1980.
A statem2nt from my Doetor will be forth coming. My appointment
for an examination with him is scheduled for Tuesday, August
12, 1980.
I respectfully submit this request for your consideration.
Sincerely,
`�������U
Kenneth Grabner
Lieutenant, Oshkosh Fire Department
TH� MEflICA! EXAN1ii�AT�ON R�Ptl3ii
POLICE AND FIRE DEP.IRT�IENT
�G
1
Ezamina[ion for } � � �% � � ��F Ni Da[e ��` /`% /�� � % �U
«� r.���
1. Name iPrinQ ��� G 1 t! .
r ,
4. Signanue of applitapL � ��%�� ��,���
5. Heighr s��� 6, Weighc_.�. , �
Wi�hout f6oes $vipp
8. Eyesight: Saellin Test: Left 20/�U
Correcced m: LeEc 2QJ��
Date of bini�� l7 � C� ( c! a-S 3. Ag�, S'�
'v 7. Chesr �U �(/J�/
d«hn Ezp�aded Mo6�lip
RiBht 20/ /� Both 20/�
Rig6t 20/�8 HatL p���
Color t� /�►/� //=OY++'G.LIi ��//
9. Heacing: R ear ��' L. eaz Discharge? �� 30. No� ��v"�
11. Deatal survey: bfark :ez�S "O" if tapped ot pivot; "I" if missing; "X" if carious; "F' if falu.
R `-'_ PetFec* - Cacin sl;gh•
�Y7'"�� �
Good repeir x Caries mark»�
8--�-6' S 4 3 i—Y' r"r'3 4 5� Pyorrh� ��� rreed desning �'/%Ld'
�Z To�,;� r_ � �� �r- FF �? .
ia. z�oa
14_ Thyroi 15. Sp � '
1G Lungs: Check for aschvw, mbetnilmyis�, bronciutit, chesc %-cay 5adiag. �
17. Hearc: Cazdio-vascalu svst�*.� �✓ `r� . �_ �'�""�� �
Pnke
pressure:
1& Cms�ro-iv[estinai crsct: Check appeadix ,���i'
Check for gucric alcer �
Gall bladder� � I '�
19. Genito-urinary: veaereat d'ueasP l7�N"
liver—��
Wacse��'°� ��
Hydco.� t V
20. Herni� �yG�r�� ��n'� ' 21. Vatitose VPK+� ��''^�
e form)
2L Han � �
23. Feei
� . (fLv o( o�her covdirioo)
24. Bones and joia�. 25. Spin� �/��� •
i
2G. D'uabilitia: (chronic cwrrn, siaus, fiscula, recYal diseace�, cutaneow disrsso, etc.) ��l�f •
27. Illnes.s and
28. Ooerations
29. Neucouc tendeaci /��A�'�U V
30. Could this mav perform duty involvivg being on his feet for 12 houa continuonily?
31. Could th'u man perform dury involving loag hours of duty involving sitting or ridinf
32.
I HERBBY CERTIFY T'FIAT THIS IS A TRUE RECORD OF THE MEI)IC.
AND T'HAT i HAVE FOUND HI�f Wi QUALIFIED C� pHySICALLY FOR
QUALIFIED
�
ABOVE EXAbf��:
is?.G�l?/ , o( i �
�
MEDfCAL F11STO,RY STATE�`fl��1T
(To be takea in presence of examining physician.)
� �
Do you believe you aze souud and well aow?�Are yoa subjecc to diniueas? C�� So seveze headache?�
To paiu in che breasd�lE�To 8uttering of the heard—lL.--To sLortnw of breac6? '�To coughs? /�_
To dianbea7 � So piln?_11�..To theumatismt�,_Have you had wre eya or any defecr of visioc? tR2 S/ Ni ��
7
Ruoning from ei[her ead '�'� Is your sense of hearing good? %FS Have you had Hu or coavulsions? u0
7f so, how frequendy? Unconscioun spell�? �%� IE so, how frequently?
i�
�y�y�? /%'� a�a�pt�y?�£/P��T% if so, were you operaced upon? �� Gonoahea? N� .
�b45' oC
Whev? . A wre of any kiad upou yonr penis? �/D When?
Aay swelliag about or of your [esdda? Nv A boIl vear [he auus? (fismla)? �0
Have you beea ruptured?yti ��E{�'it�%�� /r/zi a-K � Do you driuk ia�oaicating liqaon [o ezcas?�L ��� .
If aoy ro wha[ ex[ent? Do you ux ot have you uscd opinm, morphinS cocai¢q or anq
other nazto[ics? N� Whm? What was the cause oE your fa�h<r's dea[h? a w'��E� -/�tA,Pl
What was che cause of yout mochei � deazh?�� N g��� G Has any member of yout family had tubertulosi�,
iasaairy, epilepry, ar io9ammatory
Have you ever sQia blood? �'� � Have you eeer Gee¢ hurc u
poa the head? � a
Anfwec fully
Have yoss 6ad a spraia? '�._A stiff joint? `-" A bone or join[ ouc of piace? �0 A booe broken? vCs
What bona broken?!L'.Q/i1� 'Wy�? ) Q.l I% ������" 1i�PL Are You subjec[ to
painful coma or wro feet� y� Menrioo carefully injucies or surgical operations you may
have had upon aay part of your body, apetially burns, cuu, severe brnises, ot war wound= � C� ��1,�'4 (�'l �!d /.
fiC.hir2/,ci i � `� !i �
Wha[ hospi�aliza[ioa have you had for U. S. waz servicd��n S� g?E T/rDUBL E %��'/
Give name and addras oi physiciav who lasc attevded you, for whac ailment, wLm? ���� //�C l�%L(-�--P-u�
lD < G� �J�Un��r�,�.�%iir�! f'S�i �'of/r v�iS slr/T�/O U� i�1A•4LFiAlGE �/��jd) D K
I hereby certify tha� the foregoing statements ue true to t6e be�t of my knowledge and belief-
Signatute o Applican[
?
t'iif//tk`�� `/, •��l'�C('/y'Q/7J
�gn fvll name)
Ju1y 29� 19$0
To nembe�s o_` ihe Oshkosh Com�on Council
/
�
I rea�ectfully reouest a one year extension as an active rae�ber
of tixe O�rtsosh Police Dept. I crould appreciate i£ I could get a one
year extersion £rom January l� 1981 until Deceml�er 31, 1981.
Attached is a certificate from a licened physician.
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30��3 �ov�:
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SiacereZy Yours�
�l iCJ . ��C�
iHE MED9�CAL EXAP119;lATtON REPtlt�7
POLiCE AND FIRE DEPARTMEN'I'
�/ �f/
Esamination foc
�•-��,�tr�� _Dat 7 - C F - J'.)
(Wa cidel . . -
1. Name
4. Sigaanue oF applicanr l �fk
5. Heigh� `+ ° l/ �� 6. WdF
Withou� ahon
8. EYessghr. Suellia T'eu: Leh
Correc�ed tn: Leh
2. Date of birt �� Z� l� 3. Agr�.=—
7 /
7. Chest �-- . --' � . `/
SaiPV�d �Ordimc} 1 hn F.xPanded MobiliA Nimnt
�� Right 20/—�5-��� BOth 20/ —
. � Righe 20/_�LG Both 2p/�
Color tes � � � � i..1A^'
9. Hearin8: R ear l � L. ear �/� D'uchacge? �' n 10. Nos• /�
11. Dmtal survey: bfuk reah "O" if capped or pivo4 "I" if miss;ng: "X" if cacious; "F"' if false. .
R 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 L PecEen Cacia slighr -
Good zepa�� "� Csria markn3
8 7 6 5 4 3 2 1 I 2 3 4 5 6 7 8 � Pyonhea Need deanin�
f uc L= . 13. Thcoa ��
12. Tonsil (3. v
14. Thyroi' tti=� �� . I5. SPeech C' /o- s
16 Lungs: Check for's�F�^+ mbemilosi+, bronchici+, chesc X-rny findingi �° ��
17. Aeacc: Cazdio-vaunlat syste nJ �• �� _- —_
Palse rat ? G Alood Pressure: Systoli� i 3 C Diastolic._ ' �?
IS. Gascro•intestinal tcaa: Cltack appendi �' --
GSeck fo: guuic nlcer U�� Liver �z'-
GaLL bladdez �"�" .
19. Geuico-urinary: venereal disrss G Wassecma --
VazicDCet U . Hy&ocde h;
Kidneys G�T
20. Iietai �tY� -- 21. Varitme Vei N u
(mm Eorm)
22 Hand �l� 23. Fe ��
(fla� or «hst mndmoe)
24. Bona aad join G�r � ZS- Sp�° G�
2G D'uabilities: (chroaic rataah, sinus, fisnila, rectal dixases. ci+taaeous diseeses, etc) .
27, lliness and
28. Ooera[ions
29. Neurotic ceuden6
30. Could chis man pecfo� dusy iavolving be:ng on his feet for 12 houn continaauty?_
31. Could chis man perform duty involviag long houcs of dury involving sitting or ciding?
32. Remark � �
I HEREBY CER'YIFY 'TfIAT THIS IS A TRUE RECORD OF THE MEDICAL ERAbSiiiATION O�F THE ABOVE EXAMSNEE
ANll THAT I HAVE FOUND HIM �QU`1LIFIED ❑ pF1ySICALLY FOR THE DUTTES OF �'` ����' �'"'
QUALIFIED ,� tcim cick)
U �-� M. D.
M�:� ���
E��'
ME�KAL NISYQRY STATElt�EfdT
(To be taken ia preaence of examining physician.)
�
Do yan believe you are sound aad well now? '�� Ace you su6jecc to dizziaess? 'R �` To sevece headache? '"'
_ �
To pain in the breasd � � Ta fluttecing of che heart? "O � To shonness of bcrnth? �� To cougfis? `�->
To diacchea.� �rc To piies.� `�`�' To rheumatism? ` Iiav� yon 6ad wte eyes or say defeci of visioa? sh �
n
Running fxom ei<her eaz7 -�'., � Is your sease of hearing good? °"�" Have you had fin or coawizions? '��'
lf so, how frtqueatly? Untoascious spells? ��=� If so, how frequeadp?
Asthma? � Appeadiatis? "�"'�� if so, were yon operated upon? � Goaoahea7 �''°
WSen? A so�e oF aay kind upon your penis? �� Mhen?
Any swdiivg about or of your tes[iclest ��*- A boil aear the eaas? (fistula)? �->
n .ff�
Have you beeu ruptured? '�� Do you dri�k ineoxipting liquors to tzcess7
If noq ro what excead A r.n. � Do you use or have you used opiam, morphiue, cocaine, or aay
oth<r narmtics? � When?� Wbac was the cause of your father's deach% ��-�-�-�'�'��
What was the rause of your mothu's deathl `? =w"�'-t�-" ✓'L Hac a¢y membet of your family had tuberculosis,
insaniry, epil'epry. �ot inBammatory iheumatism? �
Have you ever spit biood? ��^' Have you ever beea hutt upoa the head? '�-�
Aaswer Fully . .
�� �
Have you had a sprain?��-�'t=A stiff joiat? �''' A bone ot joiat out of place?,-�-A bone broken? 4
W6at boues brokea? When? CaaSe? Are you subjea ro
painful toras ot sore feed �-� Mention carefully injuiies or surgical operations you map
have had upon any part of your body, especially burvs, cucs, severe bruises, or war wound ��"-"
What hospitaiiution have you had for U_ S. war urvi<e?
Give name and addzezs oE physician xho {ast attended you, for w6as ailment,
I 6ereby mctify ehat 4Se foregoipg statemen[s are true to tLe besc oE my kvowledge and belief.
Si ntre of AppIInnt
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