SAFETY REPORT

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP75-00399R000100130062-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: December 20, 2016
• Document Release Date: May 11, 2006
• Sequence Number: 62
• Publication Date: October 9, 1970
• Content Type: FORM

-
REPORTS INVENTORY
CONTROL NO.
DDS / OL / LSD 10
PREPARE IN DUPLICATE
I. TITLE OF REPORT (if a fill-in report include Form No.)
2. TYPE
STATIoTICAL
SAFETY Report
RE
O
X
NARRATIVE
RT
P
41AC INE-NA-E LISTING
PERSONNEL
TRAINING
ADMIN. GENERAL
3. FUNCTIONAL AREA X
LOGISTICS
X
SECURITY
OTHER (specify)
X
irEDICAL
X
FINANCE
4. NO. OF COPIES PREPARED
5. FREQUENCY weekly, monthly, quarterly, etc.)
.DISTRIBUTION No. of com onents no
CIA
Se
FOUR
Annually -1 Feb
number of copies)
.
curity 0,
LSD, OL/Sec. 0; LSD Safety 0
7. FORMAT (memorandum, form
8. ADP PROCESSING 9. DIRECTIVE AUTHORITY RE'UIRING REPORT
computer print-out, etc)
YES IF YES GIVE ADP PROCESSING NO. STAT
Memo
)( NO
10. PREPARING CO..IPOtJENT (include lo-iest level
contributing information to report)
II. FEEDER REPORTS (State total number and identify by Title,
Form No., or nomenclature. Attach sepe.rate sheet if necessary.)
LSD Safety Officer,
12, COST FACTORS
A. MANUAT4 P REVIEW
GRADE
HOURLY HOURS PER COST PER TIMES
RATE X REPORT = REPORT X PREPARED COST PER YEAR
GS 9.5
5.38
1/2
2.69
1
2.69
GS 5.1
3. 15
1/2
1.58
1
1. 58
B. COSTS OF COMPUTER
PRODUCED REP
O S
I TOTAL COSTS PER YEAR 4. 27
13. COMPLETE DETAILED JUSTIFICATION FOR THIS REPORT (in addition to directive or authority cited in item 9). IF KNOWN
,
INCLUDE DATE REPORT WAS FIRST STARTED AND COMPONENT WHO ESTABLISHED REQUIREMENT.
"Reporting to the CIA. Safety Officer(Office of Security) by 1 February of any
additional lost time during the preceding calendar year attributed to the injuries
which have been reported. Report is made from copies retained of FM 2652a.
It is estimated that there are thirty (30) per year.
I f41RI 75
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