Accident LocationDewitt michigan
Districtdewitt
Supervisor NameMary .
Date of Accident12/08/2023
Time of Accident09:00 PM
Employee NameBruce Williams
Address912 andrus ave
Lansing, MIchigan 48917
Map It
Phone(810) 336-1263
Date of Birth01/28/1999
Last 4 digits of your Social Security Number1640
Do you think you need to see a doctor today?No
Description of Accident
I arrived at work to do my normal duties clean out vacuume,vacuume floors,clean tables,change trash,clean toilets, mop bathrooms. Before this incident I haven't needed an inhaler except for bronchitis. I was just cleaning a room with vacume and wiping down tables and cleaning bathroom. And all of the sudden I started coughing and my lungs started to hurt and mild chest pain. The coughing lasted about 10-15 minutes then started to settle but then my breathing became labored and it felt like I couldn't catch a full breath. So I ended up finishing my shift as normal didn't think anything much of it. Went to the store after that shift and bought an over the counter inhaler. And used it and felt better for a few hrs still thinking nothing of it. Week or 2 goes by and I still feel short of breath and coughing in the morning. Went and seen my doctor and told them what happened. This happened approximately on December 8th 2023. And it is now March 20th 2024 and I have been using an inhaler for the duration of this time. I am going to see an specialist about my condition to see if it's anything serious. Also the names of the chemicals are. Tru shot 2.0 multi surface bathroom cleaner/ disinfectant. The other chemical is tru shot restrooms cleaner. Also Tru shot power cleaner and degreaser.
What part of your body has been injured? Check all that apply- Head
- Mouth
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureBruce Williams
Date03/20/2024
Accident LocationRidge wood
Districtnorthville
Supervisor NameTammy S
Date of Accident03/19/2024
Time of Accident12:15 PM
Employee NameDaneisha Moore
Address3123 Scenic Lake Dr
Ann Arbor, MI 48108
Map It
Phone(313) 550-9006
Date of Birth05/15/1998
Last 4 digits of your Social Security Number2801
Do you think you need to see a doctor today?Not Sure
Description of Accident
I don’t remember the time of the lunch but it was during lunch
What part of your body has been injured? Check all that apply- Lower Back
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureDaneisha moore
Date03/19/2024
Accident LocationBurger
Districtnorthville
Supervisor NameTori Morris
Date of Accident03/08/2024
Time of Accident09:00 AM
Employee NameLucas Peetz
Address32568 bridge st
Garden city, MIchigan 48135
Map It
Phone(734) 877-2528
Date of Birth03/09/2004
Last 4 digits of your Social Security Number8557
Do you think you need to see a doctor today?Not Sure
Description of Accident
My back just started to get extremely tight and I can not walk or stand up straight at all
What part of your body has been injured? Check all that apply- Lower Back
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureLucas peetz
Date03/08/2024
Accident Location1041 Troy Bishop Fifth Third Bank
Districtnorth_east_banks
Supervisor NameBrandy Homrich
Date of Accident03/04/2024
Time of Accident07:30 PM
Employee NameAmity Ratkus
Address107 Telford Dr
Troy, MIchigan 48085
Map It
Phone(248) 224-4069
Date of Birth05/05/1975
Last 4 digits of your Social Security Number3991
Do you think you need to see a doctor today?Yes
Description of Accident
Bending over using regular vacuum with attachment. Vacuum pulled forward and tipped due to hose recoil and landed on outer left ankle bone. Small cut. Some pain and bruising with increased swelling over last two days in foot and over outer bone. Fully functional. Moderate pain but concerned of increased swelling and discoloration.
What part of your body has been injured? Check all that apply- Left Ankle
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureAmity Ratkus
Date03/07/2024
Accident LocationMcGregor Elementary
Districtbay_city
Supervisor NameKaren Allore
Date of Accident02/29/2024
Time of Accident09:40 PM
Employee NameJessica Bissonette
Address918 Stanton st
Bay city, MIchigan 48708
Map It
Phone(989) 714-8779
Date of Birth04/04/2024
Last 4 digits of your Social Security Number9393
Do you think you need to see a doctor today?Yes
Description of Accident
I was on my last hallway in the Sensi room a teacher threw something heavy away as I was picking it up. It ripped the bag and fell right on my left little baby toes. I think I might’ve broke my one little toe.
What part of your body has been injured? Check all that apply- Left Foot
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureJessica bissonette
Date02/29/2024
Accident LocationKraft meadows
Districtcaledonia
Supervisor NameKyle Anderson
Date of Accident02/27/2024
Time of Accident05:40 PM
Employee NameYesenia Arcay
Address4766 84th st SE
Caledonia, MIchigan 49316
Map It
Phone(862) 668-5158
Date of Birth01/07/1978
Last 4 digits of your Social Security Number8788
Do you think you need to see a doctor today?Yes
Description of Accident
5:30ish back by the gym Yesenia put on the backpack vac and heard a crack or pop and just thought it was age related. It hurt through out the night. Marisa saw her over the evening looking uncomfortable and trying to stretch out her shoulder. When Yesenia went to the restroom she noticed her right shoulder was lower than her left and she could not lift her arm above her head. After that Yesenia told Marisa to call me. That was at 9:33pm. She is leaving work to head to urgent care after this report is filled out.
What part of your body has been injured? Check all that apply- Right Shoulder
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureYesenia Arcay
Date02/27/2024
Accident LocationIonia high school 1900
Districtionia
Supervisor NameKeegan Nielsen
Date of Accident02/19/2024
Time of Accident05:20 PM
Employee NameJessica Garvie
Address220 Dunham St
Sunfield, MI 48890
Map It
Phone(616) 902-7087
Date of Birth01/21/1979
Last 4 digits of your Social Security Number2324
Do you think you need to see a doctor today?Not Sure
Description of Accident
Twisted right forearm while vacuuming
What part of your body has been injured? Check all that apply- Right Shoulder
- Right Wrist
- Right Hand
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureJessica Garvie
Date02/19/2024
Accident LocationHigh school 1900
Districtionia
Supervisor NameJessica Storey
Date of Accident02/19/2024
Time of Accident05:20 PM
Employee NameJessica Garvie
Address220 Dunham st
Sun field, MIchigan 48890
Map It
Phone(616) 902-7087
Date of Birth01/21/1979
Last 4 digits of your Social Security Number2324
Do you think you need to see a doctor today?Not Sure
Description of Accident
Twisted right hand forearm while vaccuming
What part of your body has been injured? Check all that apply- Right Shoulder
- Right Wrist
- Right Hand
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureKaiya hillard
Date02/19/2024
Accident LocationEllis
Districtbelding
Supervisor NameAlexis Weaver
Date of Accident02/19/2024
Time of Accident10:35 AM
Employee NameJinyka Williams
Address4454 Noddins Rd
Belding, MIchigan 48809
Map It
Phone(616) 303-9734
Date of Birth03/29/1999
Last 4 digits of your Social Security Number9395
Do you think you need to see a doctor today?Not Sure
Description of Accident
Got called for a puke clean up in the gym but wasn't told where it was in the gym. It was right in front of the door, step on it and slipped. No injures as far as tell, is currently pregnant.
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureJinyka Williams
Date02/19/2024
Accident LocationDewitt ms
Districtoffice
Supervisor NameGreg Schramm
Date of Accident02/14/2024
Time of Accident10:00 PM
Employee NameMary Dolezal
Address300 western f512
Lansing, MI 48917
Map It
Phone(517) 749-3263
Date of Birth02/07/1987
Last 4 digits of your Social Security Number8288
Do you think you need to see a doctor today?No
Description of Accident
Cleaning under bleachers hit back on metal framing
What part of your body has been injured? Check all that apply- Middle Back
- Lower Back
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureMary Dolezal
Date02/14/2024
Accident LocationMcGregor Mentary
Districtbay_city
Supervisor NameKaren Allore
Date of Accident02/07/2024
Time of Accident10:35 PM
Employee NameJessica Bissonette
Address918 Stanton st
Bay City, MIchigan 48708
Map It
Phone(989) 714-8779
Date of Birth04/04/2024
Last 4 digits of your Social Security Number9393
Do you think you need to see a doctor today?Not Sure
Description of Accident
I was vacuuming a classroom that got changed to a new one. The cord got stuck in the door from the vacuum. I tried to get it out. I don’t know if I tripped on the cord or the rug I fell on my left side my hip and leg is fine but the top of my foot is hurting so today is February 9 after I get out of work at 11 I will be going in to get my top of my foot checked out
What part of your body has been injured? Check all that apply- Left Shoulder
- Left Wrist
- Left Hand
- Left Leg
- Left Knee
- Left Ankle
- Left Foot
- Toes on Left Foot
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureJessica Bissonette
Date02/09/2024
Accident LocationMiddle school
Districtvicksburg
Supervisor NameDarlene Case
Date of Accident02/06/2024
Time of Accident07:45 PM
Employee NamePatrick Vanemon
Address77 Thomas st.
Centerville, MIchigan 49032
Map It
Phone(269) 858-9895
Date of Birth02/06/1959
Last 4 digits of your Social Security Number6275
Do you think you need to see a doctor today?No
Description of Accident
He said he tried over the cord to the vac pack he was in the hallway when it happened. He has a cut on his right eye. But he said the cut was already there from a accident that happened at home with his dog. He tripped over his dog at home last week on Sunday.
What part of your body has been injured? Check all that apply- Right Eye
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignaturePatrick
Date02/06/1959
Accident LocationGchs
Districtgarden_city
Supervisor NameTori Morris
Date of Accident02/05/2024
Time of Accident05:15 AM
Employee NameBrian Junk
Address35763 florane
Westland, MIchigan 48186
Map It
Phone(173) 430-9829
Date of Birth01/23/1959
Last 4 digits of your Social Security Number5960
Do you think you need to see a doctor today?Not Sure
Description of Accident
Moving heaven lunch room tables from sat event .
What part of your body has been injured? Check all that apply- Lower Back
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureBrian junk
Date02/05/2024
Accident LocationGchs
Districtgarden_city
Supervisor NameTori Morris
Date of Accident02/02/2024
Time of Accident08:00 AM
Employee NameBrian Junk
Address35763 florane
Westland, MIchigan 48186
Map It
Phone(734) 309-8290
Date of Birth01/23/1959
Last 4 digits of your Social Security Number5960
Do you think you need to see a doctor today?Not Sure
Description of Accident
Hand sanitizer got into my left eye.
What part of your body has been injured? Check all that apply- Head
- Left Eye
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureBrian junk
Date02/02/2024
Accident LocationMoraine
Districtnorthville
Supervisor NameCynthia Dowell
Date of Accident01/23/2024
Time of Accident12:55 AM
Employee NameFrances Hewlett
Address25303 west nine mile rd
Southfield, MIchigan 48033
Map It
Phone(313) 932-5405
Date of Birth12/29/1956
Last 4 digits of your Social Security Number1409
Do you think you need to see a doctor today?No
Description of Accident
Slipped and fell on ice while taking trash to the dumpster at door 43
What part of your body has been injured? Check all that apply- Lower Back
- Left Shoulder
- Left Wrist
- Left Hand
- Left Leg
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureFrances Hewlett
Date01/24/2024
Accident LocationOn the 131 northbound between 44 and 36 street
Districtbyron_center
Supervisor NameStaci Common
Date of Accident01/19/2024
Time of Accident04:30 PM
Employee NameJolene Moore
Address950 Den Hertog
Wyoming, MIchigan 49509
Map It
Phone(616) 893-7876
Date of Birth09/01/1977
Last 4 digits of your Social Security Number2966
Do you think you need to see a doctor today?Yes
Description of Accident
Car accident
Some hit my car on 131 on way home from work.
44 between 36 northbound 131
What part of your body has been injured? Check all that apply- Upper Back
- Left Shoulder
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureJolene moore
Date01/23/2024
Accident LocationOn the 131 northbound between 44 and 36 street
Districtbyron_center
Supervisor NameStaci Common
Date of Accident01/19/2024
Time of Accident04:30 PM
Employee NameJolene Moore
Address950 Den Hertog
Wyoming, MIchigan 49509
Map It
Phone(616) 893-7876
Date of Birth09/01/1977
Last 4 digits of your Social Security Number2966
Do you think you need to see a doctor today?Yes
Description of Accident
Car accident
Some hit my car on 131 on way home from work.
44 between 36 northbound 131
What part of your body has been injured? Check all that apply- Upper Back
- Left Shoulder
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureJolene moore
Date01/23/2024
Accident LocationLeonard and turner st
Districtgrand_rapids_banks
Supervisor NameShamiel Sanders
Date of Accident01/21/2024
Time of Accident08:30 PM
Employee NameShamiel Sanders
Address832 cutler st
Wyoming, MIchigan 49509
Map It
Phone(616) 304-0771
Date of Birth08/03/1992
Last 4 digits of your Social Security Number7706
Do you think you need to see a doctor today?No
Description of Accident
Driver ran a red light and hit me on drivers side causing the car to be totaled
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureShamiel sanders
Date01/22/2024
Accident LocationHastings middle school
Districthastings
Supervisor NameAustin Hartwell
Date of Accident01/22/2024
Time of Accident09:00 PM
Employee NameAustin Hartwell
Address914 N Mason Rd
Vermontville, MIchigan 49096
Map It
Phone(517) 667-2738
Date of Birth10/12/1998
Last 4 digits of your Social Security Number6500
Do you think you need to see a doctor today?Not Sure
Description of Accident
Overdid it and tweaked previous surgery spots. Lots of nerve pain
What part of your body has been injured? Check all that apply- Upper Back
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureAustin Hartwell
Date01/22/2024
Accident LocationHolland Language Academy
Districtholland
Supervisor NameRobert Vancent
Date of Accident01/22/2024
Time of Accident08:15 PM
Employee NameAlba Mercado
Address13637 Signature Dr.
Holland, MIchigan 49424
Map It
Phone(616) 834-4191
Date of Birth08/20/1988
Last 4 digits of your Social Security Number2433
Do you think you need to see a doctor today?Yes
Description of Accident
I was filling up the scrubber machine when I missed a step back. When I try to balance my self I step on a machine. I felt back solid on the ground and my wrist hit the wood floor cabinet.
What part of your body has been injured? Check all that apply- Lower Back
- Left Wrist
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureAlba Mercado
Date01/22/2024
Accident LocationHS 0743
Districtfremont
Supervisor Nameserina musa
Date of Accident01/11/2024
Time of Accident03:35 PM
Employee NameSerina Musa
Address174 S Benson st
PO BOX 544
White Cloud, MIchigan 49349
Map It
Phone(231) 580-7440
Date of Birth08/26/1970
Last 4 digits of your Social Security Number3499
Do you think you need to see a doctor today?No
Description of Accident
Going into the main gym for BB game setup a student Running on the track was not paying attention and ran into me knocking me down hard... I jarred my back good, I landed mostly on right knee and left wrist. My glasses flew off and my phone case was a little damaged. Mr Walls (athletic director) was notified and is looking at cameras to determine which student did it. Several students tried to help me get up, but I was able to after I scooted to the fence to help pull myself up.
What part of your body has been injured? Check all that apply- Lower Back
- Left Wrist
- Right Knee
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureSerina M Musa
Date01/11/2024
Accident LocationL3 harris
Districtl-3_communications
Supervisor NameEmma Zapata
Date of Accident01/10/2024
Time of Accident02:10 PM
Employee NameEmma Zapata
Address1910 Jerome Ave SW
Grand Rapids, MIchigan 49507
Map It
Phone(616) 780-1410
Date of Birth07/10/1970
Last 4 digits of your Social Security Number5921
Do you think you need to see a doctor today?No
Description of Accident
I open a metal cabinet to take my purse out. When I open the door it bounce back n hit me with the corner of the door right under my left eye on the upper cheek.
What part of your body has been injured? Check all that apply- Left Eye
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureEmma Zapata
Date01/10/2024
Accident LocationWest Middle School
Districtportage
Supervisor NameReymundo Trevino
Date of Accident12/28/2023
Time of Accident07:20 PM
Employee NameEmma Douthat
Address1826 Charles Ave
Kalamazoo, MIchigan 49048
Map It
Phone(269) 443-9100
Date of Birth03/01/1998
Last 4 digits of your Social Security Number8700
Do you think you need to see a doctor today?No
Description of Accident
Chemical flew close to my eye but all is fine u washed it out under water.
What part of your body has been injured? Check all that apply- Left Eye
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureEmma Douthat
Date12/28/2023
Accident LocationNorthern High School
Districtportage
Supervisor NameReymundo Trevino
Date of Accident12/21/2023
Time of Accident11:00 PM
Employee NameReymundo Trevino
Address1918 VanZee street
Kalamazoo, MIchigan 49001
Map It
Phone(269) 929-1559
Date of Birth05/18/1987
Last 4 digits of your Social Security Number4826
Do you think you need to see a doctor today?No
Description of Accident
Removing rails from bleachers and trip and landed on my right knee
What part of your body has been injured? Check all that apply- Right Knee
AuthorizationThis electronic signature is authorization for any and all Health Care Providers, including but limited to Hospitals, Clinics, Physician Offices, Diagnostic Centers and Therapy Facilities.
I , the undersigned, hereby authorize the Custodian of Records of health care providers to which this authorization has been directed to release any and all information which may be requested regarding myself and to photocopy any records regarding me, including records which have been maintained regarding my past or present physical or mental condition and treatment rendered, including but limited to my consumption of alcohol or use of drugs including those protected under Title 242 of the Code of Federal Regulations, Part 2; Psychological or Psychiatric records, including communications made by me to a social workers, psychologist or psychiatrist; including behavioral or mental health services.
All records for any and all dates of evaluation, care or treatment to be disclosed.
Make disclosure to: York, Risk Services Group, Inc. PO Box 620 Howell, MI 48844‐0620
The purpose and need for disclosure is: At the request of the undersigned to process the above reference claim.
As a claimant, I may revoke this authorization by notifying the Custodian of Records of applicable health care provider in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions.
This authorization expires one year from the date of execution.
A PHOTOCOPY OR DIGITALLY SHARED COPY OF THIS DOCUMENT SHALL BE CONSIDERED VALID AS IF THE ORIGINAL WERE OFFERED.
Electronic SignatureReymundo Trevino
Date12/21/2023
Accident LocationLathers
Districtgarden_city
Supervisor NameLeTori Morris
Date of Accident12/21/2023
Time of Accident03:00 PM
Employee NameAndrew Taylor
Address29809 Windsor St
Garden City, MI 48135-3433
Map It
Phone(734) 897-7770
Date of Birth09/25/2021
Last 4 digits of your Social Security Number0000
Do you think you need to see a doctor today?Not Sure
Description of Accident
Fall over carpet I didn't see it in the hallway