This document is the transcript of an interview conducted on July 21, 2015 regarding a worker's compensation claim. In it, the claimant provides his name, address, height, weight, age, birthdate, marital status, and denies having any other jobs, income, military service, government benefits, volunteer work, or past exposure to chemicals. He confirms being aware that the statement is being recorded and given voluntarily.

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STATEMENT OF XXXXX
Taken: July 21, 2015
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STATEMENT OF XXXX
Taken: July 21, 2015
Q: This is XXX. I’m taking the telephone-recorded statement of XXXX regarding his worker’s
compensation claim XXXX with his employer XXXXX. Today’s date is July 21, 2015, and the
time is 1:02 p.m. You are aware this statement is being recorded, you’re giving it voluntarily and
it’s with your permission?
A: Yes.
Q: And I’m going to ask you to speak up because your voice sounds kind of low and it’s probably
just our connection, okay? You’re aware this statement was requested by the person handling
your worker’s compensation claim?
A: Yes.
Q: You’re also aware my company is XXXX, and that I’m independent?
A: Yes.
Q: State your full name and spell your last name for me, please.
A: Do you want my middle name, too?
Q: Uh, yeah, just you, just state your full name and then just spell your last name.
A: Uh, XXXXX.
Q: Your address?
A: XXXXX.
Q: Your home email address?
A: Um, my first and last name, XXXX.
Q: How tall are you and what do you weigh?

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STATEMENT OF XXXXX
Taken: July 21, 2015
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A: Uh, five nine, two and a quarter.
Q: Okay. And has that been a usual weight for you in the last few years?
A: Yes. I’ve weighed that for many years.
Q: Okay. Your age and your birth date?
A: Uh, fifty-five. Uh, XXXX
Q: Okay. Your marital status?
A: I’m single.
Q: Okay. And do you have children, any children that are dependents?
A: No.
Q: Did you serve in the military?
A: No.
Q: Are you receiving or have you applied for any Medicare, Medicaid or Social Security benefits?
A: No.
Q: Do you have any other jobs or income outside of your position with the City?
A: No.
Q: Do you do any volunteer work?
A: Not at this time.
Q: Okay. Anything in the past where you might have been around chemicals, that sort of thing?
A: No.
Q: Oh.