Created by gemini-2.0-flash on 2025-05-05

Here is a description of the image:

The image is a scan of a vintage form from the Health Department of Springfield, Massachusetts, specifically from the Division of School Inspection. The form is designed to collect data from school inspections.

The header of the form prominently displays "HEALTH DEPARTMENT, SPRINGFIELD, MASS." and below it, "DIVISION OF SCHOOL INSPECTION." There are spaces for entering the "Report from" and the "School" along with "for week ending" followed by "191" (likely a space for the year).

The main body of the form is a grid divided into columns for "Rooms inspected," "Nos.", and then sets of columns for Monday and Thursday with corresponding "Code No." sections, repeated three times. These sections likely intend to record inspection data for each room over the course of the week. To the far right, there is a "Miscellaneous" section with a list of items:

• Sanitaries (Clean, Fair, Need attention)
• Ventilation (Good, Fair, Poor)
• No. cases inspected
• Def. hearing
• Def. vision
• Def. teeth
• Adenoids
• Tonsils
• Vaccinations
• Re-inspections
• Excluded
• Re-admitted
• No disease.

Along the left side, there are instructions such as "Report new cases only. Use code numbers," "Fill out this blank from index record card and return to office weekly," "Report infectious diseases to office at once by Telephone," and "If not visited or no cases, so state in the day column."

At the bottom, there's space for "Totals," "Remarks," and lines for the "Medical Inspector" to sign with "M. D."

Created by gemini-2.0-flash-lite on 2025-05-05

Here is a description of the image:

The image is a form from the Health Department of Springfield, Massachusetts, for school inspection. The form is intended for recording health-related information on a weekly basis.

Key elements:

• Header: The top of the form clearly states "HEALTH DEPARTMENT, SPRINGFIELD, MASS." and "DIVISION OF SCHOOL INSPECTION."
• Reporting details: It includes sections for "Report from" (presumably the school or individual reporting) and the date range for the week's information ("for week ending"). There's also a line to record the school name.
• Room Inspection: This part of the form is dedicated to recording the number of rooms inspected. There are columns for each day of the week (Monday through Thursday) and space for noting the number of rooms inspected. Additional notes on the left describe the expected procedures for reporting information.
• Code Numbers: Associated with the weekly columns are numbered code columns. These codes likely reference a list of conditions, illnesses, or observations for easy and standardized reporting.
• Miscellaneous: This is a section for specific health aspects.
  • "Sanitaries": Has options for Clean, Fair, and Need attention.
  • "Ventilation": Indicates Good, Fair, and Poor conditions.
  • "No. cases inspected"
  • "Def. Hearing"
  • "Def. Vision"
  • "Def. Teeth"
  • "Adenoids"
  • "Tonsils"
  • "Vaccinations"
  • "Re-inspections"
  • "Excluded"
  • "Re-admitted"
  • "No disease."
• Totals: A line for entering totals.
• Remarks: Provides space for additional notes and observations.
• Signature: At the bottom, the form has a space for the "Medical Inspector" to sign, with the designation "M. D." (Doctor of Medicine).
• Instruction: Directions like: "Report new cases only. Use code numbers. Report infectious diseases to office at once by Telephone. Fill out this blank from index record card and return to office weekly. If not visited or no cases, so state in the day column." are included.

Overall purpose: The form appears to be a standardized method for schools to report health-related issues and conditions to the Springfield Health Department, allowing them to track, monitor, and potentially intervene to promote public health in the school system.