Employee Incident Report Form Workplace Writing

We l l s & A s s oc i a t e s , L L P
200 prospect street

East Stroudsburg, pa 18301
We l l sl l p. c om
Employee Incident Report

Date March-21-2019
Employee Manager
Name Bo John Name Tyler Stafursky
Title/position Forklift Operator Title/position Manager
Incident
Date March-20-2019
Time 11:00 a.m.
Location W&A shipping and receiving warehouse
Description of incident (if additional space is needed, use page 2)

Bo John, our forklift operator, was carrying a few pallets of wood to be put into the shelves. While
approaching the corner Bo hit the side of the shelves with the pallets and all the shelves on the
Eastern wing toppled down. Bo made it out with only a few bruises and scrapes. The shelves and
the supplies on the shelves are completely ruined because of this accident.
Employee explanation (if additional space is needed, use page 2)

Bo John’s explanation to this incident is that he took the corner slow like he should have and that
the floors were wet so the forklift only “nicked” the shelves.
Witnesses
There were a total of eight witnesses (including myself).
Action to be taken
 Verbal warning  Probation  Dismissal
 Written warning Suspension  Other
Explain rationale After reviewing the security camera footage, I noticed that he broke a few
OSHA government rules. Firstly he did not travel at a speed where it would be
easy to stop, (29 CFR1910.178(n).(8)) and he also did not sound his horn
when approached the corner where the incident happened (29 CFR
1910.178(n).(4)). Also with his excuse of the floors being wet, the floors were
cleaned at 6:00 a.m. which means that around the incident at 11:00 a.m. the
floors would be dry by then. Bo will be suspended for a week. He will also be
demoted to off- loading and he would have to take his heavy machinery
capability drivers course again.
WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 1
By signing this document, you acknowledge that you have read and understood the
information contained herein.
Bo John Tyler Stafursky

Employee Manager
March-21-2019 March-21-2019
Date Date


Employee Incident Report Form Workplace Writing

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Employee Incident Report Form Workplace Writing

Загружено:

Авторское право:

Доступные форматы

We l l s & A s s oc i a t e s , L L P

200 prospect street

Employee Incident Report

Description of incident (if additional space is needed, use page 2)

Employee explanation (if additional space is needed, use page 2)

Bo John Tyler Stafursky

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 2

Вам также может понравиться