EMPLOYEE INCIDENT AND ACTION REPORT
Date: June 30, 2060 | Employee Name: Howard Clay |
Position: Mechanic | Employee ID: 652-24-093 |
Department: Sales Department | Supervisor: Duane Brown |
Incident Details
Description of Incident:
On June 30, 2060, at approximately 9:00 AM, an incident occurred in New Jersey. The employee, Howard Clay, was involved in a workplace incident while operating a backhoe truck on Hedge Street. The incident occurred during the excavation phase of the construction project. Howard Clay was operating a Caterpillar 420F Backhoe Loader (Serial #90028) to dig a trench for utility line installation. While maneuvering the backhoe to reposition it, the rear right tire made contact with a partially buried concrete slab, causing the equipment to tip forward unexpectedly. This resulted in the backhoe's front bucket making contact with the ground, jolting Howard Clay inside the operator's cabin.
Witnesses (if any):
There were two witnesses to the incident, including the manager. Their contact information is as follows:
Witness Name | Contact Number | Email Address |
Jared Townsend | 222 555 7777 | jtownsend@email.com |
Ralph Footman | 222 555 7777 | raphfootman@email.com |
Incident Severity:
The severity of the incident is assessed as High. This classification is based on the impact it had on the employee, the potential risks to others and the damage to company property.
Injury/Illness (if applicable):
As a result of the incident, Howard Clay reported neck and back pain. He was promptly provided with on-site first aid and then transported to St. John's Hospital for further medical evaluation. His condition is currently stable, and he is under observation for any potential injuries. The employee was promptly provided with Medical Treatment, and their condition is recovering.
Action Taken
Immediate Actions:
Emergency services were contacted immediately, and the injured employee was transported to New Jersey Medical Hospital for further medical evaluation.
The incident area was secured to prevent any further accidents or injuries.
Interviews were conducted with witnesses to gather initial information about the incident.
Investigation:
A thorough investigation was initiated to determine the root causes of the incident. The investigation process included:
Reviewing CCTV footage, if available.
Interviewing Howard Clay and witnesses to obtain detailed statements.
Inspecting the equipment involved in the incident for any signs of malfunction or damage.
Consulting with relevant experts or specialists to assess the incident.
Contributing Factors:
The preliminary investigation suggests that the following factors may have contributed to the incident:
Inadequate training and supervision.
Failure to follow established safety procedures.
Equipment malfunction or maintenance issues.
Corrective Actions
Preventive Measures:
To prevent similar incidents in the future, the following corrective actions will be implemented:
Revision and reinforcement of safety procedures.
Regular equipment maintenance and inspection.
Implementation of environmental controls.
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