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We l l sl l p. c om

Employee Incident Report

Date 23 March 2019

Employee Manager
Name Tommy Alexander Name Loteicia Morrison
Title/position Forklift Driver Title/position Warehouse Manger

Incident
Date 03/22/2019
Time 8:00 pm
Location Warehouse

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

Tommy was moving a load/pallet to another location. There was not a clear path, however he still
proceeded down the aisle with the pallet. The space between the pallet of barrels and the storage
shelves became narrow and Tommy did not stop. The force from the forklift and the pallet he
was carrying caused the storage shelves to collapse. ***

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

As I was moving the load of wood to go out for delivery there were empty pallets all over and in my
path. When I was near the shipment of barrels in rack 18, I slowed down to get passed it like I did
all week with loads that were scheduled to go out for delivery. The storage shelf came crashing
down, and before anything could fall on me, I quickly jumped out of the forklift and ran out of the **

Witnesses
Hector: I heard a loud noise and turned around to see the storage shelves in the warehouse has
collapsed. I immediately called security on the radio and ran over to the scene. The air was clouded
and dusty, so I turned around and ran away from the scene. I did see a forklift parked in the middle
I was unable to see if anyone was in there or who. *

Action to be taken
 Verbal warning  Probation  Dismissal
 Written warning  Suspension  Other
Explain rationale Driver was moving at unsafe speed for warehouse forklift. As an experienced
driver, Tommy should have better judgment of driving clearance in the workplace. He should also
report any unsafe work environments such as unsafe pallet placements and non-marked route for
forklift drivers.
By signing this document, you acknowledge that you have read and understood the
information contained herein.

Tommy Alexander Loteicia Morrison

Employee Manager

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 1

 23 March 2019 23 March 2019

Date Date

*** Tommy then flee from the forklift, leaving the scene of the incident. Hector came running over
only to turn away from the dust that clouded the air. Carl from security came over soon after
Hector to also be turned away from the dust and clouded air. Bob then proceeded to the forklift
from another side (in front) to check the environment.

** way.

*Carl: I received a call over the radio that the storage shelves in the warehouse has collapsed. I
immediately ran over to the scene, the air was dusty and I was unable to see or breathe
properly. I turned and left the area where the air was clouded and proceeded to inform the other
security personnel of the matter at hand.

Bob: While working in the warehouse, I heard a loud noise and when I looked up, I noticed the
storage shelves had collapsed. There was a forklift in between the fallen storage shelves and the
pallet of barrels. I wasn’t sure if the forklift was stuck or parked, but I immediately ran over to the
ensure that the driver was okay. Upon arrival, I noticed there was no one in the forklift.

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 2