Wells & Associates, LLP

200 prospect street

East Stroudsburg, pa 18301
Wellsllp.com

Employee Incident Report

Date November 18, 2019

Employee Manager
Name Joey Baloney Name Diego Larios
Title/position Forklift Operator Title/position On-site Manager

Incident
Date November 18, 2019
Time 1:25 PM
Location Northeastern Section of Warehouse

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

At 1:25 PM, Joey Baloney was operating a forklift, which was carrying items. Joey was driving
above the warehouse’s speed limit, before slowing down to try to squeeze through a narrow
passage between items on the floor to his left and a shelf holding items to his right. The main
cause of the incident occurred when the item the forklift was carrying hit the shelf beam. This

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

After Joey was checked for injuries, he explained that he was hurrying to finish moving items to a
truck that was to delivery items to Home Depot in order to eat during his lunch break. Joey stated
that when he was trying to squeeze through, he knew then it was a bad idea to continue, but trying
to reverse “would have been too much of a hassle.” Joey then complained about how the

Witnesses
The first 4 witnesses to appear after the incident occurred were: Alfredo Linguini, Bruce Wayne,
Keith Dudemeister, and Max Payne. The four are other forklift drivers who were eating their lunch
in the break room. The next witness to appear was Arthur Fonzarelli, a floor supervisor. The next
witnesses were Trevor Phillips and JC Denton, two other workers in the warehouse.

Action to be taken
Verbal warning Probation Dismissal
Written warning x Suspension Other
Explain rationale Joey is to be suspended for 1 month. During this time, all other forklift drivers
are to be retrained on how to operate a forklift. When Joey’s suspension has ended, he too is to
be
retrained. In addition, there will be other actions taken to ensure the safety of both items and
employees. First, items on the floor are to be reorganized to allow safer passage around the
By signing this document, you acknowledge that you have read and
understood the information contained herein.

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 1

Joey Baloney Diego Larios
Employee Manager

7/18/19 7/18/19
Date
Date

Description of Incident Continued:

caused the shelf to collapse under the weight of all the items it was holding. In addition, the first
collapsing shelf caused the other surrounding shelves to collapse. When Joey noticed the shelf
collapsing, he jumped out of the forklift, where he tried to jump out of the way of the wreckage,
before running to a safe distance.
It should be noted that the area of the incident was very cluttered, making it difficult to traverse
through with a forklift. There were empty wooden pallets laying off to the sides, paper on the floor,
and the bundles of items on the floor were not well organized. This was the cause of the narrow
passageway which Joey tried to squeeze through.
In addition, the shelves seemed to be either carrying too many items, or were not installed properly.
The shelves collapsed quickly when the beam was hit by the item the forklift was carrying.

Employee Explanation Continued:

Northeastern Section of the warehouse was a “cluttered mess”, also saying it was “always a giant
pain in the ass to get around.”

Actions to be Taken:
warehouse. Next, the shelves are to be inspected. This is due to the fear that either they were not
properly installed, or they are carrying more the maximum amount of weight they can hold. Lastly,
lines will be painted on the floor to show how much space is needed to forklifts to move around
with ease.

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 2

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 3