W e l l s   &   A s s o c i a t e s ,   L L P  

2 0 0   p r o s p e c t   s t r e e t  
E a s t   S t r o u d s b u r g ,   p a   1 8 3 0 1  
W e l l s l l p . c o m  

Employee  Incident  Report  

Date   02/20/09

Employee   Manager  
Name   Kyle Miller Name   Andrew Hanes
Title/position   Fork Lift Operator Title/position   Manager of Operations

Incident  
Date   02/20/09
Time   1:00 p.m.
Location   The Warehouse

Description  of  incident  (if  additional  space  is  needed,  use  page  2)    
Operation of forklift in use, area to tight, all the equipment came crashing down at least harming
one or two workers if not more. Equipment and injuries are everywhere, protocol is in place but did
not happen.

Employee  explanation  (if  additional  space  is  needed,  use  page  2)  
I was operating the forklift. I may have been going a bit to fast. I was trying to get through a narrow
area and pushed too hard. I ended up bumping into the structure and everything started coming
down on me. Someone ran to check on me but it was all against protocol and I do not think the
structure where everything is being held is not stable at all and there should not be so much clutter
that the pathway is so narrow for workers to get in and out from.

Witnesses  
No witnesses other than the camera in place.

Action  to  be  taken  

 Verbal  warning X  Probation  Dismissal
 Written  warning  Suspension  Other
Explain  rationale   Much thorough investigation needs to be done about why certain things were in
place and to test the integrity of the structure as well as figure out why protocol
was not put into place. However we must go over more footage and figure out
if the employee was using any and all proper procedures when operating the
forklift.

WELLS  &  ASSOCIATES,  LLP       INCIDENT  R EPORT  P.  1  

By signing this document, you acknowledge that you have read and understood the
information contained herein.

Kyle Miller Andrew Hanes

Employee   Manager
02.20.09 02.20.09

Date   Date

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
WELLS  &  ASSOCIATES,  LLP       INCIDENT  R EPORT  P.  2  
  
 
 
 
 
 
 
 

WELLS  &  ASSOCIATES,  LLP       INCIDENT  R EPORT  P.  3