Wells & Associates, LLP

200 prospect street

East Stroudsburg, pa 18301
Wellsllp.com

Employee Incident Report

Date September 6, 2018

Employee Manager
Name William Smith Name Riley Flint
Title/position Machine Operator Title/position On-Duty Manager

Incident
Date September 6, 2018
Time 10:38 AM
Location Shipping and Receiving Warehouse

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

William Smith was driving the forklift in the warehouse when he hit into the shelf and it collapsed.
The collapse of the shelf led to everything on that side crashing down.

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

I was driving the forklift and when I tried to fit in between the rows I hit into the shelf. I thought I had
enough room to make it through, but I did not. The shelf collapsed and I managed to exit the forklift
and get out of the way.

Witnesses
A few other employees heard the crash and came running to see what happened. No other
employees saw the initial collision, but they witnessed the aftermath. Other employees that were in
the warehouse also ran to take cover to avoid getting injured.

Action to be taken
 Verbal warning  Probation  Dismissal
 Written warning  Suspension  Other
Explain rationale William Smith will be facing a six-month suspension from the company. His
irresponsibility put himself and many others in danger. He also caused an
immense amount of damage to the warehouse.

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 1

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

William Smith Riley Flint

Employee Manager
9/6/18 9/6/18

Date Date

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 2

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 3