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Inspection Detail
Inspection: 1139583.015 - 104928 - Walmart Store 5025
Inspection Information - Office: Indiana Department Of Labor
Site Address:
104928 - Walmart Store 5025
10420 Maysville Road
Fort Wayne, IN 46835
Mailing Address:
10420 Maysville Road, Fort Wayne, IN 46801
Union Status: NonUnion
SIC:5311
NAICS: 452112/Discount Department Stores
Inspection Type: Fat/Cat
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 05/26/2016
Emphasis:
Case Closed: 06/29/2020
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 1080272 |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 1 | 1 | ||||
| Current Violations | 1 | 1 | ||||
| Initial Penalty | $7,000 | $0 | $0 | $0 | $0 | $7,000 |
| Current Penalty | $0 | $0 | $0 | $7,000 | $0 | $7,000 |
| FTA Penalty | $0 | $0 | $0 | $0 | $0 | $0 |
| # | Citation ID | Citaton Type | Standard Cited | Issuance Date | Abatement Due Date | Current Penalty | Initial Penalty | FTA Penalty | Contest | Latest Event | Note |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. | 01001 | Other | 22.8(1)(1)(SEC2) | 10/04/2016 | 08/17/2017 | $7,000 | $7,000 | $0 | 10/28/2016 | J - ALJ Decision |
Investigation Summary
On April 11, 2016, Employee #1 was driving a forklift carrying a manual pallet jack, while a semi driver was opening the rightside door of a semi trailer. Employee #1 stopped, and the semi driver passed in front of the fork truck and opened the left side door of the semi trailer and secured it. The semi driver then went to the driver's side door of the tractor, while Employee #1 moved the forklift forward. Employee #1 got off the forklift, walked behind it and to the right side and appeared to be shoving the pallet jack off the forks and into the semi trailer. The semi driver disappeared from the scene, then walked in front of the trailer, and then reappeared entering his tractor on the driver's side. The lights on the rear of the semi trailer lite up, went dark, and lite up again, and the trailer began to move in reverse. Employee #1 was caught between the trailer and the forklift as the trailer was reversing. The force of the tractor began to shove the forklift back and to the left. Employee #1 dropped from the trailer and fell near the back tires of the semi trailer which ran over and killed him.
Keywords: Powered Industrial Vehicle, Run Over, Struck By, Tractor Trailer
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1139583.015 | 79 | M | Fatality | Occupation not reported |