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Inspection Detail
Inspection: 1341711.015 - Pilot Travel Centers Llc Store 373
Inspection Information - Office: Iowa 0751910
Site Address:
Pilot Travel Centers Llc Store 373
11957 Douglas Ave
Urbandale, IA 50322
Mailing Address:
Po Box 10146, Knoxville, TN 37939
Union Status: NonUnion
SIC:
NAICS: 447110/Gasoline Stations with Convenience Stores
Inspection Type: Referral
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 08/24/2018
Emphasis:
Case Closed: 11/27/2018
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Referral | 1362049 | Yes |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 2 | 1 | 3 | |||
| Current Violations | 2 | 1 | 3 | |||
| Initial Penalty | $13,857 | $0 | $0 | $778 | $0 | $14,635 |
| Current Penalty | $10,500 | $0 | $0 | $0 | $0 | $10,500 |
| 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. | 01001A | Serious | 19100023 B08 | 09/25/2018 | 11/09/2018 | $5,500 | $8,314 | $0 | I - Informal Settlement | ||
| 2. | 01001B | Serious | 19100023 C04 | 09/25/2018 | 11/09/2018 | $0 | $0 | $0 | I - Informal Settlement | ||
| 3. | 01002A | Serious | 19100303 B02 | 09/25/2018 | 11/09/2018 | $5,000 | $5,543 | $0 | I - Informal Settlement | ||
| 4. | 01002B | Serious | 19100303 G01 I B | 09/25/2018 | 11/09/2018 | $0 | $0 | $0 | I - Informal Settlement | ||
| 5. | 02001 | Other | 19040039 A02 | 09/25/2018 | $0 | $778 | $0 | I - Informal Settlement |
Investigation Summary
At 8:45 a.m. on July 20, 2018, Employee #1 was made aware of a water-damaged ceiling tile located in the TV room, approximately 9 foot 10 inches off the floor. Employee #1, with assistance from a coworker, proceeded to replace the ceiling tile. They retrieved a 6 foot Keller A-frame ladder from the maintenance closet. Employee #1 ascended the ladder, up to the third rung, while his coworker held the ladder in place. The employee attempted to remove a piece of the damaged ceiling tile that had become wedged. As he tried to hand the ceiling tile to the coworker, the employee leaned too far back and lost his balance. Employee #1 struck the wall, the A-frame ladder slipped out, and he fell to the floor. Employee #1 was hospitalized with a broken right ankle.
Keywords: Ankle, Ceiling Panel, Fall, Fracture, Ladder, Lost Balance
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1341711.015 | 54 | M | Hospitalized injury | Installers And Repairers |