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Inspection Detail
Inspection: 1517632.015 - Pacific States Industries Inc.
Inspection Information - Office: American Canyon District Office
Site Address:
Pacific States Industries Inc.
27240 Asti Rd
Cloverdale, CA 95425
Mailing Address:
31041 Mccray Road, Cloverdale, CA 95425
Union Status: NonUnion
SIC:
NAICS: 321113/Sawmills
Inspection Type: Accident
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 08/23/2021
Emphasis:
Case Closed: 10/02/2023
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 1740338 |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 1 | 1 | 2 | |||
| Current Violations | 1 | 1 | ||||
| Initial Penalty | $18,000 | $0 | $0 | $700 | $0 | $18,700 |
| Current Penalty | $10,000 | $0 | $0 | $0 | $0 | $10,000 |
| 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 | 3203(A)(6) | 08/23/2021 | $0 | $700 | $0 | 08/27/2021 | O - Administrative Law Judge Order | Citation has been deleted. | |
| 2. | 02001 | Serious | 3668(A)(2) | 08/23/2021 | $10,000 | $18,000 | $0 | 08/27/2021 | O - Administrative Law Judge Order |
Investigation Summary
At 4:45 p.m. on February 27, 2021, Employee #1, employed by a waste management company, was operating a forklift to pick up a dumpster staged at the top of an uphill driveway. While maneuvering the forklift, the back tire went off the edge of the asphalt, causing the forklift to slide and roll down the embankment. Employee #1 sustained a torn intestine. Emergency services transported the employee to the hospital, where he was admitted for treatment.
Keywords: Abdomen, Asphalt, Dumpster, Forklift, Roll-Over
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1517632.015 | 29 | M | Hospitalized injury | Laborers, except construction |