Inspection Detail

Inspection: 300777760 - 99 Cents Only Stores

Inspection Information - Office: Long Beach District Office

Inspection Nr: 300777760

Report ID: 0950642

Date Opened: 08/22/2001

Site Address:
99 Cents Only Stores
4000 E Union Pacific Ave
Commerce, CA 90023

Mailing Address:
, , 00000

Union Status: NonUnion

SIC:4225

NAICS: 0

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 01/30/2002

Emphasis:

Case Closed: 06/10/2003

Related Activity
Type	Activity Nr	Safety	Health
Accident	101050342

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations				5		5
Current Violations				5		5
Initial Penalty	$0	$0	$0	$2,435	$0	$2,435
Current Penalty	$0	$0	$0	$1,350	$0	$1,350
FTA Penalty	$0	$0	$0	$0	$0	$0

Violation Items
#	Citation ID	Citaton Type	Standard Cited	Issuance Date	Abatement Due Date	Current Penalty	Initial Penalty	FTA Penalty	Latest Event
1.	01001	Other	342 A	01/25/2002	02/27/2002	$300	$375	$0	I - Informal Settlement
2.	01002	Other	23400023	01/25/2002	02/27/2002	$150	$375	$0	I - Informal Settlement
3.	01003	Other	23400024	01/25/2002	02/27/2002	$150	$375	$0	I - Informal Settlement
4.	01004	Other	3203 B02	01/25/2002	02/27/2002	$150	$185	$0	I - Informal Settlement
5.	01005	Other	3664 A11	01/25/2002	02/06/2002	$600	$1,125	$0	I - Informal Settlement

Investigation Summary

Investigation Nr: 201055902

Event: 08/14/2001

Employee injured by forklift in collision

At approximately 6:30 a.m. on August 14, 2001, Employee #1 was operating a Yale electric pallet jack, Serial Number A803N08453V, traveling down aisle five to deliver paperwork to a receiving office in a 99 Cents Only store. At the same time, another employee was operating a Crown Equipment electric forklift, Serial Number 1A112534, traveling down the main aisle toward the same receiving office to deliver paperwork. The accident occurred at the intersection of the main aisle and aisle five directly in front of the receiving office. As Employee #1 approached from the left, the other employee in the forklift approached from the right and collided with the pallet jack, striking Employee #1 on the right hip. Employee #1 stated that he slowed the pallet jack but was unable to honk because of a malfunctioning horn; the other employee stated he did not have time to slow down or honk his horn before the two collided. Employee #1 was transported to the East Los Angeles Doctor's Hospital and then to Pacific Alliance Medical Center, where he was treated for a fractured pelvic bone on his right side.

Keywords: FRACTURE, HORN, OBSTRUCTED VIEW, INDUSTRIAL TRUCK, PELVIS, STRUCK BY, JACK

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	300777760			Hospitalized injury	Fracture	Industrial truck and tractor equipment operators

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