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Inspection Detail
Inspection: 314756636 - Ross Dress For Less
Inspection Information - Office: High Hazard Unit - South
Site Address:
Ross Dress For Less
17800 Perris Blvd
Moreno Valley, CA 92551
Mailing Address:
, , 00000
Union Status: NonUnion
SIC:4225
NAICS: 493110/General Warehousing and Storage
Inspection Type: Accident
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 12/28/2011
Planning Guide: Safety-Manufacturing
Emphasis: S:Targeted Compl & Consult
Case Closed: 05/22/2015
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 101694933 |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 2 | 2 | 4 | |||
| Current Violations | 1 | 1 | 2 | |||
| Initial Penalty | $21,375 | $0 | $0 | $560 | $0 | $21,935 |
| Current Penalty | $2,700 | $0 | $0 | $150 | $0 | $2,850 |
| 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 | 23400022 B | 12/28/2011 | 01/27/2012 | $150 | $185 | $0 | 01/11/2012 | F - Formal Settlement | |
| 2. | 01002 | Other | 4070 A | 12/28/2011 | 01/27/2012 | $0 | $375 | $0 | 01/11/2012 | F - Formal Settlement | Citation has been deleted. |
| 3. | 02001 | Serious | 3578 G | 12/28/2011 | 01/04/2012 | $2,700 | $3,375 | $0 | 01/11/2012 | F - Formal Settlement | |
| 4. | 03001 | Serious | 3650 T | 12/28/2011 | 01/04/2012 | $0 | $18,000 | $0 | 01/11/2012 | F - Formal Settlement | Citation has been deleted. |
Investigation Summary
At approximately 2:30 a.m. on July 14, 2011, Employee #1, with Ross Dress for Less, was operating a Raymond stand-up forklift (SU 704, Serial Number R30- 06-12414) in a warehouse distribution center. He traveled down a ramp with a trailing load of wood pallets. His focus was on the load rather than his direction of travel. When Employee #1 realized the forklift was about to hit a retaining wall, he attempted to jump from the forklift. His left leg became pinned between it and the wall. Employee #1 was hospitalized for treatment. His leg was surgically amputated below his knee.
Keywords: AMPUTATED, WALL, STAND-UP OPERATOR, WAREHOUSE, PINNED, CAUGHT BETWEEN, INDUSTRIAL TRUCK, BACKING UP, INATTENTION, LEG
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 314756636 | Hospitalized injury | Amputation | Industrial truck and tractor equipment operators |