Inspection Detail

Inspection: 125759167 - Jeff A. Dennis

Inspection Information - Office: American Canyon District Office

Inspection Nr: 125759167

Report ID: 0950622

Date Opened: 05/06/2005

Site Address:
Jeff A. Dennis
1336 Woolner Ave.
Fairfield, CA 94533

Mailing Address:
, , 00000

Union Status: NonUnion

SIC:4214

NAICS: 484210/Used Household and Office Goods Moving

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 06/23/2005

Emphasis:

Case Closed: 06/29/2006

Related Activity
Type	Activity Nr	Safety	Health
Accident	362329468

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations				4		4
Current Violations				4		4
Initial Penalty	$0	$0	$0	$250	$0	$250
Current Penalty	$0	$0	$0	$250	$0	$250
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	3203 A	07/06/2005	08/08/2005	$50	$50	$0	-
2.	01002	Other	3209 A	07/06/2005	07/11/2005	$50	$50	$0	-
3.	01003	Other	3241 A	07/06/2005	07/11/2005	$50	$50	$0	-
4.	01004	Other	3668 F	07/06/2005	07/11/2005	$100	$100	$0	-

Investigation Summary

Investigation Nr: 201487634

Event: 04/11/2005

Employee Is Injured in Fall from Loft

On April 11, 2005, Employee #1 was working on a loft to retrieve boxes when it collapsed and he fell 8 ft. He dislocated his ankle. Employee #1 was hospitalized for reasons unrelated to this injury.

Keywords: COLLAPSE, DISLOCATED, FALL, ANKLE

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	125759167			Hospitalized injury	Dislocation	Laborers, except construction

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