Inspection Detail

Inspection: 302684808 - State Farm Mutual Automobile Insurance Co

Inspection Information - Office: Or-E-Salem 1054100

Inspection Nr: 302684808

Report ID: 1054118

Date Opened: 12/17/1999

Site Address:
State Farm Mutual Automobile Insurance Co
4600 25th Avenue Ne
Salem, OR 97313

Mailing Address:
, , 00000

Union Status: NonUnion

SIC:6331

NAICS: 0

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 02/14/2000

Planning Guide: Safety-Manufacturing

Emphasis:

Case Closed: 11/24/2000

Related Activity
Type	Activity Nr	Safety	Health
Accident	101612281

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations	3					3
Current Violations	1					1
Initial Penalty	$8,000	$0	$0	$0	$0	$8,000
Current Penalty	$750	$0	$0	$0	$0	$750
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	Contest	Latest Event	Note
1.	01001	Serious	702022307 G	03/02/2000	03/07/2000	$0	$5,000	$0	03/17/2000	L - State Settlement	Citation has been deleted.
2.	01002	Serious	702022317	03/02/2000	03/07/2000	$0	$1,500	$0	03/17/2000	L - State Settlement	Citation has been deleted.
3.	01003	Serious	19100178 L03 IM	03/02/2000	03/07/2000	$750	$1,500	$0	03/17/2000	L - State Settlement

Investigation Summary

Investigation Nr: 201611621

Event: 12/17/1999

Employee Dies As He Escapes Overturned Fork Lift

At approximately 9:00 a.m. on December 17, 1999, Employee #1 died instantly as he tried to escape from an overturning fork lift. He picked up an empty pallet in the warehouse area and traveled across the yard. Apparently, he turned the fork lift sharply causing it to overturn. Employee #1 tried to jump off the fork lift as it was falling over; however, the fall over protection structure hit him. He died instantly.

Keywords: EJECTED, ASPHYXIATED, INDUSTRIAL TRUCK, OVERTURN

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	302684808			Fatality	Asphyxia	Industrial truck and tractor equipment operators

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