Inspection Detail

Inspection: 306271750 - Avery Dennison

Inspection Information - Office: Springfield Area Office

Inspection Nr: 306271750

Report ID: 0112600

Date Opened: 11/12/2003

Site Address:
Avery Dennison
One Better Way
Chicopee, MA 01022

Mailing Address:
, , 00000

Union Status: Union

SIC:2678

NAICS: 322233/ Stationery, Tablet, and Related Product Manufacturing

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 01/05/2004

Emphasis: L:Forklift

Case Closed: 03/30/2004

Related Activity
Type	Activity Nr	Safety	Health
Accident	100690478
Referral	200696516	Yes

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations	2					2
Current Violations	2					2
Initial Penalty	$6,875	$0	$0	$0	$0	$6,875
Current Penalty	$5,875	$0	$0	$0	$0	$5,875
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	Note
1.	01001A	Serious	19100176 C	01/16/2004	02/18/2004	$5,000	$5,000	$0	-
2.	01001B	Serious	19100144 A02	01/16/2004	01/22/2004	$0	$0	$0	I - Informal Settlement	Citation has been deleted.
3.	01002	Serious	19100178 P01	01/16/2004	01/22/2004	$875	$1,875	$0	I - Informal Settlement

Investigation Summary

Investigation Nr: 200690592

Event: 10/30/2003

Employee is killed in fall from forklift

On October 30, 2003, Employee #1 died of blunt head trauma after he fell onto a concrete floor, while exiting a stand on a fork lift.

Keywords: HEAD, INDUSTRIAL TRUCK, CONCRETE

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	306271750			Fatality	Concussion	Freight, stock and material handlers, n.e.c.

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