Inspection Detail

Inspection: 307455782 - Three - G"S, Inc

Inspection Information - Office: San Bernardino District Office

Inspection Nr: 307455782

Report ID: 0950633

Date Opened: 02/08/2005

Site Address:
Three - G"S, Inc
1643 W Orange Grove
Orange, CA 92868

Mailing Address:
22695 Old Canal Blvd, Yorba Linda, CA 92887

Union Status: NonUnion

SIC:7361

NAICS: 561310/Employment Placement Agencies

Inspection Type: Accident

Scope: Complete

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 06/08/2005

Emphasis:

Case Closed: 06/08/2005

Related Activity
Type	Activity Nr	Safety	Health
Accident	102439502

Investigation Summary

Investigation Nr: 202440434

Event: 12/30/2004

Employee's Leg Is Fractured When Struck by Forklift

At 8:00 a.m. on December 30, 2004, Employee #1 was moving wooden planks with a Kom Forklift, Model Number FG25ST-11, Serial Number 469023A. Employee #1 got off the forklift, then put the forklift in neutral and set the brakes. As Employee #1 was securing a pallet, his back was to the forklift. The forklift popped into gear, moved forward, and struck Employee #1, pinning his left leg between the forklift and steel tubing. Employee #1 was transported to Saint Joseph Hospital, Orange, CA, where he was hospitalized for treatment of a shattered left tibia.

Keywords: FRACTURE, BRAKE, CAUGHT BETWEEN, INDUSTRIAL TRUCK, STRUCK BY, LEG

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	307455782			Hospitalized injury	Fracture	Supervisors, n.e.c.

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