Inspection Detail

Inspection: 310607197 - Dominos Pizza Llc Dba Dominos Pizza

Inspection Information - Office: San Bernardino District Office

Inspection Nr: 310607197

Report ID: 0950633

Date Opened: 06/11/2009

Site Address:
Dominos Pizza Llc Dba Dominos Pizza
301 South Rockefeller Ave
Ontario, CA 91761

Mailing Address:
, , 00000

Union Status: NonUnion

SIC:4222

NAICS: 493120/Refrigerated Warehousing and Storage

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 11/10/2009

Emphasis:

Case Closed: 02/11/2011

Related Activity
Type	Activity Nr	Safety	Health
Accident	102608130

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations				1		1
Current Violations				1		1
Initial Penalty	$0	$0	$0	$410	$0	$410
Current Penalty	$0	$0	$0	$410	$0	$410
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	Other	3203 A04	11/10/2009	12/14/2009	$410	$410	$0		-

Investigation Summary

Investigation Nr: 202597530

Event: 05/19/2009

Employee Is Injured by Pallet Jack Handle

At approximately 9:30 a.m. on May 19, 2009, Employee #1, working for Domino's Pizza, was operating a Toyota Electric Truck pallet jack, Model Number 7HBE30, Serial Number 7HBE30-69903, and was retrieving a pallet from a storage rack. When the pallet jack became stuck, he got off the vehicle, stood in front of the handle, and gave the vehicle some gas while attempting to pull out the vehicle (his hands were on the vehicle's control handle). The vehicle abruptly moved, and the handle struck him in his abdominal area. He continued to work for an hour and a half and then became nauseated. Employee #1 drove himself to a local clinic and was then transported by an ambulance to the Arrowhead Regional Medical Center, where he underwent surgery and was hospitalized for four days with internal injuries.

Keywords: ABDOMEN, FOOD PREPARATION, WORK RULES, EQUIPMENT OPERATOR, MECH MAT HANDLING, STORAGE RACK, STRUCK BY

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	310607197			Hospitalized injury	Other	Industrial truck and tractor equipment operators

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