Inspection Detail

Inspection: 312355241 - Pac N Save

Inspection Information - Office: Oakland District Office

Inspection Nr: 312355241

Report ID: 0950614

Date Opened: 02/03/2009

Site Address:
Pac N Save
555 Floresta Blvd
San Leandro, CA 94578

Mailing Address:
, , 00000

Union Status: Union

SIC:5411

NAICS: 445110/Supermarkets and Other Grocery (except Convenience) Stores

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 03/23/2009

Emphasis:

Case Closed: 10/23/2009

Related Activity
Type	Activity Nr	Safety	Health
Accident	361612419

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations				2		2
Current Violations				2		2
Initial Penalty	$0	$0	$0	$1,025	$0	$1,025
Current Penalty	$0	$0	$0	$150	$0	$150
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 A06	03/24/2009	04/26/2009	$0	$465	$0		I - Informal Settlement
2.	01002	Other	3272 C	03/24/2009	04/26/2009	$150	$560	$0		I - Informal Settlement

Investigation Summary

Investigation Nr: 201509114

Event: 01/26/2009

Employee Is Injured after Trip and Fall

On January 26, 2009, Employee #1, a bakery deli clerk, tripped on a hose that had been left on the floor and fell on her side. Approximately three minutes later, she noticed her arm was injured. Employee #1 was hospitalized at Kaiser Hospital in Hayward for an open fracture of her left elbow. The employer reported that another worker admitted to leaving the hose in the bakery department walkway during a 10 minute break. No other contributing factors were found.

Keywords: FRACTURE, HOSE, TRIPPED, FALL, ELBOW, WORK SURFACE, INATTENTION

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	312355241			Hospitalized injury	Fracture	Sales counter clerks

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