We l l s & A s s oc i a t e s , L L P

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East Stroudsburg, pa 18301
We l l sl l p. c om

Employee Incident Report

Date October 31, 2018

Employee Manager
Name James Tucker Name Patricia Robinson
Title/position Forklift Operator Title/position On-Duty Manager

Incident
Date October 29, 2018
Time 3:45 pm
Location Warehouse

Description of incident (if additional space is needed, use page 2)

James was operating the forklift when he quickly approached an area that was too small for the load he was
carrying. He slowly pushed through the narrow opening but the front of the load knocked into the shelf and
brought the shelves down like a domino effect. James was able to jump off the forklift with no injuries and
get to safety. There was a lot of debris/dust from the collapse of all the shelves and products that made it
hard to see what the damage really was. James could have prevented this by taking another route or by
organizing his materials better on the forklift. He should always be attentive and aware of his surroundings
while operating the forklift.

Employee explanation (if additional space is needed, use page 2)

I was transporting materials on the forklift when I came to an area that seemed cluttered and narrow.
I thought I could fit, but I misjudged, and, before I knew it the shelves were coming down. I was able to jump
off and go find help.
Witnesses
There were 4 or 5 witnesses that heard the crash; and came from the back of the warehouse, but, with all
the debris/dust flying around it was hard for them to see anything.
Mark ran toward the noise and saw the debris/dust and checked to see if anyone was stuck or hurt; when he
did not find anyone, he went to go look for James.
Paul, the Supervisor, followed Mark toward the crash; he seemed a little confused and, when he saw the
damage and no one there he went to go look for answers.

Action to be taken
 Verbal warning  Probation  Dismissal
√Written warning  Suspension √ Other – RE-TRAINING
Explain rationale: This was a preventable accident with a lot of damage. Even though the area appeared
cluttered and unorganized, James was maneuvering very quickly and appeared to be unaware of his
surroundings. Too much product on the shelves and the pushing of the forklift caused the collapse.
James should receive a written warning so he understands the severity of this as well as take a refresher
course on the safety, guidelines and operations of a forklift in a warehouse environment.
WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 1
By signing this document, you acknowledge that you have read and understood the information contained herein.

James Tucker Patricia Robinson

Employee Manager
October 31, 2018 October 31, 2018

Date Date

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 2