Wells & Associates, LLP

200 prospect street

East Stroudsburg, pa 18301
Wellsllp.com

Employee Incident Report

Date 11/07/2019

Employee Manager
Name Ronald McDonald Name Julia Craig
Title/position Warehouse Worker Title/position On-duty Manager

Incident
Date 11/06/2019
Time 5:07 AM
Location Warehouse C, near the barrels

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

Employee, Ronald McDonald, was driving a forklift down the lane in Warehouse C near the barrels
at 5:07 AM with a low stacked, wide pile of wood panels. The employee was driving too fast and did
not have the wood panels stacked properly. (continued)

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

Employee stated that he didn’t mean to be speeding, he thought he had plenty of room to make it
through. He had no concern that the wood was even going to touch the shelving unit. He heard
things starting to collapse and just ran as fast as he could to get out of there.

Witnesses
N/A -In the view of the camera, no one else was seen on the scene of the incident

Action to be taken
 Verbal warning  Probation  Dismissal
 Written warning  Suspension  Other
Explain rationale Employee must be drug tested due to crashing the forklift, will be given a
written warning that calls for termination if it happens again, and suspension of
1 week for failure to follow rules and regulations

By signing this document, you acknowledge that you have read and understood the
information contained herein.

Ronald McDonald Julia Craig

Employee Manager
11/07/2019 11/07/2019

Date Date

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 1

He came to a slow roll because the lane began to get smaller and proceeded to try and fit between the
shelving units on his right and barrels on his left. He got the corner of the wood pile caught on a shelving
unit. The shelving units begin to collapse, and the employee jumped out of the forklift, fell to his knees,
stood up and sprinted away out of sight of the camera. About 3 employees came running to the scene after
about 5-10 seconds later from all different angels. They looked over the pile of broken shelving units with
A lot of dust flying through the air. They did not see anything, so they ran towards the
direction that the other employee ran in. This employee is to work on his visibility. A recommended practice
For the individual is to use spotters to increase his visibility.

WELLS & ASSOCIATES, LLP INCIDENT REPORT P. 2