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Inspection Detail
Inspection: 1549829.015 - Industrial Water Service Inc.
Inspection Information - Office: Van Nuys District Office
Site Address:
Industrial Water Service Inc.
513 Church Street
Fillmore, CA 93015
Mailing Address:
2040 Eastman Avenue, Oxnard, CA 93030
Union Status: NonUnion
SIC:
NAICS: 488390/Other Support Activities for Water Transportation
Inspection Type: Accident
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 09/10/2021
Emphasis:
Case Closed: 04/05/2023
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 1776449 |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 4 | 4 | ||||
| Current Violations | 4 | 4 | ||||
| Initial Penalty | $0 | $0 | $0 | $6,230 | $0 | $6,230 |
| Current Penalty | $0 | $0 | $0 | $2,450 | $0 | $2,450 |
| FTA Penalty | $0 | $0 | $0 | $0 | $0 | $0 |
| # | Citation ID | Citaton Type | Standard Cited | Issuance Date | Abatement Due Date | Current Penalty | Initial Penalty | FTA Penalty | Contest | Latest Event | Note |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. | 01001 | Other | 342(A) | 09/16/2021 | $2,000 | $5,000 | $0 | 05/18/2022 | O - Administrative Law Judge Order | ||
| 2. | 01002 | Other | 3203(A) | 09/16/2021 | $150 | $410 | $0 | 05/18/2022 | O - Administrative Law Judge Order | ||
| 3. | 01003 | Other | 3395(H) | 09/16/2021 | $150 | $410 | $0 | 05/18/2022 | O - Administrative Law Judge Order | ||
| 4. | 01004 | Other | 3395(I) | 09/16/2021 | $150 | $410 | $0 | 05/18/2022 | O - Administrative Law Judge Order |
Investigation Summary
At 10:00 a.m. on May 27, 2021, Employee #1, a delivery driver, was servicing a customer location and had just changed out one tank used for a water treatment system. After loading the used tank onto the truck using a lift gate, he slipped on the wet metal surface of the ramp and fell less than 4 feet to the ground, landing on his feet but striking his head on the metal ramp during the fall. He sustained an intracerebral hemorrhage on the left inferior frontal lobe and was hospitalized for treatment.
Keywords: Brain, Head, Hemorrhage, Lift, Liftgate, Slip, Slippery Surface, Struck Against, Struck By, Traumatic Brain Injury
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1549829.015 | 34 | M | Hospitalized injury | Driver-sales workers |