Inspection Report Tue Nov I0, 20l5 1:49:27 AM RID CSHO ID Supervisor ID Inspection Number - Optional Report Number - Case Closed Date- - 0950661 Y1691 F2003 1084143 003-16 Establishment Name Blue Apron, lne. Doing Business As (DBA) Establishment Private Sector Typebeusiness Corporation 1 311991 Owner Name ,l Primary NAICS Site Address 3151 Regatta Blvd. Site Phone (888)-278- I Extn- Site FAX- B60 - 5694 RICHMOND, CA, 94804 I Business Address 3151 Regatta Blyd. Business Phone Business FAX I CA, 94304 Mailing Address: 3151 Regatta Blvd. E-mail - Mobile Phone CA, 94804 Site Activity NAICS Inspected. 311991 Days on Site 3 Federal EIN 454001636 DUNS Temporary or Fixed Site? I. Entry .First Closing?Conference Opening Conference 12-AUG-2015 Second Closing'Co'nference Walkeround 14-AUG-2015 Exit 14-AUG-2015 Inspection Initiating Type Complaint Secondary Type I Other Initiating Type Inspection Category i Health Scope of Inspection Comprehensive Reason No,lnspe0tion . Sampling Performed? Eripln. for-.No Irisp. Federal Strategic Initiatives National Emphasis State Emphasis Local Emphasis Primary Emphasis Employed in Establishment 950 Walkaround? I - Advance Notice? Ccivered By Inspection 7 670 Interviewed? Flag for Follow-up Controlled By Employer 950 Union? . Reason Related Activity 'i . Activity Number Activity Type Satis?ed A 5 EstablishmientName 1009636 Complaint Both Safety Health I Blue Apron Inc. 1009639 Complaint Both Safety Health Blue Apron Inc. 1009640 Complaint Both Safety Health Blue Apron Inc. 1009644 Complaint Both Safety Health Blue Apron Inc. 1009647 Complaint Both Safety Health Blue Apron Inc. Page 2 5m: Apron, Inc Tut Nev 10.2015 ll 49.27 AM Nr man Kzlaled Inspeuicns Number Establishmem Name Related lnspeuion Type Addilicml Codes Type Value 14 Emerworkbr's insurance ca itr, lfnuna. enter 1fself. emerSELF Employer Rzplesenlatives Conlaclzd Firs| Name Las' Name Job Tulc Pamcipafiun Intervicwzd? Emily Birbrr Counsel Credentials, Opening Conference Dawd Manngu Conference Samantha Bruck HR Manager Credcmials,0pzniug Ben Singer Genrral Counsel Opening Brian McEvoy Assistant General Ma Cr=demizls, Opening Confcrenc: Employus Contacted Name - Job Title Warehouse/Raul" Occupation "g Address Ham Wurk Mobile Email Participation Credentials Nme -- JnhTille Receivmg/Invemor Address Ham: Work Mabilz - Email Parliciyafion Credsmi Name -- Joh Tine Rumm Occu zfion Address Home Work Mobil: -- Emil Panicipation Credmuals Name -- Job 1" I: MachIn20peralor Occupalion Address Page; TuaNov 114927AM BlutApmn. In: Nr H134 I41 11-min. Work Mnbil: -- 'Email Participation Credermals Name -- m: Food 'Occnpanun Address [Home wm Mobil: 'E'mail Credenllals !Nalnc m: Irwcmory Occupation Address Home Work Mobile 'Email Panicipaiion Name Job Til|e PackrOuUchk [Knack Address 'Home Work Mobile Emzll Panicipafion Credenlials Name -- Jab Tille Receiving Occupation Address wm Mobile - {Email Pmmpanion Credenuals I I CSHO signature I Dale [7 0 {i/Ifil/Zd'fi' STATE OF CALIFORNIA DIVISION OF SAFETV AND HEALTH 1' 2m0p1.Rpt.b'a.( 7' 1, FY I A. lnsp. No. 9/ r' 5. Reglon 6 I 5. Employer flyernr/x (HG prim/7r DEA 7.M m?enl 7mg Namimm" K, r379" Phone/Va F'honecanIacIan/y' agape Inspeclmn crow Amy/z/ Mir 6/ '94xv>> SVLK- "13% El . S'ion a resent unng um :1er All M0 one Na Opemng cresrng 6mm "5 EV m/ (fizz/z my)! (2 Dservsd VIoIalions recurs Actions C/nsmg Dare as Dates: 0 . 6 10. Small Employev Renew - any." 1M1ppening Conference 15. Review 19. Evaluanun or Sarety Health Progrlm ow ID fl? - EHecrive Average xp/am Purpose Salary ResponsIbI/Iry 9/ Program ecrrve Emp/oyee Pamorpeuun onee Mode-I Program Used Trimmg cm Pmcedure El Prewously Reviewed PPE a" WSHA Posrer Dare Housekeeping g/ orkers'conrp Insurance 9/ 300 Log 5 quired Prooram Elements ngIts/Vafiances esponsIbIe Person 20. Adjustment Facturs (in Inspect "mans/Enforcement 'Gocd Faith Size 'Hlslom Eigensam lo Inspecr ommunIcalIun (am Good 0740) 1-10 Good I peer/ens I Averagelj (30) 11725 Farr 7 veslrgalIon Procedures 0) Poor (20) 25-50 a) Poor 12' rence firm/7mg cardkee pecrran Records a/nmg Records 0) 51-100 @401 >100 Does not sppIy (o penemes Ioraccrdenr-reIered Sennus, Repeat GI Serious rIEmpIayerdoes noI have an operahv: IHPP Closmg anl rene Dare din/lie, gimp/aye, mynp/oyees MIG/alums Weapons Efibar'e ConsuIr names my Reqmremenls gll'orma/ Conference pear ances zard Communication ongram nen Program ammg 17. Iner Requivemenls Poster paste 14. Follnw-Up Inspection Recommended? Reason E/Emergency Acrron Plan Frre Prevennon PIan Cltatmns Issued? - Wane--Elegan-- ea! l/lness Prevennan Procedures 16. ass Julisdiclional ReIerraI 015! Workers' Comp Insurance [34-15mm WeIIere Comm Pasler i I rmaiio Address 5 e/ 1/ Lg? 7&1 [Pm'gfl 7 507! as by Phone Fax, 1 I ma Kr Address. 5 I rarneo FI/sl-Ard PravIder (113(5) 09 300 Pnone Wm"; 21. my Inlormalion arp Pannersmp 50/9 Owner CI LLC Igulrn/ 1e ah 'meiyfi m4! 9 MI II Worms Owner/amoemICarp W341. fluff/f. Web Ema 1 Lemon olRecords:355/ KL Bus No 74001} - 5511' Ex Dare Ln: No, Exp Dare Garment Registranon No 400/030 FLC No Exp Dare: Name 022 -- 345 (5 Omar ch NO, other We, IA (Rem zuIzeoa-IZI STATE OF CALIFORNIA DIVISION SAFETV AND HEALTH Page 2 ol 2 Address Ctty Stats Phonetst Ctly state Phons(s) I 23 Mum Employer Yes ?9 It Yes obtatn the rn orrna Ian on oac amp oyorrnvotved a. Emptoyer Emptoyor Address Address Contact Name Contact Name I Phone (bus Phone tcett) Phone (bus Phone (cc/t) - Contract govemtng Emp/oyer's won199?" WOW ICED 9M /Lr my low. Mt {(94 I II yes htsloty tn case flte 25 Previous Citallon Histavy Efloncations Provided: 4 Gutdeto 13 Cat OSHA Poster Other 27V Addkional Sheets; II addmonat sheets ate attached check this box 1A moot am now Entry and an Opening conference Were conducted on August 12, 2015 with the following personnel present; David Rei?schrieider, General Manager of Blue Apron, Inc, Samantha Bruck, Human Resources Manager of Blue Apron, Inc, Ben Singer, General Counsel of Blue Apron, Inc. via phone conference, Brian McEvoy, Assistant General Manager of Blue Apron, Inc, Emily Bieber, Counsel with Morgan Lewis Firm, Lucy Thomas, Regional Sales for True Blue, Inc. (Labor Ready) via phone conference, Ti?any Rhoe, Select Sta?ing Representative via phone conference, Shawn Spalding, Express Employment Professionals Representative via phone conference, Tara Huj?nan, Associate Safety Engineer, DOSH, HHC U, Oakland and Dalia Rassier, Graduate Student Intern, DOSH, HHC U, Oakland. During the opening conference credentialslwere presented, the purpose of the inspection and inspection procedures were explained to the employer. The employer?s HPP and OSHA 300 Logs were reviewed and requested along with other required documents on the OSHA Form JAY. The employer was given a copy of the User 's Guide to a' consultation pamphlet, and the employee rights. Permission to inspect the facility was granted by Emily Bieber, Counsel ?om Morgan Lewis. A comprehensive inspection of the facility was conducted on August 1 4, 2015. Employee interviews were conducted on August 18, 2015. During the exit conferenqe held on August 26, 2015 noted violations and corrective measures were discussed. Prior to exiting the CSHO discussed the anticipated closing date with the employerl'. STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF OCCUPATIONAL SAFETY AND HEALTH High Hazard Unit North 1515 Clay Street, Ste. 1303, Box 40 Oakland CA 94612 Tel: (510) 622-3009 Fax: (510) 622-3025 DOCUMENT REQUEST EMPLOYERE i DATE: a Postmark by: EMPLOYER CONTACT: Inspector: As discussed during the inspection on 12? it has been determined that copies of the following documents are required for review. Please provide the inspector with the required copies by the "postmark" date noted above. If the copies are not provided by that date, it will be interpreted as an admission that the documents do not exist, and possible citations and monetary penalties could result. ?ral ER ID No.1 . Licenses Permits: [Easiness License late ER Tax ID No. CSLB El Garment Reg. El Faml Labor Contractor Rec?d El Facility Layout (?oor plan, evacuation routes, etc) Rec?d 9/ OSHA Leg 300 (from 2 to 2015 1430: w/ 50:0 A Rec?d lg? CI OSHA 5020 (Employer's First Report of Injury) Rec?d DWC Form (Worker's Compensation Claim). I Rec?d Worker's Compensation Insurance Carrier ?3 refer; I253 LSaferya'lnspecti'ohRecords j' i mployee Training Recordse/li?at lilies; Prevention eggs}; ?EEiSE?sis i D/First Aid Kit approval 8 CCR 3400 9/ Emergency Action Plan 8 CCR 3220 Fire Prevention Plan 8 CCR 322! Rec?d Hazard Communication Program 8 CCR 5i. 4 I .?cle? S/Material-Safcry-Bafa-W La lot/[1? m9) MW . tununnw-hu- u: '1.r?yl1? .. - - El ReSpiratory Protection Program 8 CCR 5/44 Rec?d Hearing Conservation Program (Noise) 8 CCR 5097 I . Rec?d 2 fi? El Exposure Control Plan Bloodbome Pathogens 8 CCR 5193 Rec?d 5/ Workplace Exposure Records/Menitoring Results 55 '5 AI IF AM )1 Rec?d 2 A Chemical Hygiene Plan 8 CCR 5l9l . Rec?d 0 Carcinogen Registration 8 CCR Article H0 A oei? c?d Permits I Variances, for AD Safety Instructions/Equipment Manuals I Rec?d. 4 bar m: wemxleg NAM-ES ?rms Reads Ml if s/ FDRL Luz-r '01: AWIH. DRIVERS If If you require an extension of time in order to satisfy this request, please contact the inspector identi?ed with your inSpection at the phone numbers above before the deadline. INSPECTION NO. I 054 INSPECTOR ID. ?h?l I OPT RPT N0. Hg l0/l2) Maintenance Records of Equipment 0er 14 133828 State of California - Division of Occupational Safety and alth Inspection Number 1084143 ORKSHEE Opt. lnsp. Number. 003? 16 Establishment Name Blue Apron, Inc. I . Type of Violation Regulatory Citation Number 1 Item/Group 1 Number Exposed . No. Instances 1 REC Std. Alleged Viol. 461(c) Abatement MultiStep Abatements Final Abatement Action Type/Dates PeriOd PPE Period Plan Report 30 Abatement Documentation Required 1 Date Verified I Substance Codes I AVDNariable Information jl BCCR 461(0): The permit shall be posted under glass in a conspicuous place on or near the air tank or in a weatherproof container secured to the unit. and shall be available at all times to any quali?ed inspector. Prior to and during the course of the inspection, including, but not limited to August 14, 2015, the employer did not ensure that the lngersoll Rand air compressor SN: 5024282 located near the employee security check-in had a permit posted under glass in a conspicuous place on or near the air tank. - - Penalty Calculations Adjustment Factors Proposed Adjusted Probabil Size Good Faith His Penalty 0% 15% 0% $425.00 Repeat Factor Employee Exposure: Pa Em Duration 9 Address pation Em 0 Duration Freq Address Phone ESHO Y1691 0 3 1 5 12 Aug 2015 IISSUE oArel Severity Extent Likelihood Total Adj. Factors Ll .lMl Ll Ll IMI 15% OSHA ??lBillB H (Rev. 9f93) Page - . . BLUE APRON. INC. Inspection Nr.108414?t. Citation Nr. 1 Item/Group 1 Elemental Analysis-List numerically each descriptive element of the cited Title 8 CCR section in the Elements column. In the Evidence Summag column. specify ea tem of evidence found during the inspection which substantiates the descriptive element (eg. hazards. Operation, equipment. location and/or measurements). Uncle Tygets) of Evideng specify the classi?cation of the evidence described under Evidence Summary. Observation (OB). Employer Admission, (EA). Employer Oral Statement(EOS). Other Oral Statement (008). Employer Written Statement (EWS). Other Written Statement (0W8). Photograph (PH). Business Record (BR). Document (DO). Sample Measurement (SM). Monitoring Measurement (MM). Equiprnent/Partsir Machinery (EPM). Other. please specr?y. Types of Elements Evidence Summary . EVidence 1. The permit shall be posted under glass in a 1. A permit for the lngersoll Rand air compressor located PH conspicuous place on or near the air tank or . . near the employee security check-in area expired in 1983. 2. in a weatherproof container secured to the unit. and 2. The permit posted was in a weatherproof container PH 3. shall be available at all times to any quali?ed secured to the wall above the unit. inspector. 3. The updated permit was not available or sent to the DO inspector as requested on the Document request Form (1AY) until 09/15/2015. Photo Comments: 3764-69 Additional Witness Documentation-List the name. address and phone number of each person having percipient information of the factual elements in above. After name list the element numbers from above which the person is able to personally verify. Citation Classi?cation: a. Assuming that an accident or exposure occurs. what are the liker consequences? Regulatory violation. b. Actual Mangement Knowledge; or Constructive Management Knowledge (check below all that apply): DViolation Common Practice At Jobsite Accident At Jobsite Previously From Same Violation(s) I: Proximity of Supervisors To Violation Special Duty To Inspect-Competent Person At Excavation DViolation Readily Visible to Anyone Passing By [3 Employer Received Complaints From Other Employees of Violative Condition DObligation Anticipated: Foreseeable Hazards Asbestos Containing Construction Materials in Older Buildings) Condition Existed Long Enough For Employer Awareness .Other (Please State) 0. Documentation as to Why Violation is Serious. General or Regulatory Posting requirement. Use the Documentation Worksheet to document evidence of any of the following: d. Prior Violations (Repeat) e. Intention. Knowing Reckless Conduct (Willful)-Willful Elements Worksheet must be attached. f. Failure to Abate OSHA 4811 Bil-l (Rev. 9193) State of California . Division of Occupational Safety and ,-alth Ins ection Number 1084143 DOCUMENTATION WORKSHEET . Oppt- Insp' Number 003_ 1 6 Establishment Name Blue Apron, lnc. Type of Violation Regulatory Citation Number 1 Item/Group 2 Number Exposed No. Instances 1 REC Std. Alleged Viol. 3203(b)(1) Abatement MultiStep Abatements Final Abatement Action Type/Dates Period PPE Period Plan Report 30 Abatement Documentation Required I Date Veri?ed I I [Substance Codes I . . fAVD/Variable Information 8CCR 3203(b)(1): Records of scheduled and periodic inspections required by subsection to identify unsafe conditions and work practices, including person(s) conducting inspection, the unsafe conditions and work practices that have been identified and action taken to correct the identified unsafe conditions and work practices. These records shall be maintained for at least one (1) year. Prior to and during the course of the inspection, including, but not limited to August 14, 2015, the employer did not ensure that records of scheduled and periodic inspections to identify unsafe conditions and work practices, including person(s) conducting the inspection, the unsafe conditions and work practices that have been identi?ed and action taken to correct the identi?ed unsafe conditions and work practices were conducted and maintained for at least one year. Penalty Calculations . Seve Probabil Adjustment Factors Proposed, Adjusted Size Good Faith Penalty 0% 15% 0% $425.00 Repeat Factor Employee Exposure: pahon mp ame Address Em Duration pahon Em r0 Duration Address Rhone FTA Y1691 IOPT. 003 1 5 12 Aug 2015 IISSUE Severity Extent Likelihood Total Adj. Factors Ll .le .lHl isi Li Li 15% OSHA -'iBi'1BlH (Rev. 9l93) Page . . i . . . BLUE APRON, INC. Inspection Nr.108414- Citation Nr. 1 Item/Group 2 Elemental Analysis-List numerically each descriptive element of the cited Title 8 CCRI section in the Elements column. In the Evidengg Summag column, specify ea tern of evidence found during the inspection which substantiates the descriptive element (eg. hazards, operation, equipment. locatiOn andlor measurements). Unde . Typelst of Evidence specify the classi?cation of the evidence described under Evidence Summary. Observation (OB). Employer Admission. (EA). Employer Oral Statement (EOS). Other Oral Statement (008). Employer Written Statement (EWS). Other Written Statement (OWS), Photograph Business Record (BR). Document (DO). Sample Measurement (SM), Monitoring Measurement (MM), EquipmentlF?artsil Machinery (EPM). Other: please speci?y. Types of Elements - . Evidence Summary - EVidence 1. Records of scheduled and periodic inspections 1. Scheduled and periodic inspections not conducted or DO required by subsection to identify unsafe . maintained as requested on the Document Request Form conditions and work practices, WW) and as stated in the employer's IIPP. 2. including person(s) conducting inspection, 2. 3. the unsafe conditions and work practices that have 3. been identi?ed and action taken to 4. Scheduled and periodic inspections not conducted or DO, OB 4. correct the identi?ed unsafe conditions and work maintained as requested on the' Document Request Form practices. These records shall be maintained for at least (1AY). i one (1) year. Exception: Employer with 10 employees may elect to maintain inspection records only until the hazard is corrected. - Photo Comments: 3698-3773 Additional Witness Documentation-List the name, address and phone number of each person having percipient information of the factual elements in above. After name list the element numbers from above which the person is able to personally verify. Citation Classi?cation: a. Assuming that an accident or exposure occurs. what are the likely consequences? Regulatory violation. b_ DActual Mangement Knowledge; or Constructive Management Knowledge (check below all that apply): DViolation Common Practice At Jobsite [3 Accident At Jobsite Previously From Same Violation(s) El Proximity of Supervisors To Violation - Special Duty To Inspect-Competent Person At Excavation DViolation Readily Visible to Anyone Passing By Employer Received Complaints From Other Employees of Violative Condition Obligation Anticipated: Foreseeable Hazards Asbestos Containing Construction Materials in Older Buildings) Condition Exisled Long Enough For Employer Awareness Other (Please state} c. Documentation as to Why Violation is Serious, General or Regulatory Record keepingviolation. Use the Documentation Worksheet to document evidence of any of the following: (1. Prior Violations (Repeat) . e. Intention, Knowing Reckless Conduct Elements Worksheet must be attached. f. Failure to Abate OSHA -1enaIH (Rev. 9:93) State of California Division of Occupational Safety and Jalth I Inspection Number 1084143 DOCUMENTATION WORKSHEET Opt. Insp. Number 003 1 6 Establishment Name Blue Apron, Inc. . 7 Type of Violation General Citation Number 1 ltemfGl?OUP 3 Number Exposed 7 No. Instances 2 REC Std. Alleged Viol. 2340.2(b) Abatement MultiStep Abatements Final Abatement Action Type/Dates Period PPE Period Plan Report 30 Abatement Documentation Required I I Date Verified I Substance Codes I AVDNariable Information 8CCR Installation and use. Listed or labeled equipment shall be installed and used in accordance with any instructions included in the listing or labeling. Prior to and during the course of the inspection, including, but not limited to August 14, 2015, the employer did not ensure that listed or labeled equipment, such as surge protectors and flexible extension cords located in the Packaging area connected to the. 3M-Matic Case Sealing machine, were installed and used in accordance with any instructions used in the listing or labeling. Penalty Calculations Adjustment Factors Proposed Adjusted Severity Probability Gravity GBP Size Good Faith - History Penalty 1000 -250 -250 500 0% 15% 0% $210.00 Repeat Factor Employee Exposure: Occupation Packing Associate Employer Blue Apron, Inc. Mr of Employees 7 Duration 8 hours I Frequency I Daily Employee Name Unknown Employee Em ro rn n1 {955' Duration Phone FTA I IESHOIDI Y1691 003 _10 12Aug 2015 IISSUE DATEI Severity - Extent Likelihood Total Adj. Factors Llr'lMl 15% OSHA (Rev. 9193) Page . i i BLUE APRON, INC. Inspection Nr.108414c Citation Nr. 1 Item/Group 3 Elemental Analysis-List numerically each descriptive element of?the cited Title 8_ CCR section in the Elements column. In the Evidence Summary column. specify ea tem of evidence found during the inspection which substantiates the descriptive element (eg. hazards. operation. equipment. location and/or measurements). Unde Tygets) of Evidence specify the classi?cation of the evidence described under Evidence Summary. Observation (OB), Employer Admission, (EA), Employer Oral Statement (EOS). Other Oral Statement (008). Employer Written Statement (EWS). Other Written Statement (0W5). Photograph (PH), Business Record (BR). Document (DO). Sample Measurement (SM), Monitoring Measurement (MM). Equipmenthartsr? Machinery (EPM). Other: please speci?y. . Types of Elements Evidence Summary EVidenCB 1. Listed or labeled equipment Surge protectors powering the 3M-Matic Case Sealing PH 2. shall be installed and used in accordance with any System. instructions included in the listing or labeling. 2. The surge protectors were daisy chained to each other PH and to extension cords to get power to the 3M-Matic Case Sealing System. Photo Comments: 3739-46 Additional Witness Documentation-List the name, address and phone number of each person having percipient information of the factual elements in above. After name list the element numbers from above which the person is able to personally verify. Citation Classi?cation: a. Assuming that an accident or exposure occurs. what are the likely consequences? Electric shock. thermal burns. b_ DActual Mangernent Knowledge; or Constructive Management Knowledge (check below all that apply): DViolation Common Practice At Jobsite '3 Accident At Jobsite Previously From Same Violation(s) Proximity of Supervisors To Violation Special Duty To Inspect-Competent Person At Excavation. EViolation Readily Visible to Anyone Passing By Employer Received Complaints From Other Employees of Violative Condition EIObligation Anticipated: Foreseeable Hazards Asbestos Containing Construction Materials in Older Buildings) Condition Existed Long Enough For Employer Awareness Other (Please 51318) 0. Documentation as to Why Violation is Serious, General or Regulatory Not a regulatory. The potential injuries do not ?t the serious de?nition in BCCR 330(h). Use the Documentation Worksheet to document evidence of any of the following: d. Prior Violations (Repeat) e. intention, Knowing Reckless Conduct (Willful)-Willfui Elements Worksheet must be attached. f. Failure to Abate OSHA -1BI1BIH (Rev. 9193) State of Callfomla of Occupallonal Salely and eallh Inspecmm Number 1084143 DOCUMENTATION WORKSHEEY Opt Numbev 0037 16 Name Blue Apron Type of Vtolatlon General Citatlon Number 1 ltem/Group 4 Number Exposeo 11 No Instances 1 REC 5m Alleged \fiol 2500 101a) Abatement Abalemems Flnal Aba|emem Acllun Type/Dates Femd PPEPenod Plan Report {Ibalemem Documentallon Required Dale Venfled Substance Codes AVD/Variable lnlormatlon BCCR 2500 10(3) Flexlble cords and cables shall be connected to deytoes and so that s|ram reltel is proytdeo prevent pull lrom belng directly to or termlnal screws to and during me course at the lnspectton' mcludtng. but nal Ilmlted to August 14' 2015,1712 employer did not ensure mat the flexmle com connected to the tan the area was plavlded w1tn straln rellEHo protect pull lransmmed to yolnls ano termlnal screws Penale Calculattons Adjustment Factors Proposed Adjusted Seventy Gravity GBP SIZE Good Falm Htstory Pena'ly 1001: .250 -250 500 0% 15% 0% $210 00 Repeat Factor Employee Exposure' Occupatton Employer Blue Apron' lnc. Nr 01 Employees Duratlon 8 News Frequency 1 Dally Employee Name Occupallorl Employer Nr o1 Employees Duratton Frequency 'Emptoyee Name Address Phone FTA ESHOID V1691 OPT RPM 003 -- 16 12Aug 2015 ISSUE DATE Seventy Extent leetmoou Tolal Adj Factors MI ls HI 15% osmmemm amt Page ,u i A i BLUE APRON, INC. inspection Nr.10841iio Citation Nr. 1 ltemlGroup 4 Elemental Analysis-List numerically each descriptive element of the cited Title 8 CCR section in the Elements column. In the Evidence Summam column, specify ea tem of evidence found during the inspection which substantiates the descriptive element hazards, operation, equipment, location andlor measurements). Unde Typem of Evidence specify the classi?cation of the evidence described under Evidence Summary. Observation (OB), Employer Admission, (EA). Employer Oral Statement (EOS). Other Oral Statement (008). Employer Written Statement Written 5 Statement (OWS), Photograph (PH). Business Record (BR). Document (DO). SampleMeasurement (SM). Monitoring Measurement (MM), EquipmenUPartsl Machinery (EPM). Other: please speci?y. - . Types of Elements Evidence Summary Evidence 1. Flexible cords and cables 1. Flexible cord connected to the fan in the shipping area. PH 2. shall be connected to devices and ?ttings 2. The cord was connected to the fan. PH 3. so that strain relief is provided which will prevent pull 3. Strain relief at the end of the cord was not provided. PH from being directly transmitted to joints or terminal Pull was being transmitted on the joints and/or terminal screws. . screws. Photo Comments: 3757-59 Additional Witness Documentation-List the name. address and phone number of each person having percipient information of the factual elements in above. After name list the element numbers from above which the person is able to personally verify. . i Citation Classi?cation: 3. Assuming that an accident or exposure occurs. what are the likely consequences? Electric shock. thermal burns. b. UActual Mangement Knowledge; or Constructive Management Knowledge (check below all that apply): DViolation Common Practice At Jobsite I: Accident At Jobsite Previously From Same Violation(s) 8 Proximity of Supervisors To Violation Special Duty To Inspect-Competent Person At Excavation EViolation Readily Visible to Anyone Passing By Employer Received Complaints From Other Employees of Viotative Condition ?3 Obligation Anticipated: Foreseeable Hazards Asbestos Containing Construction Materials in Older Buildings) Condition Existed Long Enough For Employer Awareness Other (Please 51318) c. Documentation as to Why Violation is Serious, General or Regulatory Not a regulatory. The potential injuries do not ?t the serious definition in BCCR 330(h). Use the Documentation Worksheet to document evidence of any of the followingf d. Prior Violations (Repeat) . e. Intention. Knowing Reckless Conduct (Willful)-Willfu Elements Worksheet mus_t be attached. f. Failure to Abate OSHA 11811 BIH (Rev. 9N3) State of California Division of Occupational Safety and .ealth . - Ins ection Number 1084143 DOCUMENTATION WORKSHEET OF: Insp- Number 003_ 1 6 Establishment Name Blue Apron, Inc. Type of Violation General Citation Number 1 Item/Group 5 Number Exposed 7 No. Instances 1 REC Std. Alleged Viol. 2500.25 Abatement MultiStep Abatements Final Abatement Action Type/Dates PeriOd PPE Period Plan Report 30 Abatement Documentation Required I I Date Verified Substance Codes I [AVDNariable Information 8CCR 2500.25: Flexible cords shall be repaired or replaced if the outer sheath is damaged such that any conductor insulation or conductor is exposed. Repair of the outer sheath shall only be permitted if the conductors are not damaged and the completed repair retains the insulation, outer sheath properties, and usage characteristics of the cord being repaired. Prior to and during the course of the inspection, including, but not limited to August 14, 2015, the employer did not ensure that the yellow flexible extension cord located in the Packing area connected to the 3M-Matic Sealing machine #1 was repaired or replaced when the outer sheath was damaged such thatthe conductor insulation was exposed. Penalty Calculations Adjustment Factors Proposed Adjusted Severity Probability Gravity GBP Size Good Faith History Penalty 1000 -250 7 -250 500 0% 15% 0% $210.00 Repeat Factor Employee Exposure: Occupation Packing Associate Employer Blue Apron, Inc. Nr of Employees 7 Duration 8 hours Frequenciy I Daily Employee Name Unknown Employee Address 3151 Regatta Blvd. 360 Phone Richmond, CA 94804 888?278?5594 pation 7 Em Duration Address Phone FTA IESHOIDI Y1691 IOPT.RPT 003 1 6 12Aug 2015 DATEI Severity Extent Likelihood Total Adj. Factors lH.l isi Liximi 15% OSHA (Rev. 9193) Page . . - . BLUE APRON, Inspection Nr.108414- Citation Nr. 1 Item/Group 5 Elemental Analysis-List numerically each descriptive element of the cited Title 8 CCR section in the Elements column. In the Evidence Summary column. specify ea lem of evidence found during the inspection which substantiates the descriptive element hazards, operation. equipment. location andlor measurements). Unde Typets) of Evidence specify the classi?cation of the evidence described under Evidence Summary. Observation (OB). Employer Admission. (EA). Employer Oral Statement (EOS). Other Oral Statement (008). Employer Written Statement (EWS). Other Written Statement (OWS). Photograph (PH). Business Record (BR). Document (DO). Sample Measurement (SM). Monitoring Measurement (MM). Equipmenthartsl Machinery (EPM). Other: please speci?y. . Types of Elements . . Evidence Summary EVidence 1. Flexible cords 1. Yellow flexible extension cord todated in the Packaging PH 2. shall be repaired or replaced area. 3. if the outer sheath is damaged such that any 2. The yellow cord was not repaired or replaced. PH conductor insulation or conductor is exposed. 3. The outer sheath was damaged and the internal PH 4. Repair of the outer sheath shall only be permitted if insulated conductors were visible. the conductors are not damaged and 4. NIA 5. the completed repair retains the insulation, outer 5. . sheath properties, and usage characteristics of the cord being repaired. Photo Comments: 3739-46 Additional Witness Documentation-List the name. address and phone number of each person having percipient information of the factual elements in above. After name list the element numbers from above which the person is able to personally verify. - - Citation Classi?cation: a. Assuming that an accident or exposure occurs. what are the likely consequences? Electric shock, thermal burns. b. DActual Mangement Knowledge; or Constructive Management Knowledge (check below all that apply): Violation Common Practice At Jobsite Accident At Jobsite Previously From Same Violation(s) Proximity of Supervisors To Violation Special Duty To Inspect-Competent Person At Excavation EViolation Readily Visible to Anyone Passing By - (Employer Received Camplaints From Other Employees of Violative Condition Obligation Anticipated: Foreseeable Hazards Asbestos Containing Construction Materials in Older Buildings) Condition Existed Long Enough For Employer Awareness '3 .Other (Please stale) Documentation as to Why Violation is Serious. General or Regulatory Not a regulatory. The potential injuries do not ?t the serious de?nition in 8CCR 330(h). Use the Documentation Worksheet to document evidence of any of the following: d. Prior Violations (Repeat) e. intention. Knowing Reckless Elements Worksheet must be attached. f. Failure to Abate OSHA (Rev. 9193) State 0' Californta Dlvislon 0i Occupational Saler anc ealth lnspectroh Number 1054143 DOCUMENTATION WORKSHEET 0m my. Number 003_ 16 Name IBlue Apron the Type ol vlolatron General cltatron Number them/Group 5 Number Exposed 242 No Instances 1 Sta Alleged Vrol 3210(5) Abatement Abalemenls Ftnal Abatement Actlon Type/Dales Period PPE Period Plan Repon 30 Abatement Documentatlon' Requlred Date Vellned Substance Codes AVDNarlable lntormatlon BCCR azlota) Guardralls shall he proyroeo on all open Sldes ot unenclosed eleva|ed work locatlorls' such as root open and glazed states or lanomgs, oalconles or porches, platforms runways. ramps levels more than 30 metres above the lloor, ground' or otherworlan areas or a ourtolng as defined rn Secuon 3207 of the GISO Where overhead clearance rhstallatlon ol a 42-inch guardratl a tower rat or rarls shall be rnstallen The shall be plovtded a where the platform runway or ramp l5 5 leet or more above places where employees normally work or pass and the lack ota toeboaro could create a hazard lrom tools' material, oreoulpment, Prlor to and ounng the course or the inspectton, lncludlng' but not to August 14, 2015' the employer am not ensure that the and the platlorrn located tn the tollowtng areas were equlpped guardratls on all open sloes 1 Room emergency extt platlorm- 54" to concrete ground Penalty calculatrons Adjustment Factors Proposed Adjusted Seventy Probabiltiy Gravtty GBF slze Good Falth Htstory Penalty 1500 0 F375 tars 0% 15% 0% $795 00 Repeat Factor Employee Exposure. occupatron warehouse/Recenan Employer Blue Apron, Inc NrolEmptoyees Duratton Bhours Frequency Dally Employee Name Address Phone -- Occupatton Employer Blue Apron Nrol Employees 7 Duratrou shouts Frequency uarly Employee Name -- FTA ytsat DPT 003 -- leug 2015 ISSUE DATE Seventy Extent "/aTolalAdl Factors :g 5% ustu renew" may Page Blue Apron. Inc lnspeclron Nr 1054143 .allan Nr llem/Gmup 6 Employee Exposure Occupeuon Food Packmg Employer Blue Apron, Nr cl Employees Durallon 8 hours Frequency Dally Employee Name Address Phone -- Occupalron Knack Employer alue Apron Inc Mr of Employees "4 Duralron 5 hours Frequency Dally Employee Name Address Phone Occupatlon Employer Nr pl Employees nurallon Frequency Employee Name Address Fnone Cecupeuon Employer Nr el Employees Duranon Frequency Employee Name Address Phone oecupelran Employer Nr cl Employees Durallon Frequency Employee Name Address Pnone Occupalron Nr 01 Employees Durauon Frequency Employee Name Address Phone Occupallen Employer Nr 01 Employees Durzhon Frequency Employee Name Address Fnone Page BLUE I Inspection Nr.10841?.- Citation Nr. 1 Item/Group 6 Elemental Analysis-List numerically each descriptive element of the cited Title 8 CCR section in the Elements column. In the Evidence Summag column, specify ea tern of evidence found during the inspection which substantiates the descriptive element (eg. hazards, operation, equipment. location and/or measurements). Unde Tyge(s) of Evidence specify the classi?cation of the evidence described under Evidence Summary. - Observation (OB), Employer Admission. (EA), Employer Oral Statement (EDS), Other Oral Statement (008), Employer Written Statement (EWS), Other Written Statement (OWS), Photograph (PH), Business Record (BR), Document (DO), Sample Measurement (SM), Monitoring Measurement (MM), EquipmentIPartSir Machinery (EPM), Other: please specifiy. A . . Types of Elements Evidence Summary EVidence 1. Guardrails shall be provided on all open sides of 1. Guardrails were not provided on the open side of a 54" PH, unenclosed elevated work locations, such as: rdof platformilanding that the Packing area emergency exit openings, open and glazed sides of landings, balconies lead to. or porches, platforms, runways; ramps or working levels 2. NA NA more than 30 inches above the ?oor, ground, or other 3. working areas of a building as defined in Section 3207 of 4. - the GISO. 2. Where overhead clearance prohibits installation ofa 42-inch guardrail, 3. a lower rail or railsshall be installed. 4. The railing shall be provided with a toeboard where the platform, runway, or ramp is 6 feet or more above places where?employees normally work or pass and the lack of a toeboard could create a hazard from falling tools, material, or equipment. Exceptions: See exceptions 1 through 13. Photo Comments: 3760-63 Additional Witness Documentation-List the name. address and phone number of each person having percipient information of the factual elements in above. After name list the element numbers from above which the person is able to personally verify. Citation Classi?cation: . a. Assuming that an accident or exposure occurs, what are the likely consequences? Fractures, lacerations, contusions. b. DActual Mangement Knowledge; or Constructive Management Knowledge (check below all that apply); DViolation Common Practice At Jobsite [3 Accident At Jobsite Previously From Same Violation(s) Proximity of Supervisors To Violation Special Duty To Inspect-Competent Person At Excavation EViolation Readily Visible to Anyone Passing By [3 Employer Received Complaints From Other Employees of Violative Condition DObligation Anticipated: Foreseeable Hazards Asbestos Containing Construction Materials in Older Buildings) Condition Existed Long Enough For Employer Awareness other (Please State) c. Documentation as to Why Violation is Serious, General or Regulatory Not a regulatory. The potential injuries do not fit the serious definition in BCCR 330(h). Use the Documentation Worksheet to document evidence of any of the following: d. Prior Violations (Repeat) e. Intention, Knowing Reckless Conduct (Willful)-Willful Elements Worksheet must be attached. f. Failure to Abate OSHA -1BI1BIH (Rev. 953) State 0' Callfornla of Occupational Saler ano ealth Inspeetron Number 1084143 DOCUMENTATION WORKSHEET om In" Numb" 00% '6 Establishment Name Apron, Inc Type ol VIolatIon General brtatrc'rn Number 1 Item/Group 7 Number Exposed I 2 No Instances REC Alleged Vlol 5164(a) Abatement Abatements Abatement Aclron Type/Dales Perlod PPEPerlod l=Ian Report an ytbetentent Documentation Required Date yen led Substance Codes |2260y 0040. 2150' 2590 AVDNalIable InVolmatIon scar? 5164(3) Substances when mrxed, react vlolenlly, or evolve onlc vapors or gases, or In combrnatron become hazardous by reason o1 power, or other propenles' shall be evaluated before stonng lncompanble substances shall be separated lrarn each other In storage by drstance, or by pamfions' dIkEs, perms, secondary contatnrnent or otherwrse, su as preclude accrdental contact between them Pnor to and durlhg the course ol the Inspechon, Includlng, but not named In August 14' 2m5, Ihe employer not ensure that substances when rnrxed. react violently, evolve toxrc gases, and In combrnahon become hazardous by reason cl llammabrIIty or other propenies, were evaluated tor compatibrlity prior to storrng Penalty Calculallons Adyustment Fac|ors Proposed Adrusted Seventy I Probablhw Gravlly GEP srze Good Fallh Hlstory Fenalw 1000 I 7250 e250 500 0% 15% 0% $210 00 Repeat Factor Employee Exposure Eccupatlon Marntenance Tech Employer Blue Apron Inc Mr pl 2 Durahon 3 hours Frequency Dauy Employee Name Address 3151 Regatta 850 phone mond, CA 94304 5559735594 Owupatron Employer Nr ol Employees Duratron Frequency Employee Name Address Phone FTA ESHO ID Y1691 OPT RPT 3 16 12 Aug 2015 ISSUE DATE Sevelily Exlent Likelihood TotaI Ady Factors I I 15% osu waters". sisal I. Page BLUE APRON, INC. Inspection Nr.108414- Citation Nr. 1 ltemlGroup 7 Elemental Analysis-List numerically each descriptive element of the cited Title 8 CCR section in the Elements column. In the Evidence Summary column, specify ea tem of evidence found during the inspection which substantiates the descriptive element (8.9. hazards, operation. equipment, location andlor measurements). Unde Tyge(s) of Evidence specify the classi?cation of the evidence described under Evidence Summary. Employer Admission, (EA), Employer Oral Statement (EOS), Other Oral Statement (008), Employer Written Statement (EWS), Other Written Statement (0W8). Photograph (PH). Business Record (BR), Document (DO). Sample Measurement (SM), Monitoring Measurement (MM), Equipmenthartsl Machinery (EPM), Other: please speci?y. Types of Elements Evidence Summary EVidence 1. Substances which, when mixed, react violently, or 1. Zep Driveway Concrete Pressure Wash (corrosive - PH, DO evolve toxic vapors or gases, or which in combination caustic soda - Sodium Hydroxide) stored with spray paint become hazardous by reason of toxicity, oxidizing cans (?ammable) and paints (flammable). The mixture of power, ?ammability, explosibility, or other properties, caustics and ?ammables cause violent heat and gas 2. shall be evaluated for compatibility before storing. generation. - 3. Incompatible substances shall be separated from 2. The chemicals were not evaluated prior to storing. OB each other in storage by distance, or by partitions, dikes, 3. The chemicals were stored in a metal storage cabinet PH berms, secondary containment or othenivise, so as to on different shelves in the maintenance area. preclude accidental contact between them. Note: Some typical examples of such incompatible substances are: Mineral acids and oxidizing agents; mineral acids and cyanides; oxidizing agents and combustible materials; acids and alkalis. Photo Commentsz3771-73 Additional Witness Documentation-List the name. address and phone number of each person having percipient information of the factual elements in above. After name list the element numbers from above which the person is able to personally verify. Citation Classi?cation: 3. Assuming that an accident or exposure occurs. what are the likely consequences? Chemical burns, thermal burns, respiratory illnesses. b. EIActual Mangement Knowledge; or Constructive Management Knowledge (check below all that apply): Violation Common Practice At Jobsite Accident At Jobsite Previoust From Same Violation(s) Proximity of Supervisors To Violation El Special Duty To Inspect-Competent Person At Excavation DViotation Readily Visible to Anyone Passing By Employer Received Other Employees of Violative Condition Obligation Anticipated: Foreseeable Hazards Asbestos Containing Construction Materials in Older Buildings) Condition Existed Long Enough For Employer Awareness other (Please state) c. Documentation as to Why Violation is Serious. General or Regulatory Not a regulatory. The potential injuries do not ?t the serious de?nition in BCCR 330(h). Use the Documentation Worksheet to document evidence of any of the following: d. Prior Violations (Repeat) e. Intention. Knowing Reckless Conduct (WillfuI)-Willful Elements Worksheet must be attached. f. Failure to Abate OSHA 431mm (Rev. 9193) State of Callfornla Division of Occupational Saiety ant) ealih lnspection Numbel 1034143 DOCUMENTATION WORKSHEET 0m Numbev 003_ 16 Establishment Name Blue Apron lnc, Type or Violation General itation Number i item/Group a Number Exposed 215 No Instances 1 REC Alleged Viol steatgitsi Abatement MulliSlep Abatements Final Abatement Aclioh Typyoates Paliod PPE Period Plan Reporl 30 Abatement Documentation Required LDaie Vellfied ubstance Codes 1430' 0175, 5227, 23m, 2260 AvDNarlable Ihiurmatlon 5194(g)(8) The employer shall maintain copies ol the requlred material savory data sheets lor each hazardous substance in the workplace and shall ensure that they are readily accessible during each work shilt to employees when they are in their work areas (Electronic access microfiche, and other alternative to maintaining paper copies or the material salery data sheets are permitted as long as no barriers to immediate employee access in each workplace are created by such options) Prior to and during the course ol the inspection, including out not timileo to August 14' 2015. the employer did not ensure that copies at the required material salety data sheets eacn hazardous substance in the workplace were readily accessible durlng each work enilt to employees when they are in their work areas Penain Calculations Adiustment Factors Proposed Ad iusleo Severlly Probability Gravity GBP size Good Faith History Fe"le mm) .250 -250 500 0% 15% 0% 52m 00 Repeat Factor Employee Exposure Occupation Food Packing Employer Blue Apron, inc Nr of Employees 2i 5 Duration a hours Frequency Dariy we Occupation Employer Blue Apron, inc. NI ol Employees Duratlon Frequency Employee Name Address Phone FTA ESHO ID Y1691 OPT RPT a 3 -- 15 12 Aug 2015 ISSUE DATE Severity Extent Likelihood are Total Adi Factors 15% aw soai Page . - . .lnspection Nr.1oa41i.- Citation Nr. 1 Item/Group a Elemental'Analysis-List numerically each descriptive element of the cited Title 8 CCR section in the Elements column. In the Evideng Summau ea tem of evidence found during the inspection which substantiates the descriptive element hazards. operation. equipment. location and/or measurements). Unde Typets) of Evidence specify the classi?cation of the evidence described under Evidence Summary. Observation (OB). Employer'Admission. (EA). Employer Oral Statement (EOS). Other Oral Statement (008). Employer Written Statement (EWS). Other Written Statement (OWS). Photograph (PH), Business Record (BR). Document (DO). Sample Measurement (SM). Monitoring Measurement (MM). Equipmentharts! Machinery (EPM), Other: please speci?y. . Types of Elements Evidence Summary EVidenCB 1. The employer 1. Blue Apron, Inc. as per their business license. BR 2. shall maintain copies of the required material safety 2. Copies of each hazardous substance in the work area DO. PH, data sheets for each hazardous substance in the . was not maintained for employees on each shift. OB workplace . Hazardous chemicals in the Food Packing area included. 3. and shall ensure that they are readily accessible, but were not limited to, Diversey Signet Hard Surface during each work shift to employees when they are in A Sanitizer (corrosive), Diversey Signet Heavy Duty their work areas. Non-Acid Washroom Cleaner/Disinfectant (corrosive), and (Electronic access. micro?che. and other alternative to Meritech Self-Clean Solution (corrosive). maintaining paper copies of the material safety data 3. The Right to Know binder located in the Food packing PH, OB sheets are permitted as long as no barriers to immediate area was empty. employee access in each workplace are created by such options). Photo Comments: 3715-22. 3771-73 Additional Witness Documentation-List the name. address and phone number of each person having percipient information of the factual elements in above. After name tist the element numbers from above which the person is able to personally verify. Citation Classi?cation: a. Assuming that an accident or exposme occurs. what are the likely consequences? Chemical burns. respiratory illnesses, mucous membrane burns, corneal injuries. b_ DActual Mangement Knowledge; or [Constructive Management Knowledge (check below all that apply): Violation Common Practice At Jobsite [3 Accident At Jobsite Previously From Same Violation(s) Proximity of Supervisors To Violation Special Duty To Inspect?Competent Person At Excavation EViolation Readily Visible to Anyone Passing By Employer Received Complaints From Other Employees of Violative Condition DObligation Anticipated: Foreseeable Hazards Asbestos Containing Construction Materials in Older Buildings) Condition Existed Long Enough For Employer Awareness Other (Please SlateDocumentation as to Why Violation IS Serious. General or Regulatory Not a regulatory. The potential injuries do not ?t the serious definition in BCCR 330(h). Use the Documentation Worksheet to document evidence of any of the following: d. Prior Violations (Repeat) e. Intention. Knowing Reckless Conduct (Witlful)-Willfut Elements Worksheet must be attached. f. Failure to Abate - OSHA 9193) State at Callfornla of Occupational Safety ant. DOCUMENTAYION WORKSHEET salth Inspecllon Number 1084143 Opl Insp Number 003-- 15 Name Blue Apron Inc Type or Vlolallon Sencus Cllatron Number 2 Item/Group Number Exposed 15 No Instances REC Alleged Vrol 5185(n) Abalemem Mulustep Abatements Perlod PFE Perlod Plan Report Flnal Abatement Aclron Type/Dates 7 batemenl Documentatlon Requlred Dale Verlfled SubstanceCodes 2310'1591 AVDNanaoIe lnformalton BCCR 5155(n) [or qulck or or llre eyes and body shall be provrded ln accordance Seclton 5162 unless the storage oettenes are equrpped reslstent or flame arreslol type vents or (2) located ln a compartment or other locetlpn such as to preclude employee exposure Prior to end durrng the course ol the mspectlan, moludrng but no! Irmrted to August 12, 2015' me employer not ensure for qurolt or the eyes and may was proylded ln Ihe Recewmg area where a Crown Rcaauo SN 1A289356 standup truolt rs charged Penalty Calculetlons Adjustment Factors Proposed Adjusted seventy Gravin GEP Size Good Falln Hlslory Penalw 15000 4500 .4500 9000 0% 15% 0% 59000 00 Repeat Fac|or Employee Exposure 'Uocupatrorl Employer Blue Apron Nra? Employees 15 Duratlon 10 mrnutes Frequency Daily Employee Name Address Phone Oecupetlon Employer Employees Duratlon Frequency 'Employee Name Address Phone FTA Y1691 OPT 3 -- 12Aug 2015 ISSUE DATE Seventy Extent leelrhood Total Adr Factors tells-Howey rear Page BLUE APRON. INC. Inspection Nr.1084=. . . Citation Nr. 2 ItemlGroup 1 Elemental Analysis-List numerically?each descrigtivg element of the cited Title 8 CCR section in the Elements column. In the Evidence Summa? column. specify ea tem of evidence found during the inspection which substantiates the descriptive element (9.9. hazards. operation. equipment. location andfor measurements). Uncle Tygets) of Evidence specify the classi?cation of the evidence described under Evidence Summary. . Observation (OB). Employer Admission. (EA). Employer Oral Statement (EOS). Other Oral Statement (008). Employer Written Statement (EWS). Other Written Statement (OWS). Photograph (PH). Business Record (BR). Document (DO). Sample Measurement (SM). Monitoring Measurement (MM). Equipmenthartsl Machinery (EPM). Other: please speci?y. Types of . Elements Evidence Summary EVidence 1. Facilities for quick drenching or flushing of. the eyes 1. An emergency wash and shower was not provided - PH. OB and body where the Crown R0300 Series standup lift truck SN: 2. shall be provided in accordance with Section 5162 1A289366 is charged. unless the storage batteries are: 2. 1. An emergency wash and shower was not PH, OB 3. (1) equipped with explosion resistant or ?ame provided where the Crown R0300 Series standup lift truck arrestor type vents; or SN: 1A289366 is charged. 4. (2) located in a compartment or other location such 3. The batteries were not equipped with explosion PH. DO as to preclude employee exposure. resistant or flame arrestor type vents. The SDS references vents. however, it does not indicate that they are explosion resistant or ?ame arrestors. 4. The charging of the battery was not located in a PH compartment or a location that would preclude employee exposure. Photo Comments: 3702-03 Additional Witness Documentation-List the name. address and phone number of each person having percipient information of the factual elements in above. After name list the element numbers from above which the person is able to personally verify. Citation Classi?cation: a. Assuming that an accident or exposure occurs. what are the likely consequences? Death. blindness. chemical burns. thermal burns. lacerations. b. DActual Mangement Knowledge; or Constructive Management Knowledge (check below all that apply): Emulation Common Practice At Jobsite El Accident At Jobsite Previously From Same Violation(s) Proximity of Supervisors To Violation Special Duty To Inspect?Competent Person At Excavation EViolation Readily Visible to Anyone Passing By Employer Received Complaints From Other Employees of Violative Condition Dooligation Anticipated: Foreseeable Hazards Asbestos Containing Construction Materials in Older Buildings) Condition Existed Long Enough For Employer Awareness Other (Please Stale) c. Documentation as to Why Violation is Serious. General or Regulatory Not a regulatory or a general. The potential injuries fit the serious de?nition in BCCR 330(h). Use the Documentation Worksheet to document evidence of any of the following: d. Prior Violations (Repeat) I e. Intention. Knowing Reckless Conduct (Willful)-Willfu Elements Worksheet must be attached. f. Failure to Abate OSHA (Rev. 933) State of California . DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF OCCUPATIONAL SAFETY AND HEALTH DOCUMENTATION WORKS 1. Establishment Name: 2. Page 1 of 1 Blue Apron, Inc. 3_ The company is engaged in; Cold storage and preishable food preperationlshipping. using the following operation(s) Slicing, bagging, fork lifts and standing cherry pickers for storage. 4. Description of equipment, processes and raw materials used in the operation(s) Raw fruits and vegetables, small augers for flour siftiung and bagging. small conveyor systems. 5. Flow Diagram: No Page Sketch or map No Page 6. Production rates are: 7. Work Hours24 hours/day 8. The company's building or worksite consist of: 100,000 sq ft El [:ISafety Belts, etc. 9. Ambient weather conditions were: Sunny 10. Windows and/or doors were: Closed 11. Heating system: Off 12. Air Conditioning: Yes Other Excavation, Trenches, Earthwork Vehicles, Traf?c Control Floor. Roof Wall Openings Scaffolds Ladders I: Saws-power Powder-Actuated Tools Misc. Construction Tools 8. Equip. [1 Roo?ng Operations Equipment Process Safety Management: Type: anc General Industry Conditions and Structures [3 Special Design Requirements Access Workplace Work Areas [1 Construction Hand and Portable Powered Tool 8; Equipment Industrial Trucks. Tractors, Haulage vehicles Earth Moving Powered Transmission Equip, Prime Movers. Machines Parts Points of Operations Other Hazardous Parts of Machinery Compressed Gas Air Equipment Cranes Other Hoisting Equip. El Noise Control of Haz.l Substances Dusts. Fumes. Mists, Vapbrs, etc. Con?ned Spaces Haz. Substances 8. Processes Regulated Carcinogens Flammable Liq., Gases 8. Vapors El Spray Coating Operations Dip Tanks Electrical Equipment jire/Fgrotection 13. Hazards evaluated: Sanitation Window Cleaning Powered Platforms for Exterior Building Maintenance Safe Practices and Personal Protection Miscellaneous Safe Practices Personal Safety Devices and Ammonia refrigeration Safeguards General Plant Equipment'and Special Operations EITree Work, etc. DAgricultural Operations DMarine Terminal Operations Abrasive Wheels D-General Mobile Equipme and Auxiliaries . IE Signature: A Date: 12 Aug 15 Region IdentNo?lgi Opt. Rept. No. Insp No. 6 1 1 003? 16 1084143 1BX (07101195) [915 349,30: 4/ - FF. 12.6wa 175/961wig/ck gain/M fly-- v- i My Af-- .M MD wgzagfl 64fi/30P . gp 4304 "Owl/2113M aw . . .415 a. (M0 dqQeMyLz/y/ [5622; - _%ggi_gg arM-fwm . i' M444 MW 1 Wn?w 2224,;- r) . I fad? Hi I, 029/; Ma; ?ux/u. ??mxvj L?zo?za/ 1., 7146 #2 ?41 faer aim/21135257 5 A 1 My; Carol-W) Gem/L113 4&4?iik Eb? - I ghmad) kw . 1 IA Ma?a CL 7 #95 mm: Mm: .r/L'o i??mbiz "?/Zdt?d ImW?J%ma WW1 My, 6M pro (Xe-ca Mal? I I 1 1 (944% My Mac/M. yaw/? za/W/z - . 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