State of California - Inspection 1309103

 

Department of Industrial Relations Inspection Dates: 04/17/2018 08/16/2018
Division of Occupational Safety and Health Issuance Date: 08/16/2018

Fremont District Office CSHO ID: 84158

39141 Civic Center Drive, Suite 310 optional Report 023?1 8

Fremont, CA 94538
Phone: {510) 7942521 Fax: 1510) 794?3889

Citation and Notification of Penalty

Company Name: Tesla, Inc.

Establishment DBA: I .
and its successors . 

Inspection Site: 45500 Fremont Blvd. I
'Fremont, CA 94538

 

 

Citation 1 Item 1 Type of Violation: Regulatory

Title 8 CCR Section 14300.29jb] Forms.
Implementation. -
(3) How quickly must each injury or illness be recorded?
You must enter each recordable injury or illness on the Form 300 and Form 301
Incident Report within seven (7) calendar days of receiving information that a recordable injury or
illness has occurred. 

Prior to and during the course of the inspection, the employer failedto enter on its Form

300 and Form 301 Incident Report the recordable injury of one of its employees who was
placed on a work restriction on 2/16/18 within seven calendardays of having received information
that the injury had occurred. i -

 

 

 

 

 

 

See pages 1 through 4 of this Citation and Notification of Penalty for information an employer and employee rights and responsibilities?u
Citation and Notification of Penalty Page 5 of 8 - V1 Rev 1,12018