Incident Report Incident Report it 29665 Reported By: - Qualily Review Pending Review Status: Employee Section Name: William Casillas Em" . . - wlcasfllas@teihm Type' Employee Dale of Hire: 12-App2017 Job Title: Production Associals Sectlun Suparvisor Ema". Name: Cos! Center 30314000 Numbec incident Location Tasla Site: Department Seal Assemny Page Area: Model SIX Final Sea! Production Line: Manual Sequencing Assembly Workcenter 55 Number/Carumn Number. Person present at incident sire: Summary of Incident/Sequence at Events Incident Description: I Shock from an electrical forklifli Date Reported: 07-Dec-2017 Date of Incident: 06-Dec-2017 Shift Start Tlme: 3:30 PM Time 01 Incident: 11:30 PM Name: Kaiser Was Employun working within the scope of the job when the occurred Yes What was dolnc lust More the incident occurred?'. Rulling senator shipmanl we wha' I - dlat: contalnment actlon to reduce ttI - "or addlilona militias-2; u" 9 mm: The forkll'lt wen placed out of service Was mob". equlpmom involvnd in the Maiden! 7: Na (EH35 Only) Type: OSHA RamlabIe OSHA Last Tm"? Recordable Type- Designated -- Injury/Illness Injury EHSS Partner. Category: I Body Pan: Hand 'nJ'urv Type: Contact with electrme Fohnlial No Incldent Tlrne Total Lost Tune: 2 Restricted DutyLon Time 1443502017 15Dso-2017 Raymund Duly 15020-2017 t, Why Reason: Problem Statement Associate claimed to have gotten elawloal shock from a furklifl. Rpuon wny it [flaphippo"? hlppon? MppIn? 15m: 17m mm am Is In The Associate The means Incident auppoaadly Amlale recalved Wlfliflfl was being walked up to ma touched mu uncuan on < lmmedtake Causes . nun-din- hum-m Inn-nodal: . PM can "mum comma Am: Cam E'W'mion mm Law 2754 SEQ Slanwamueducale SEQ 11 An: rm to mm" empvoyees an 31m "fi'ife' mm main is dmanoe "peculiar: 9 mobda 333.9301: dose as a ram eqmpmenvnedssfilns. man mobile c" .9 "imam. o3" Additional Nous shock is not clear at [his poinlrhak the associau's heauh gut warsene'd whiz" received. The associa'a did ma! he was not not feeling wed'd l'k tom'Assouata did seek medmal attention \he sum restfiigad to Assam had another doctofs appmniment on the 7m and was excused [mm work on the 7m and assigned back to duty on the em