| Report Date | March 24, 2021 |
|---|---|
| Injury Time | 04:30 PM |
| State | WV |
| Injury Date | 03/22/2021 |
| Longitude | -80.217799 |
| Well Lease | Bunner |
| Pad | Bunner |
| Country | United States |
| Latitude | 39.662899 |
| Township/City | Fairview |
| 911 Address | 72 Upper Days Run Rd |
| Weather | Clear 65 Degrees |
| Well Number | Construction |
| Well Field | Blacksville |
| Position | Truck Driver |
| Company | AJ Burk |
| Personnel/Witness Name | Warren Burhammer |
| Days Into Hitch | 1 |
| Years With Company | 10 |
| Years In Oil/Gas | 10 |
| Personnel/Wittness Phone | (304) 695-3442 |
| Witness Name | Joe Frame |
| Time Lost | no time lost |
| Task | Warren was climbing down out of his truck bed, after strapping his load down. |
| Summary | In the process he lost his balance and fell to the ground striking his left elbow and injuring his left shoulder. He was taken to St Josephs ER for evaluation, where x-rays determined that he had a left shoulder contusion. He was cleared to return to work 3/24 with no restrictions. |
| Witness Statement | Employee lost footing while stepping down from truck |
| Drug Test | none |
| Injury Location | Left Shoulder |
| Treatment | Rest |
| Proper PPE | Proper PPE was in use |
| Contributing Factors | Uneven ground |
| Notification Timeline | Immediate |
| Corrective Action | Maintain 3 points of contact |
| Supervisor Phone | (304) 629-6309 |
| Supervisor Email | Email hidden; Javascript is required. |
| Supervisor Name | Bob Daniel |
| HSE Name | Eddie Carder |
| Supervisor Office Phone | (304) 997-8153 |
| HSE Phone | (304) 629-6309 |
| HSE Office Phone | (304) 997-8153 |
| Comp. Man Name | Josh Frazier |
| Comp. Man Email | Email hidden; Javascript is required. |
| HSE Email | Email hidden; Javascript is required. |
| Comp. Man Office Phone | (304) 517-6188 |
| Comp. Man Phone | (304) 517-6188 |
| NNE Name | John Landis |
| NNE Email | Email hidden; Javascript is required. |
| NNE Phone | (304) 216-6854 |
| NNE Office Phone | (304) 212-0415 |
| NNE HSE Name | Andy Travis |
| NNE HSE Office Phone | (304) 212-0415 |
| NNE HSE Email | Email hidden; Javascript is required. |
| NNE HSE Number | (304) 951-0909 |
| Employee That Submitted Report | Andy Travis |
| Date Updated | March 24, 2021 |
| Approval Status | Unapproved |
| Employee's Other Reports |
