Report DateAugust 13, 2021
Injury Time09:15 AM
Injury Date08/09/2021
LongitudeW 80-16-25
Well LeaseERP Well Pad Water Line
PadERP Well Pad
CountryUnited States
LatitudeN 39-40-25
911 Address31 Happy Lane Fairview, WV 26570
Well NumberERP water line
Well FieldBattelle
CompanyForquer Contracting
Personnel/Witness NameShane Matthew
Days Into Hitch10
Years With Company4
Years In Oil/Gas4
Personnel/Wittness Phone(304) 810-2155
Witness NameShane Matthew
Time Lostunknown

Unloading a loaded ice cooler from vehicle.
Incident occurred to Zachary Keener. Time with Forquer; 4 years. Cell Number 304-276-6196


He and Shane were lifting cooler from back of truck. Zachary's knee gave out causing him to fall. Right knee popped and swollen.

Witness Statement

"He picked up cooler his knee gave out and he fell down with cooler landing on top of him"

Drug Testunknown
Injury LocationERP Water Line
Proper PPEYes
Contributing Factorsunlevel ground
Notification TimelineWithin 30 minutes of incident
Photos & Videosknee-incident.pdf
Corrective ActionTrain employee on proper lifting techniques
Supervisor Phone(304) 276-2905
Supervisor EmailEmail hidden; Javascript is required.
Supervisor NameRod Varner
HSE NameJordy Forquer
Supervisor Office Phone(304) 879-5251
HSE Phone(304) 216-5172
HSE Office Phone(304) 879-5251
Comp. Man NameMike Shreve
Comp. Man EmailEmail hidden; Javascript is required.
HSE EmailEmail hidden; Javascript is required.
Comp. Man Office Phone(304) 212-0432
Comp. Man Phone(304) 918-3050
NNE NameDavid McDougal
NNE EmailEmail hidden; Javascript is required.
NNE Phone(304) 941-5033
NNE Office Phone(304) 212-0419
NNE HSE NameAndy Travis
NNE HSE Office Phone(304) 212-0415
NNE HSE EmailEmail hidden; Javascript is required.
NNE HSE Number(304) 951-0909
Employee That Submitted ReportDave McDougal
Date UpdatedAugust 13, 2021
Approval StatusUnapproved
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