| Report Date | August 13, 2021 |
|---|---|
| Injury Time | 09:15 AM |
| State | WV |
| Injury Date | 08/09/2021 |
| Longitude | W 80-16-25 |
| Well Lease | ERP Well Pad Water Line |
| Pad | ERP Well Pad |
| Country | United States |
| Latitude | N 39-40-25 |
| Township/City | Blacksville |
| 911 Address | 31 Happy Lane Fairview, WV 26570 |
| Weather | unknown |
| Well Number | ERP water line |
| Well Field | Battelle |
| Position | Laborer |
| Company | Forquer Contracting |
| Personnel/Witness Name | Shane Matthew |
| Days Into Hitch | 10 |
| Years With Company | 4 |
| Years In Oil/Gas | 4 |
| Personnel/Wittness Phone | (304) 810-2155 |
| Witness Name | Shane Matthew |
| Time Lost | unknown |
| Task | Unloading a loaded ice cooler from vehicle. |
| Summary | 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 Test | unknown |
| Injury Location | ERP Water Line |
| Treatment | unknown |
| Proper PPE | Yes |
| Contributing Factors | unlevel ground |
| Notification Timeline | Within 30 minutes of incident |
| Photos & Videos | knee-incident.pdf |
| Corrective Action | Train employee on proper lifting techniques |
| Supervisor Phone | (304) 276-2905 |
| Supervisor Email | Email hidden; Javascript is required. |
| Supervisor Name | Rod Varner |
| HSE Name | Jordy Forquer |
| Supervisor Office Phone | (304) 879-5251 |
| HSE Phone | (304) 216-5172 |
| HSE Office Phone | (304) 879-5251 |
| Comp. Man Name | Mike Shreve |
| Comp. Man Email | Email hidden; Javascript is required. |
| HSE Email | Email hidden; Javascript is required. |
| Comp. Man Office Phone | (304) 212-0432 |
| Comp. Man Phone | (304) 918-3050 |
| NNE Name | David McDougal |
| NNE Email | Email hidden; Javascript is required. |
| NNE Phone | (304) 941-5033 |
| NNE Office Phone | (304) 212-0419 |
| 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 | Dave McDougal |
| Date Updated | August 13, 2021 |
| Approval Status | Unapproved |
| Employee's Other Reports | This user has no other entries. |
