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ARCHIVED REPORTS XR0004323
EnvironmentalHealth
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1399
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3500 - Local Oversight Program
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PR0544686
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ARCHIVED REPORTS XR0004323
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Last modified
7/23/2019 11:47:02 AM
Creation date
7/23/2019 11:34:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004323
RECORD_ID
PR0544686
PE
3528
FACILITY_ID
FA0000916
FACILITY_NAME
7-ELEVEN INC #19976
STREET_NUMBER
1399
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21633034
CURRENT_STATUS
02
SITE_LOCATION
1399 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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INCIDENT REPORTING GUIDE <br />' .u3ddant Class w rte. k A minor [haus tSeslt K [Lass Il:A serious tnddertt that [amass 11! A highly skF9firant <br /> �vfttt at VW 3orxt13evel " rWJ1Ares notM=bon to CorporaW to*Wd requtdng 1mmecUte <br /> ~ _ . t within 24 hours riottitcatiori and asaVstanoe from <br /> Ky �� Suslriess Unft and Corporate <br /> ESartwies of o First Aid o Personal injury(mora than fust aid a Hospitalization(of one or more <br /> UvAderts to employee subcontractor or public) persons) <br />' o [Briar darnage<S200 <br /> o Any motor vehicle accident a Multiple injury of employees <br /> o Non reportable quantity spdl sub-contractors or public <br /> o Damage to property greater than <br /> o Now mess event $200 but Vass than$10 000 o Unprotected chemical exposure <br /> o Unsafs condttwn or action o Near miss incident that could have o Death <br /> boon very senous <br /> o Damage to property greater <br />' Nolo If there is a question as to Class I o Rre[Explosion than$10 000 <br /> or II,follow Class It notification actions o Non-emergency notification of o Reportable quantity spill <br /> regulatory agency is required reisase <br /> o Served with subpoena o Emergency notification of <br /> (DO NOT ACCEPT,have subpoena regulatory agency <br /> delivered to CT Corporation System, <br />' our Registered Agent at o Regulatory agency response to <br /> 800-336-3376 or contact Legal Dept incident site(inspection) <br /> In Norwood for additional assistance <br /> no written investigabon report is o Contact or appearance of news <br /> required for a subpoena) or public media <br /> Notification Actions i On-scene person notifies Une 1 On-scene person notifies lane i On-scene person notifies tine <br /> Manager'immediately by phone Manager immediatety by phone Manager'immediately by phone <br /> i <br /> 2 Provide PIR form to tine Manager 2- lane Manager notifies the Drshlct, 2 Manager immediately notifies <br /> and H&S Representatrve(s)" Hub or Area Manager Business Unit Business Unit Manager H&S <br />' immediately follow<ng the tncidenL Manage[ H&S Represen-tatrve(s)" Representative(s)—,Human <br /> Human Resources Representatrve Resources and Corporate <br /> 3 Line Manager Investigates and Corporate H&S Director and CEO Director H&S(80075-0647 <br /> follows up within 48 hours with PIR form immediatety folkymng Mailbox'11gll)by phone PIR <br /> ' the mcidenL form is provided by fax <br /> immediately to(617-769-9861) <br /> 3 line Manager provides a detailed addressed to Corporate Director <br /> 'Line management=reporting manager final invesbgabon report within 48 H&S <br />' project manager,operabonsloffice hours atter the onginai PIR is <br /> manager and district hub or area submitted The final report must be 3 incident management team <br /> manager submitted to District, Hub or Area conlerences by phone and <br /> Manager Business Unit Manager formulates an action plan <br /> ^H&S representatrve=includes district H&S Representatrve(s) Human <br /> 1 H&S representatives and business unit Resources Representatrve <br /> H&S manager Carporale Director H&S and CEO <br /> ' Note that all lost-time Injury events vntl <br /> be iuvesbgaled by the respective <br /> Business Unit Manager with a fir+al <br /> report to Oe CEO <br /> Rev 096 <br />
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