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Page 2 Fri Feb 17, 2012 3:(4pm <br />Jazz Group, Inc. dba Imperial Truck Wash & Repair Inspection Nr. 314995093 Citation Nr. 03 Item/Grs 001 <br />antal Analysis - List numerically each descriptive element of the cited Title 8 CCR section In the Elements column. In the Evidence Summary <br />nn, specify each item of the evidence found during the inspection which substantiates the descriptive element (s.g, hazards, operation, equipment, <br />location and/or measurements.) Under TVDe(S) of Evidence specify the classification of the evidence described under Evidence Summary. <br />*Observation (OB), Employer Admission (EA), Employer Oral Statement IEOS), Other Oral Statement (OOS), Employer Written Statement (EWS), Other <br />Written Statement (DWS), Photograph (PH), Business Record (BR), Document (DO), Sample Measurement (SM), Monitoring Measurement (MM), <br />Equipment/Parts/Machinery (EPM), Other: please specify[ <br />Elements <br />Evidence Summary <br />Types <br />of Evidence <br />3384, Hand Protection <br />(a) Hand protection shall be required for employees <br />On or about 1/12112, Employer failed to provide or <br />OOS <br />whose work involves unusual and excessive <br />require employees using hydrofluoric acid during <br />exposure of hands to cuts, burns, harmful physical <br />car wash activities to wear hand protection. <br />or chemical agents or radioactive materials which <br />are encountered and capable of causing injury or <br />impairments. <br />A serious burn injury occurred on 1112/12, <br />DOS <br />resulting in hospitalization of 3 days. <br />Photo (Y/(d) ? Comments: <br />Additional Witness Documentation - List the name, address and phone number of each person having percipient Information of the factual elements <br />-',vs. After each name list the element numbers from above which the person is able to personally verify. <br />Citation Classification: <br />a. Assuming that an accident or exposure occurs, what are the likely consequences? <br />b. Management Knowledge (check all below that apply) <br />ElActual Management Knowledge <br />Violation Common Practice at Jobsite <br />x Proximity of Supervisors to Violation <br />x Violation Readily Visible to Anyone Passing By <br />x Obligation Anticipated: Forseeable Hazards (i.e. Asbestos <br />Containing Construction Material In Oil., Buildings <br />Condition Existed Long Enough For Employer Awareness <br />ElConstructive Management Knowledge <br />Accident at Jobsite Previously from Same Violation(s) <br />Special Duty to Inspect -Competent Person at Excavation <br />Employer Received Complaints from Other Employees of <br />Violation Condition <br />Other (please state) <br />c. Documentation as to Why Violation is Serious, General or Regulatory. <br />Use the Documentation Worksheet to document evidence of any of the following: <br />d. Prior Violations <br />a. Intentional, Knowing, or Reckless Conduct (Willful) - Willful Elements Worksheet must be attached. <br />f. Failure to Abate. <br />OSHA-111/11IIHprint(Rev. 9/93) <br />