Masons Sand & Gravel Company Metal/Non-Metal

received notification by mail 11/16/09 from workers compensation claiming injury was injured 3/20/09, we are presently waiting for information from workers compensation or employee. He has been laid off since 9/8/09 because of the lack of work at the mine site. Filled out this form to the best of our kneowledge of what we know.

IW fell through catwalk that was over water. He had contusions to left lower leg, right rib area & upper right arm.

The company's supervisor had a heart attack and had to be transported to the hospital by an ambulance. He had to have immediate surgery in order to open up a blocked artery.

EMPLOYEE WAS IN THE TIGHT CONFINES OF A CLUTCH COMPARTMENT ON A DRAG LINE TRYING TO BREAK A BOLT LOOSE. PULLED SOMETHING IN LOWER RIGHT GROIN. WE ARE NOT SURE IF PROBLEM CAME ON THE JOB OR NOT. WE HELD UP FILING UNTIL WE KNEW THAT THE EMPLOYEE WAS BETTER AND HAD NO MORE PROBLEMS.

Left leg slipped while disassembing hydraulic cylinder on digger head of suction dredge, causing leg to hit steel plate.

WHILE DISCONNECTING PIPE AT SLEEVE JOINT, LOADER WAS DIRECTED TO BACK UP. ONE BINDER WAS STILL ATTACHED SO PIPE WOULD NOT COME LOOSE. PIPE LINK SWUNG TOWARDS EMPLOYEE BUMPING HIM AND KNOCKING HIM DOWN ON TOP OF PIPE. THE LOADER MAN LOWERED THE PIPE TO THE GROUND SO HE COULD ROLL OFF OF THE PIPE.

STEPPED ON ROCK AND TWISTED FOOT. CARRYING 5 GALLON BUCKET STEPPED ON UNEVEN GROUND AND TWISTED FOOT.

USING DRUM DOLLEY. BARREL SLIPPED OFF DOLLEY, CAUSING DOLLEY TO FLIP BACKWARDS HITTING CHEEK BONE, CAUSING SLIGHT LACERATION ON CHEEK BONE.

GOING TO THE FRONT OF DREDGE TO ADJUST MICRO SWITCHES FOR DIGGERS AND STEPPED IN A HOLE IN FLOORING AND BANGED SHIN BETWEEN I BEAM. A BRUISE AND BUMP CAME UP ON SHIN. NOTE-EMPLOYEE DIDN'T MAKE IT CLEAR TO US THAT HE WAS GOING TO GET TREATMENT UNTIL THE PLACE CALLED.

STANDING ON PIPE WRENCH TO LOOSEN BOLT, SLIPPED AND FELL OFF BALANCE AND JAMMING SHOULDER.

OCMING DOWN FROM LOADER AFTER WASHING WINDSHIELD ON CAT 980B LOADER. EE WENT TO DR. ON 1-3-01. XRAY DIDN'T SHOW ANYTHING--WAITING FOR WORKERS' COMP. TO AUTHORIZE MRI AND FURTHER TESTS.

EE WAS LIFTING PIPE (10" STEEL) ON 5-11-98 AT 5PM HE REPORTED A STRAIN IN GROIN AREA. ON 5/14/98 HE TOOK DAY OFF TO GO TO A DR. ON 5/21/98 HE CALLED IN TO SAY HE WILL BE OFF 3 WEEKS FOR A HERNIA OPERATION.\

MAN STANDING BETWEEN CLOSELY PARKED PU TRUCK & A MAINTENANCE TRUCK, TRUCKS FACING SAME DIRECTION. DRIVER OF MAINT. TRUCK STARTED A BACKING TURN, PINCHING THE STANDING PERSON BETWEEN RIGHT FRON T FENDER OF MAINT. TRUCK & L DOOR OF PU TRUCK & THEREFORE BRUISING HIS LEFT THIGH.

2 MEN UPRIGHTING A 375LB DRUM OF OIL. EE'S FEET SLIPPED AND BARREL SLID, AND EE WENT TO HIS KNEES WHEN 1 END OF THE DRUM WAS APPROX 1 FT UP FROMFLOOR. ON 3RD ATTEMPT, EE SAID HIS BACK WAS HURI ING, AND THE OTHER EE CONTD THE LIFT AND UPRIGHTED THE BARREL

OIL & WATER ON FLOOR--SLIPPED--HURT BACK. THREE DAYS LATER RETURNED TO WORK, CLAIMS DR. CORRECTED SLIP DISC CONDITION.

REPAIRING SERVICE TRUCK BUMPER. WHILE ON FLOOR HAD BOTH FEET ON IT. BUMPER ROLLED CAUSING A FALLAND BUMP INJURY TO LEFT ELBOW.

HAD OIL ON SHOE SOLES AND SLIPPED ON PLANK AND BANGED LFT LEG CAUSING A BRUISE. HE WORKED REST OF DAY. HE WENT TO A CLINIC DR ON 9-10-96.

STRONG WIND - ENTEERING END LOADER CAB - WIND CAUGHT CAB DOOR. SLAMMED AGAINST LOWER LEFT LEG.

STANDINGT ON LOADER FENDER-OILY SHOES FEET SLIPPED FELL TO GROUND ON LEFT SHOULDER BROKE CLAVICAL

OLD SMALL FARM TRACTOR BEING TOWED TO START. UPSET AT VERY SLOW SPEED. EE FELL OFF. CONTUSION TOCHEST & ABDOMINAL WALL.

CLEARING 6" STONES FROM DREDGE LADDER INTAKE ONE FELL A COUPLE FEET STRIIN GLEFT WRIST AND BAKC UP LEFT HAND, BRUSIING SAME. SHOULD HAVE CLEANED UPPER STONES FIRST.

LIFTING STRAIN NOT IN PROPER LIFTING POSTURE.

CHIPPING SLAG FROM WELD. FLAKE BOUNCED AROUND BEHIND FACE SHIELD THEN ENTERED EYE.

CLAIMED BACK INJURY FROM 02-07-91 FLAIRED UP

FELL OFF CONVEYOR CATWALK WHILE PULLING WEEDS AND LEANING OVER HANDRAIL.CONVEYOR WALK IS 30" ABOVE GROUND AT THE INJURY.

LIFTING MATERIAL FROM SHORE INTO A BOAT. STRAIN TO LOWER BACK.

2 WELDERS ON JOB. RECEIVED FLASH BURN IN THE EYES. IMPROPER USE OF EYE SHIELD. (HOOD).

HWHILE USING A CUTTING TORCH TO CUT STEEL PLATE A CUT SECTION DROPPED TO THE GROUND STRICKING THE PERSONS LEFT TOP OF FOOT

LOWER BACK STRAIN- HAD JUST COMPLETED TIGHTENING A PIPE, THEN BENT OVER TO PICK UP ANOTHER TOOL AND BACK PAINED WHEN RETURNED TO STANDING POSITION.

SAID MAN WAS HOLDING SIDE LINE CABLE TO DREDGE IN PROCESS OF MOVING SIDE ANCHOR WHEN DREDGE PULLED ON CABLE THROWING HIM BACKWARDS STRAINING HIS ABCK.

MAN TRIPPED STEPPING OVER MACHINERY ON DREDGE

PERSON WAS STAN8ING ON CONVEYOR BELT REPAIRING A CHUTE ABOVE IT. PERSON THEN SLIPPED OFF BELT AND STRADDLED THE BELT WITH HIS LEGS BRUISING THE INSIDE OF EACH LEG.

PERSON WORKING 3N STOCK ROOM FELL OVER BOXES THAT WERE BEING MOVED. PERSON FELL ON RIGHT SHOULDER. PULLED RIGHT SHOULDER MUSCLES.

STEPPED ON BOAR8 WITH NAIL PROTRUDING.RAIL PENETRATED SOLE OF SHOE AND FOOT.

I NAME WAS STAN8ING NEAR OR ON A CABLE LYING ON GROUND A LOADER STARTED TO PULL ON CABLE THIS UP ENDED I NAME AND HE LANDED ON HIS LEFT SHOULDER CAUSING A SHOULDER SEPERATION.

SHOVELING BANK 1RAVEL PUSHED SHOVEL INTO PILE AND HIT IMMOVABLE OBJECT RESULTING IN A SPRAIN.WORKED UNTIL 4-17-86 USED TIME OFF TO FIND NEW JOB.