Report an Injury - Please fill out
Work Date
Work Order Name
Job Order
Job Name
Arborist
Site
9033 Dark Pond Lane, Harrison, TN, 37341
*********LINE ITEM ***********
Type of Work/Service Name:
TRPs, Closures, Tasks, Waivers, etc.
Post Job Questions:
Work Order Line Item #
Internal Notes
Service Description
<p>Remove - EMERGENCY TREE REMOVAL- </p><p>Perform Removal of splitting Leyland Cypress tree with the purpose of limiting damage to the house or structure. Limiting the overall scope of the claim by minimizing future damages is a key goal. </p><p>Remove using conventional climbing, rigging, and felling techniques. The limbs will be lowered using rigging and the trunkwood will be cut in short sections and allowed to fall freely to the ground near the base of the tree. Haul away all cut tree material from the property, leaving stump material cut as low as practicable by chain saw. </p><p>We will hand carry tree debris or utilize a hand cart to move the sections of tree because of limited access OR to minimize disturbance to property. OR </p><p>We will use a tractor to move the sections of the tree which will result in minor turf damage. We will use plastic mats to try to minimize damage to the grass. </p><p> </p><p>Job Details: </p><p> Stump grinding is not included in this service. Stumps and rootballs will be cut as low as practicable(unless otherwise stated) </p><p> </p><p> </p>
Type of Work/Service Name:
Price
Task Status
Was Anyone Injured
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Yes
No
Name of Injured Worker
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Alex Soriano
Antulio Giron
Benjamin Johnston
Bryan Martinez Del Rello
Candidate Worker - On Interview
Carlos Garcia
Christian Malcolm
Curtis Miller
Derrick Angles
Diego Ivan Martinez
Dirk Brown
Edward Kelemencky
Eric Duncan
Erick Reyes
Falarryo Buckley
Gabriel Martinez
Gerber Lopez
Gustavo Carillo
Isaiah Coffey
Israel Martinez
Jacob Jenkins
James Hawkins
Jeremy Hardison
Jesus Ivan Rogel Mercado
John "Frank" DeFrances
Jonathan Covarrubias
Jorge Antonio Araujo
Josh Turner
Juan Jose Mendoza
Juan Laracuente
Juells Dorton
Julio Cesar
Leonardo Hernandez
Marcelo Barrera
Marcos Martinez
Martin Rangel
Michael Crowe
Miguel Hernandez
Milton Polio
Nahun Lemus
Orlando Misael Diaz Morales
Osvaldo Martinez
Ricardo Cano
Sal Aguilar
Stephen "Fletch" Locke
Stephen Sindall
Sterling Copeland
Thomas Cross
Tierson Boutte
Tyler Baxter
Yovaniel Rivera
Zach Moore
Explain injuries:
Injury Date
Injury Time
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7am
8am
9am
10am
11am
12noon
1pm
2pm
3pm
4pm
5pm
6pm
7pm
8pm
9pm
10pm
Injury Day of the Week
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Injury Site Conditions (grade, terrain, proximity to targets, etc.)
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Grade
Terrain
Proximity to targets
Other
If Other, please explain:
Injury Environmental Conditions
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Heat
Sun
Rain
Wind
Other
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Injury Risk Anticipated and/or documented in Job Site Safety Briefing/in Pre-Job Safety?
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Yes
No
Please Explain Injury Risks Anticipated
What object or substance caused harm?
What is the injury or illness?
What happened to cause the injury?
What was employee doing before injury?
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