EFTA01223549.pdf

LSJE, LLC 6100 Red Hook uarters, Suite B-3, St. Thomas, VI 00802-1348 Phone: E-mail: [email protected] Vehicle/Equipment Accident Report Vehicle/Equipment: Lull Date of Incident: 12/13/18 GSJ Location of Incident Danny Helper (Blan) Witness: Position: Witness: Position: broken window in delivery truck - rear Description of Incident: Was employee operating vehicle within proper operation procedures and following all safety regulations? ❑ Yes ❑ No If No, Please Explain: roken rear window in delivery truck Description of Damage: Cost of Repair: Insurance Claim: r Print Employee Name: Brian Bates Employee Signature: Date: Supervisor Signature: Date: EFTA01223549