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Home My WebLink AboutHAZMAT 05-0042 - 12674 GATEWAY DR - HAZARDOUS MATERIALS LEAK CONTROL & CONTAINMENT ON 1/5/200512674 GATEWAY DR HAZARDOUS MATERIALS LEAK CONTROL & CONTAINMENT HAZMAT # 05-0042 Incident Report 2005-0000042-000 i Tukwila Fire Department OS- d042 AMC ENVIRONMENTAL SERVICES 20500 Richmond Beach Drive NW Seattle, WA 98177 Emergency Response 1 -800 -33 -SPILL Matt Chaney Emergency Response Supervisor mgchaney@nrces.com Cell Phone: (206) 730-2543 Phone: (206) 546-7159 Pager: (425) 267-7293 Fax: (206) 546-7170 1 Page: 1 Printed: 01/05/2005 21:31:45 Basic Alarm Date and Time Arrival Time ' Controlled Date and Time Last Unit Cleared Date and Time Response Time Priority Response Completed Incident Type Initial Dispatch Code Aid Given or Received Action Taken 1 Action Taken 2 EMS Provided Apparatus - Suppression Personnel - Suppression Personnel Property Loss Contents Loss Property Value Contents Value Hazardous Material Released Property Use Location Type Address City, State Zip District Directions 08:43:47 Wednesday, January 5, 2005 08:49:16 10:59:10 Wednesday, January 5, 2005 0:05:29 Yes Yes 323 - Motor vehicle/pedestrian accident (MV Ped) 25R1 N - None 32 - Provide basic life support (BLS) 44 - Hazardous materials leak control & containment Yes 4 9 $0.00 $0.00 $0.00 $0.00 6 - Household/office solvent or chemical spill 965 - Vehicle parking area Address 12674 GATEWAY DR TUKWILA, WA 98168 5351 12674 GATEWAY DR ,TUK Person Involved - KEEKIN, JILL/COWORKER, Involvement Code Last Name Street Address Phone REP KEEKIN, JILL/COWORKER 2062418870 AMC ENVIRONMENTAL SERVICES 20500 Richmond Beach Drive NW Seattle, WA 98177 Emergency Response 1 -800 -33 -SPILL Matt Chaney Emergency Response Supervisor mgchaney@nrces.com Cell Phone: (206) 730-2543 Phone: (206) 546-7159 Pager: (425) 267-7293 Fax: (206) 546-7170 1 Page: 1 Printed: 01/05/2005 21:31:45 Incident Report 2005-0000042-000 Tukwila Fire Department EMS Patient - Trammell, Nathan First Name Last Name Street Address City, State Zip Gender Date of Birth Age Race Ethnicity Arrived At Patient Date and Time Patient Transfer Date and Time Provider Impression / Assessment Cause of Illness/Injury Highest Level of Care Initial Level of Care Human Factors Nathan Trammell 408 Monroe AVE NE Renton, WA 98056 1- Male January 11, 1979 25 1 - White 0 - Other 08:49:16 Wednesday, January 5, 2005 09:15:00 Wednesday, January 5, 2005 38 - Trauma 29 - Motor vehicle accident 2 - EMT -B (Basic) 2 - EMT -B (Basic) None Page: 2 Printed: 01/05/2005 21:31:45 Incident Report 2005-0000042-000 Tukwila Fire Department EMS Patient - Trammell, Nathan Injuries Injured Body Site 1" Injury Type 1 - Head 16 - Laceration Page: 3 Printed: 01/05/2005 21:31:45 Incident Report 2005-0000042-000 Tukwila Fire Department EMS Patient - Trammell, Nathan Flow Chart Procedures Used Bleeding Control, Oxygen Therapy, Spinal 4 Page: 4 Printed: 01/05/2005 21:31:45 Incident Report 2005-0000042-000 Tukwila Fire Department Apparatus - E53 Apparatus ID Response Time ' Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Type Personnel 1 Personnel 2 Personnel 3 E53 0:03:29 08:44:02 08:45:47 08:49:16 09:59:08 Yes 3 1 11 - Engine 1166 - Butler, Wesley Position: FFI Amount 1: $0.00 Amount 2: $0.00 1167 - Dyer, Steven Position: FFI Amount 1: $0.00 Amount 2: $0.00 1122 - Peterson, Lavem Position: LT Amount 1: $0.00 Amount 2: $0.00 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Wednesday, January 5, 2005 , Apparatus - E52 Apparatus ID Response Time Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Type Personnel 1 Personnel 2 Personnel 3 E52 0:04:04 08:44:02 08:46:45 08:50:49 10:59:10 Yes 3 1 11 - Engine 1176 - Crowley, Mark Position: FFI Amount 1: $0.00 Amount 2: $0.00 1129 - Wheeler, Stephen Position: LT Amount 1: $0.00 Amount 2: $0.00 1121 - Hayman, Ben Position: FFI Amount 1: $0.00 Amount 2: $0.00 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Apparatus - A54 Page: 5 Printed: 01/05/2005 21:31:45 Incident Report 2005-0000042-000 , -v -uu1-t �-- Tukwila Fire Department Apparatus - A54 Apparatus ID Response Time Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Type Personnel 1 Personnel 2 A54 0:33:28 08:56:06 Wednesday, January 5, 2005 09:29:34 Wednesday, January 5, 2005 08:56:06 Wednesday, January 5, 2005 09:29:34 Wednesday, January 5, 2005 Yes 2 1 75 - BLS unit 1107 - Nichols, Jeff Position: FFIII Amount 1: $0.00 Amount 2: $0.00 1131 - Wojcik, Peter Position: LT Amount 1: $0.00 Amount 2: $0.00 Apparatus - B51 Apparatus ID Response Time Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Type Personnel 1 B51 0:12:19 08:58:50 09:11:09 08:58:50 09:11:09 Yes 1 1 92 - Chief officer car 1108 - Ewing, David Position: CAPT Amount 1: $0.00 Amount 2: $0.00 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Authority Reported By Officer In Charge Reviewer 1122 - Peterson, Lavern 21:11:57 Wednesday, January 5, 2005 1122 - Peterson, Lavern 21:11:57 We sday January 5, 2005 ogi Narratives Narrative Name Narrative Type Author Narrative Text CAD Narrative CAD Narrative CAD Incident Number: TF05000040 Page: 6 Printed: 01/05/2005 21:31:45 Incident Report 2005-0000042-000 Tukwila Fire Department Narratives Cross Ref Inc#s for each Jurisdiction Involved: #1={TP05000363 Updated addl location info: near UNK Short Report: INJURY ACCIDENT AT MINOLTA BLDG IN THE PARKING LOT./ <08:44:28>TXT: CORRECTION****RP WAS IN A FORKLIFT BEING TOWED BY A TRUCK, FORKLIFT DROPP ED <08:45:14>ING FROM HEAD, INSTRUCTIONS GIVEN. IS CONSC AND BREATHING NORMALLY.... 2005010508 <08:45:46>NAM: KEEKIN, JILL/COWORKER PHO: 2062418870 TXT: PATIENT IS CLEAR OF THE TOW TRUCK AND FORKLIFT. <08:46:27>, TRI MED FROM 188/EVH E53<08:50:19>, HYDROLIC SPILL E53<08:55:51>, ADV B51 2 BAGS OF SODA ASH } Narrative Name New Narrative Narrative Type Incident Narrative Date 21:24:48 Wednesday, Jan 5, 2005 Author 1122 - Peterson, Author Rank LT Author Assignment 1 Narrative Text At 0843 hours on Wednesday January 5, 2005 we were dispatched to a motor vehicle accident involving a pedestrian. Four units were assigned to this incident. Nine personnel responded. We arrived on scene at 0849 hours and cleared at 1059 hours. The incident occurred at 12674 GATEWAY Dr, TUKWILA in District 5351. The general description of this property is vehicle parking area. The primary task(s) performed at the scene by responding personnel was to provide basic life support (BLS). No mutual/automatic aid was given or received. Truck towing forklift in the parking lot, the forklift was going too fast and rolled throwing the driver out. The driver of the forklift struck his head causing a large laceration that required treatment and transport to Valley Medical Center. The forklift's batteries came out spilling a small quantity of sulfuric acid on the parking lot surface. The oil from the forklift also spilled on the parking lot surface. Upon our arrival E-53 did Pt. care while E-53 did containment and neutralization of the acid spill. E-53 set up command and called L&I, and had the owners of the fork lift call a private company for spill clean-up. One patient was involved with this incident. Alarm number 0000042 has been assigned to this incident. Special Studies Special Study Name Special Study 0 End of Report Page: 7 Printed: 01/05/2005 21:31:45 Incident tecejved 'Errte 'red Diskatched Enroute Onscene Clgsed History for:#TF05000040 CN: $TF05000042 01/05/05 08:43:47 BY CRO7 /VC5172 01/05/05 08:43:47 BY CRO7 /VC5172 01/05/05 08:44:02 BY FD23 /VC0496 01/05/05 08:45:47 01/05/05 08:49:16 01/05/05 10:59:10 Xref:#TP05000363 o5—OG u 2� Initial Type:ACCINF TG: Initial Alarm Level:1 Final Type:ACCINF (INJURY ACCIDENT (2A))Pri:lDispo:25R1 Alrm Lev: 1 Police TP100 Fire TF5351 Grp:T7Beat: Lt/Lg: Police Rms: Fire Rms: Medic Rms: Loc:12674 GATEWAY DR ,TUK near UNK (V) Name:KEEKIN, JILL/COWORKER Addr: 08:43:47 VC5172 CRO7 ENTRY 08:43:47 CRO7 $ASNCAS 08:44:02 VC0496 FD23 DISP E53 08:44:02 FD23 08:44:28 VC5172 CRO7 08:44:46 VC0496 FD23 08:45:14 VC0385 FD22 08:45:14 VC5172 CRO7 08:45:19 VC0385 FD22 08:45:19 FD22 08:45:46 VC5172 CRO7 08:45:47 08:46:14 08:46:27 08:46:45 08:47:18 08:49:16 08:50:19 TF7187 E53 VC5172 CRO7 VC0385 FD22 VC1140 FD24 FD24 FD24 Phone: 2062418870 INJURY ACCIDENT AT MINOLTA BLDG IN THE P ARKING LOT./ $TF05000042 #TF7187 JOHNSON, JEFF #TF7866 ROOKSTOOL, EDWARD #TF7946 GREEN, DAVE C/F3 ASST E52 #TF4256 WHEELER, STEVE #TF8523 HAYMAN, BEN #TF8793 CROWLEY, MARK C/F3 SUPP TXT: CORRECTION****RP WAS IN A FORKLIFT BEING TOWED BY A TRUCK, FORKLIFT DROPP E D CONTRL GRP: T9 ---> T7. TOWROT E52 AMB,TUKTRI,TUK,TRI-MED AMBULANCE,2062435 622 SUPP TXT: BLEEDING FROM HEAD, INSTRUCTIONS GI VEN. IS CONSC AND BREATHING NORMALLY.. . ASST TRI2 ASNCAS TRI2 SUPP [12674 GATEWAY DR ,TUK] $XF05000383 NAM: KEEKIN, JILL/COWORKER PHO: 2062418870 TXT: PATIENT IS CLEAR OF THE TOW TRUCK A ND FORKLIFT. *ENROUT E53 GDISPO D/25R1 SUPP TRI2 , TRI MED FROM 188/EVH ENROUT E52 CLEAR TRI2 ONSCNE E53 FD24 MISC E53 , ONE OVERTURNED FORK LIFT WITH BATTERY ACID SPILL , HYDROLIC SPILL 08:50:49 FD24 ONSCNE E52 Q8:5:51 FD24 MISC E53 , ADV B51 2 BAGS OF SODA ASH '08156:06 FD24 ASSTOS A54 [12674 GATEWAY DR ,TUK] #TF4856 CZULEGER , MATT #TF7643 NICHOLS, JEFF 08:57:36 FD24 NEWLOC E53 [GATEWAY CMD] 08:.58:50 FD24 ASSTOS B51 [12674 GATEWAY DR ,TUK] #TF8163 EWING, D AVE 09:07:16 VC5055 FD24 CONTCT E53 , REQING TO CALL L&I - RPT INDUSTRIAL AC CIDENT W/INJS 09:07:51 FD24 CONTCT E53 , NO PRODUCT GOING INTO STORM DRAIN - BU SN CALLING ANOTHER PVT CO FOR CLEAN UP 09:11:09 TF8163 B51 MOBINS B51 09:11:57 VC5055 FD24 CONTCT E53 , 206.835.1000 09:12:26 FD24 CONTCT E53 , NUMBER FOR L&I - 206.835.1000 09:14:23 FD24 CONTCT E53 , CHET RAY - SAFETY COMPLIANCE SUPV - 20 6.835.1051 09:23:33 FD24 CONTCT E53 , 206.948.9029 09:24:11 FD24 CONTCT E53 , L&I ADV'D 09:24:22 FD24 OLIS E52 09:25:10 FD24 CONTCT E53 , TERMINATING CMD 09:27:58 FD24 NEWLOC E53 [12674 GATEWAY DR ,TUK] 09:28:00 FD24 ONSCNE E53 09:29:34 VC5998 FD23 CLEAR A54 09:40:54 VC5055 FD24 UNAVL E52 09:40:56 FD24 OLIS E53 09:59:08 TF7187 E53 IQIS E53 10:52:22 VC5055 FD24 CONTCT E52 , PVT SPILL CO ON LOCN 10:59:10 TF4256 E52 MOBINS E52 10:59:10 E52 CLOSE E53 D/25R1 Incident Report 2005-0000042-000 Tukwila Fire Department ENVIRt NMENTAL SERVICES 20500 Richmond Beach Drive NW Seattle, WA 98177 Emergency Response 1.800.33 -$PILL Matt Chaney , Emergency Response Supervisor ; mgchaneyCnrces corn Cell Phone: (206) 730.2543 Phone: (206) 546-7159 Pager: (425) 261.7293 Far: (206) 548.7170 Page: 1 Michael O'Hagan Compliance Safety & Health Officer Department of Labor and Industries 12806 Gateway Drive 2061835-1061 PO Box 69050 FAX 206/835-1053 Seattle WA 98168-1050 oham2350Lni.wa.gov www.Lni.wa.gov/WISHA o Printed: 01105/2005 21:31:4 5 0001 Basic Alarm Date and Time Arrival Time Controlled Date and Time Last Unit Cleared Date and Time Response Time Priority Response Completed incident Type Initial Dispatch Code Aid Given or Received Action Taken 1 Action Taken 2 EMS Provided Apparatus - Suppression Personnel - Suppression Personnel Property Loss Contents Loss Property Value Contents Value Hazardous Material Released Property Use Location Type Address City, State Zip District Directions 08:43:47 Wednesday, January 5, 2005 08:49:16 10:59:10 Wednesday, January 5, 2005 0:05:29 Yes Yes 323 - Motor vehicle/pedestrian accident (MV Ped) 25R1 N - None 32 - Provide basic life support (BLS) 44 - Hazardous materials leak control & containment Yes 4 9 $0.00 $0.00 $0,00 $0.00 6 - Household/office solvent or chemical spill 965 - Vehicle parking area Address 12674 GATEWAY DR TUKWILA, WA 98168 5351 12674 GATEWAY DR ,TUK Person Involved - KEEKIN, JILL/COWORKER, Involvement Code Last Name Street Address Phone REP KEEKIN, JILL/COWORKER 2062418870 ENVIRt NMENTAL SERVICES 20500 Richmond Beach Drive NW Seattle, WA 98177 Emergency Response 1.800.33 -$PILL Matt Chaney , Emergency Response Supervisor ; mgchaneyCnrces corn Cell Phone: (206) 730.2543 Phone: (206) 546-7159 Pager: (425) 261.7293 Far: (206) 548.7170 Page: 1 Michael O'Hagan Compliance Safety & Health Officer Department of Labor and Industries 12806 Gateway Drive 2061835-1061 PO Box 69050 FAX 206/835-1053 Seattle WA 98168-1050 oham2350Lni.wa.gov www.Lni.wa.gov/WISHA o Printed: 01105/2005 21:31:4 5 0001 Incident Report 2005-0000042-000 Tukwila Fire Department EMS Patient - Trammell, Nathan First Name Last Name Street Address City, State Zip Gender Date of Birth Age Race Ethnicity Arrived At Patient Date and Time Patient Transfer Date and Time Provider Impression / Assessment Cause of Illness/Injury Highest Level of Care Initial Level of Care Human Factors 1.11111. I 41111 25 I - White 0 - Other 08:49:16 Wednesday, January 5, 2005 09:15:00 Wednesday, January 5, 2005 38 - Trauma 29 - Motor vehicle accident 2 - EMT -B (Basic) 2 - EMT -B (Basic) None Page: 2 Printed: 01;05/2005 21:3 I 5 0002 Incident Report 2005.0000042-000 Tukwila Fire Department EMS Patient - Redacted [6a] Injuries Injured Body Site 1 Injury Type 1 - Head 16 - Laceration Page: 3 Printed: 01 l05I2005 21.31 45 0003 Incident Report 2008.0000042-000 Tukwila Fire Department EMS Patient - Redacted [6a] Flow Chart . Procedures Used Bleeding Control, Oxygen Therapy, Spinal Page: 4 Printed: 01/05/2005 :45 0004 Incident Report 200540000424100 Tukwila Fire Department Apparatus -11:53 Apparatus ID Response Time Apparatus Dispatch Date sad Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time APParatus Pricey TesPonse Number of People Apparatus Use Apparatus Type Personnel 1 Personnel 2 Personnel 3 1353 0:03:29 08:44:02 08:45:47 08:49:16 09:59:08 Yes 3 1 11- Engine 11645 - Butler, Wesley Position: FF1 Amount 1: 50.00 Amount 2: 60.00 1167 - Dyer, Steven Position: FF1 Amount 1: 50.00 Amount 2: 50.00 1122 - Peterson, Lavern Position: LT Amount 1:50.00 Amount 2: 50.00 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Apparatus - 852 Apparatus ID Response Time Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Personnel 1 Personnel 2 Personnel 3 852 0:04:04 08:44:02 08:46:45 08:50:49 10:59:10 Yes 3 1 11- Engine 1176 - Crowley, Mark Position: FFI Amount 1: 50.00 Amount 2: 60.00 1129 - Wheeler, Stephen Position: LT Amount 1: 50.00 Amount 2: 50.00 1121- Hayman, Ben Position: FFI Amount l: 50.00 Amount 2: 50.00 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Wednesday, January 5, 2005 Page: 5 Printed: 01/05/2005 21:31:45 0005 Incident Report 200084000042400 - 5—pOt4 ?— Tukwila Fire Department fit„ ..Ccs A, Page: 6 Printed: 01/05/2005 21:31:4 5 0006 Apparatus - A54 . Apparatus ID Response Time Apparatus Dutch Date and Time En route to scene date and oboe Apparatus Arrival Date and Time Apparatus Clear Date and Time APparatns priority response Number of People Apparatus Use Apparatus Type Personnel l Personnel 2 A54 0:33:28 08:56:06 Wednesday, January 5, 2005 09:29:34 Wednesday, January 5, 2005 08:56:06 Wednesday, January 5, 2005 09:29:34 Wednesday, January 5, 2005 Yes 2 1 75 - BLS unit 1107 - Nichols, Jeff Position: PPM Amount I: 50.00 Amount 2: 80.00 1131- Wojcik, Peter Position: LT Amount 1: 80.00 Amount 2: 80.00 Apparatus BSI - t Apparstua ID Response Tlme Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Data and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Type Personnel 1 B51 0:12:19 08:58:50 Wednesday, January 5, 2005 09:11:09 Wednesday, January 5, 2005 08:58:50 Wednesday, January 5, 2005 09:11:09 Wednesday, January 5, 2005 Yes 1 . 1 92 - Chief officer car 1108 - Ewing, David Position: CAPT Amount 1: 50.00NO Amount 2: 50.00 /NA"' Authority Reported By Officer In Charge Reviewer 1122 - Peterson, Lavern 21:11:57 Wednesday, January 5, 2005 1122 - Peterson, Lavern 21:11:57 W y aauaty 5, 2005 - :low Narratives Narrative Name Narrative Type Author Narrative Text CAD Narrative CAD Narrative - , CAD Incident Number: TF05000040 Page: 6 Printed: 01/05/2005 21:31:4 5 0006 Incident Report 20054000042400 Tukwila Pire Department Narratives Cross Ref Ines for each Jurisdiction Involved #1-(TP05000363 Updated addl location info: near UNK Short Report INJURY ACCIDENT AT MINOLTA BLDG IN THE PARKING LOT./ <08:44:28>TXT: CORRECTION'"***RP WAS IN A FORKLIFT BEING TOWED BY A TRUCK, FORKLIFT DROPP ED <08:45:14>1NG FROM HEAD, INSTRUCTIONS GIVEN. IS CONSC AND BREATk4ING NORMALLY.... 2005010508 <08:45:46>NAM: KEEKIN, JILL/COWORKER PHO: 2062418870 TXT: PATIENT IS CLEAR OF THE TOW TRUCK AND FORKLIFT. <011:46:27>,1111 MED FROM 188/EVH E53<08:50:19>, HYDROLIC SPILL E53<08:55:51>, ADV B51 2 BAGS OF SODA ASH ) Narrative Name New Narrative Narrative Type Incident Narrative Date 21:24:48 Wednesday, J ;, 5, 2005 Author 1122 - Peterson, Author Rank LT Author Assignment Narrative Text At 0843 hours on Wednesday Jassy 5, 2005 we were dispatched to a motor vehicle accident involving a pedestrian. Four units were assigned to this incident. Nine personnel responded. We arrived on scene at 0849 hours and cleared at 1059 hours. The incident occurred at 12674 GATEWAY Dr, TUKWILA in District 5351. The general description of this property is vehicle parking area The primary task(s) performed at the scene by responding personnel was to provide basic life support (BLS). No mutual/automatic aid was given or received. Truck towing forklift in the parking lot, the forklift was going too fast and rolled throwing the driver out The driver of the forklift struck bis head causing a large laceration that required treatment and transport to Valley Medical Center. The forklifts batteries came out spilling a small quantity of sulfuric acid on the parking lot surface. The oil from the forklift also spilled on the parking lot surface. Upon our arrival E-53 did Pt. care while E-53 did cant and neutralization of the acid spill. E-53 set up commend and called Lal, and had the owners of the fork lift call a private company for spill clean-up. One patient was involved with this incident. Alarm number 0000042 has been assigned to this incident Spacial Studies Special Study Name Special Study 0 End of Report Page: 7 Printed: 01/05/2005 21:31:43 0007 Innident History for:#TF05000040 CN: $TF05000042 Xref:#TP05000363 gece4ved 01/05/05 08:43:47 BY CRO7 /VC5172 Eriterea 01/05/05 08:43:47 BY CRO7 /VC5172 Dispatched 01/05/05 08:44:02 BY FD23 /VC0496 Bnroute 01/05/05 08:45:47 Oriacene 01/05/05 08:49:16 Closed 01/05/05 10:59:10 Initial Type:ACCINF TG: Initial Alarm Level:l Final Type:ACCINF (INJURY ACCIDENT (2A))Pri:lDispo:25R1 Alrm Lev: 1 Police TP100 Fire TF5351 Grp:T7Beat: Lt/Lg: Police Rms: Fire Rms: Medic Rms: Loc:12674 GATEWAY DR ,TUK near UNK (V) Name:KEEKIN, JILL/COWORKER Addr: 08:43:47 Phone: 2062418870 VC5172 CRO7 ENTRY INJURY ACCIDENT AT MINOLTA BLDG IN THE P ARKING LOT./ $TF05000042 #TF7187 JOHNSON, JEFF #TF7866 ROOKSTOOL, EDWARD #TF7946 GREEN, DAVE C/F3 FD23 ASST E52 #TF4256 WHEELER, STEVE #TF8523 HAYMAN, BEN #TF8793 CROWLEY, MARK C/F3 SUPP TXT: CORRECTION****RP WAS IN A FORKLIFT BEING TOWED BY A TRUCK, FORKLIFT DROPP E D CONTRL GRP: T9 ---> T7. TOWROT E52 AMB,TUKTRI,TUK,TRI-MED AMBULANCE, 2062435 622 SUPP TXT: BLEEDING FROM HEAD, INSTRUCTIONS GI VEN. IS CONSC AND BREATHING NORMALLY.. . ASST TRI2 [12674 GATEWAY DR ,TUK] ASNCAS TRI2 $XF05000383 SUPP NAM: KEEKIN, JILL/COWORKER PHO: 2062418870 TXT: PATIENT IS CLEAR OF THE TOW TRUCK A ND FORKLIFT. 08:43:47 CRO7 $ASNCAS 08:44:02 VC0496 FD23 DISP E53 08:44:02 08:44:28 VC5172 CRO7 08:44:46 VC0496 FD23 08:45:14 VC0385 FD22 08:45:14 VC5172 CRO7 08:45:19 VC0385 FD22 08:45:19 FD22 08:45:46 VC5172 CRO7 08:45:47 TF7187 E53 08:46:14 VC5172 CRO7 08:46:27 VC0385 FD22 08:46:45 VC1140 FD24 08:47:18 FD24 08:49:16 FD24 *ENROUT 853 GDISPO D/25R1 SUPP TRI2 , TRI MED FROM 188/EVH ENROUT E52 CLEAR TRI2 ONSCNE E53 08:50:19 FD24 MISC E53 , ONE OVERTURNED FORK LIFT WITH BATTERY ACID SPILL , HYDROLIC SPILL 08'50:49 98:50:51 08156:b6 04:57:36 08:58:50 09:07:16 09:07:51 09:11:09 09:11:57 09:12:26 09:14:23 09:23:33 09:24:11 09:24:22 09:25:10 09:27:58 09:28:00 09:29:34 09:40:54 09:40:56 09:59:08 10:52:22 10:59:10 10:59:10 FD24 ONSCNE 852 FD24 MISC E53 , ADV B51 2 BAGS OF SODA ASH FD24 ASSTOS A54 [12674 GATEWAY DR ,TUK] #TF4856 CZULEGER , MATT #TF7643 NICHOLS, JEFF FD24 NEWLOC E53 [GATEWAY CMD] FD24 ASSTOS B51 [12674 GATEWAY DR ,TUK] #TF8163 EWING, D AVE VC5055 FD24 CONTCT B53 , REQING TO CALL L&I - RPT INDUSTRIAL AC CIDENT W/INJS FD24 CONTCT E53 , NO PRODUCT GOING INTO STORM DRAIN - BU SN CALLING ANOTHER PVT CO FOR CLEAN UP TF8163 VC5055 VC5998 VC5055 TF7187 VC5055 TF4256 B51 MOBINS B51 FD24 CONTCT E53 FD24 CONTCT E53 FD24 CONTCT E53 FD24 CONTCT 853 FD24 CONTCT 853 FD24 OLIS E52 FD24 CONTCT E53 FD24 NEWLOC E53 FD24 ONSCNE E53 FD23 CLEAR A54 FD24 UNAVL E52 FD24 OLIS E53 E53 IQIS E53 FD24 CONTCT E52 B52 MOBINS E52 E52 CLOSE E53 , 206.835.1000 , NUMBER FOR L&I - 206.835.1000 , CHET RAY - SAFETY COMPLIANCE SUPV - 6.835.1051 , 206.948.9029 , L&I ADV'D , TERMINATING CMD [12674 GATEWAY DR ,TUK] , PVT SPILL CO ON LOON D/2581 20 Inok:ent Report 2005-0500042 -000 Tukwila Fire Department (LIVE) 444 ANDOVER PK E TUKWILA, WA 98188 206 575 4404 Printed: 071'25/2019'14:34:05 Number of Pages: 4 Page 1 of 4 Printed: 07/25/2019 14:34:05 Basic Alarm Date and Time Arrival Time Controlled Date and Time Last Unit Cleared Date and Time Response Time Priority Response Completed Reviewed Fire Department Station Shift Incident Type Aid Given or Received Alarms Action Taken 1 Action Taken 2 Casualties EMS Provided Apparatus - EMS Apparatus - Other Personnel - EMS Personnel Personnel - Other Property Loss Contents Loss Property Value Contents Value Hazardous Material Released Property Use City, State Zip District Census Tract Directions ' 08:43:47 Wednesday, January 5, 2005 08:49:16 10:59:10 Wednesday, January 5, 2005 0:05:29 Yes Yes Yes 53 C 322 - Motor vehicle accident with injuries N - None 1 32 - Provide basic life support (BLS) 44 - Hazardous materials leak control & containment No Yes 3 1 8 1 $0.00 $0.00 $0.00 $0.00 6 - Household/office solvent or chemical spill 965 - Vehicle parking area Tukwila, WA 98168 001 0272.00 12674 GATEWAY DR ,TUK Situation Initial Dispatch Code , 25R1 Person Involved - Patient #1, Involvement Code Last Name Street Address Phone REP Patient #1 2062418870 Apparatus - E53 Apparatus ID Response Time Apparatus Dispatch Date and Time En route to scene date and time E53 0:05:14 08:44:02 Wednesday, January 5, 2005 08:45:47 Wednesday, January 5, 2005 Page 1 of 4 Printed: 07/25/2019 14:34:05 Inckient Report 2005-0500042 -000 Tukwila Fire Department (LIVE) 444 ANDOVER PK E TUKWILA, WA 98188 206 575 4404 Printed: 07/25/2019 14:34:06 Number of Pages: 4 Page 2 of 4 Printed: 07/25/2019 14:34:06 Apparatus - E53 Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Type Personnel 1 Personnel 2 Personnel 3 08:49:16 Wednesday, January 5, 2005 09:59:08 Wednesday, January 5, 2005 Yes 3 2 11- Engine TF1166 - Butler, Wesley Position: FFI TF1167 - Dyer, Steven Position: FFI TF1122 - Peterson, Lavern Position: LT Apparatus - E52 Apparatus ID Response Time Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Type Personnel 1 Personnel 2 Personnel 3 E52 0:06:47 08:44:02 Wednesday, January 5, 2005 08:46:45 Wednesday, January 5, 2005 08:50:49 Wednesday, January 5, 2005 10:59:10 Wednesday, January 5, 2005 Yes 3 2 11 - Engine TF1176 - Crowley, Mark Position: FFI TF1129 - Wheeler, Stephen Position: LT TF1121 - Hayman, Ben Position: FFI Apparatus - A54 Apparatus ID Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Type Personnel 1 Personnel 2 A54 08:56:06 Wednesday, January 5, 2005 09:29:34 Wednesday, January 5, 2005 08:56:06 Wednesday, January 5, 2005 09:29:34 Wednesday, January 5, 2005 Yes 2 2 75 - BLS/Aid unit TF1107 - Nichols, Jeff Position: FFIII TF1131 - Wojcik, Peter Position: LT Page 2 of 4 Printed: 07/25/2019 14:34:06 Incident Report 2005-0500042 -000 Tukwila Fire Department (LIVE) 444 ANDOVER PK E TUKWILA, WA 98188 206 575 4404 Printed: 07/25/2019 14:34:06 Number of Pages: 4 Cross Ref Inc#s for each Jurisdiction Involved: #1={TP05000363 Updated addl location info: near UNK Short Report: INJURY ACCIDENT AT MINOLTA BLDG IN THE PARKING LOT./ <08:44:28>TXT: CORRECTION****RP WAS IN A FORKLIFT BEING TOWED BY A TRUCK, FORKLIFT DROPP ED <08:45:14>ING FROM HEAD, INSTRUCTIONS GIVEN. IS CONSC AND BREATHING NORMALLY.... 2005010508 <08:45:46>NAM: KEEKIN, JILL/COWORKER PHO: 2062418870 TXT: PATIENT IS CLEAR OF THE TOW TRUCK AND FORKLIFT. <08:46:27>, TRI MED FROM 188/EVH E53<08:50:19>, HYDROLIC SPILL E53<08:55:51>, ADV B51 2 BAGS OF SODA ASH } Narrative Name 05-0042 Narrative Type Incident Narrative Date 21:24:48 Wednesday, January 5, 2005 Author 1122 - Peterson, Lavern Page 3 of 4 Printed: 07/25/2019 14:34:06 Apparatus - B51 Apparatus ID Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Type Personnel 1 B51 08:58:50 Wednesday, January 5, 2005 09:11:09 Wednesday, January 5, 2005 08:58:50 Wednesday, January 5, 2005 09:11:09 Wednesday, January 5, 2005 Yes 1 0 92 - Chief officer car TF1108 - Ewing, David Position: CAPT Authority Reported By Officer In Charge Reviewer TF1122 - Peterson, Lavern 21:11:57 Wednesday, January 5, 2005 TF1122 - Peterson, Lavern 21:11:57 Wednesday, January 5, 2005 TF1159 - Schell, James 19:28:41 Wednesday, February 9, 2005 Narratives Narrative Name Narrative Type Author Narrative Text CAD Narrative CAD Narrative - , CAD Incident Number: TF05000040 Cross Ref Inc#s for each Jurisdiction Involved: #1={TP05000363 Updated addl location info: near UNK Short Report: INJURY ACCIDENT AT MINOLTA BLDG IN THE PARKING LOT./ <08:44:28>TXT: CORRECTION****RP WAS IN A FORKLIFT BEING TOWED BY A TRUCK, FORKLIFT DROPP ED <08:45:14>ING FROM HEAD, INSTRUCTIONS GIVEN. IS CONSC AND BREATHING NORMALLY.... 2005010508 <08:45:46>NAM: KEEKIN, JILL/COWORKER PHO: 2062418870 TXT: PATIENT IS CLEAR OF THE TOW TRUCK AND FORKLIFT. <08:46:27>, TRI MED FROM 188/EVH E53<08:50:19>, HYDROLIC SPILL E53<08:55:51>, ADV B51 2 BAGS OF SODA ASH } Narrative Name 05-0042 Narrative Type Incident Narrative Date 21:24:48 Wednesday, January 5, 2005 Author 1122 - Peterson, Lavern Page 3 of 4 Printed: 07/25/2019 14:34:06 Incident Report 2005-0500042 -000 Tukwila Fire Department (LIVE) 444 ANDOVER PK E TUKWILA, WA 98188 206 575 4404 Printed: 07/25/2019 14: 34:06 Number of Pages: 4 Narratives Author Rank Author Assignment Narrative Text Narrative Name Narrative Type Narrative Date Author Author Rank Author Assignment Narrative Text LT 1 At 0843 hours on Wednesday January 5, 2005 we were dispatched to a motor vehicle accident involving a pedestrian. Four units were assigned to this incident. Nine personnel responded. We arrived on scene at 0849 hours and cleared at 1059 hours. The incident occurred at 12674 GATEWAY Dr, TUKWILA in District 5351. The general description of this property is vehicle parking area. The primary task(s) performed at the scene by responding personnel was to provide basic life support (BLS). No mutual/automatic aid was given or received. Truck towing forklift in the parking lot, the forklift was going too fast and rolled throwing the driver out. The driver of the forklift struck his head causing a large laceration that required treatment and transport to Valley Medical Center. The forklifts batteries came out spilling a small quantity of sulfuric acid on the parking lot surface. The oil from the forklift also spilled on the parking lot surface. Upon our arrival E-53 did Pt. care while E-53 did containment and neutralization of the acid spill. E-53 set up command and called L&I, and had the owners of the fork lift call a private company for spill clean-up. One patient was involved with this incident. Alarm number 0500042 has been assigned to this incident. Audit Other 16:43:48 Sunday, April 10, 2005 TF1159 - Schell, James FFI 1 Changed incident type code from 323 car vs ped to mva 322 James R. Schell 4/10/5 Special Studies Special Study Name Special Study 0 End of Report Page 4 of 4 Printed: 07/25/2019 14:34:06