LSJE, LLC

LSJE, LLC Vehicle/Equipment: 6100 Red Hook Phone: uarters, Suite B-3, St. Thomas, VI 00802-1348 E-mail: [email protected] Vehicle/Equipment Accident Report Lull Location of Incident Witness: Witness: Date of Incident: 12/13/18 GSJ Danny Description of Incident: Position: Position: Helper (Blan) broken window in delivery truck - rear Was employee operating vehicle within proper operation procedures and following all safety regulations? K Yes K 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