APPENDIX 2

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 06801143
• Release Decision: RIFPUB
• Original Classification: U
• Document Page Count: 1
• Document Creation Date: March 8, 2023
• Document Release Date: May 28, 2019
• Case Number: F-2018-00022

Approved for Release: 2019/05/16 C06801143
CY 2016 ANNUAL OCCUPATIONAL SAFETY & HEALTH REPORT TO THE SECRETARY OF LABOR
APPENDIX 2
FATALITIES, HOSPITALIZATIONS, AMPUTATIONS, Loss OF AN EYE REPORT
Report each event separately. Summarize the event(s) in the narrative of the overall report.
Total number offatalities: 0
Total number of hospitalizations: 0
(PLEASE DUPLICATE AS NEEDED)
Fatality, Hospitalization, or Other Reportable Event
1:1 Fatality CI Hospitalization 0 Amputation 0 Loss of an Eye
Was it work related? Yes 0 No 0
Number of employees injured: [Number Injured]
Number of employee fatalities: [Number of Fatalities]
Date of the Incident: [Date]
Time of the Incident: [Time]
Description of workplace operations: [Operations Description]
Description of the incident: [Incident Description]
Analysis of workplace cause: [Cause Analysis]
Were corrective actions taken? Yes LI No 1=1
If yes, please describe the actions taken: [Description of Actions]
Were programmatic changes made? Yes 1=1 No LI
If yes, please describe the changes made: [Description of Changes]
APPENDIX 2 � FATALITIES, HOSPITALIZATIONS, AMPUTATIONS, Loss OF AN EYE REPORT
Approved for Release: 2019/05/16 C06801143