HomeMy WebLinkAbout0850-72_Highland Haven Development Sewer Project - RDA_15.1RECORD OF TELEPHONE CONVERSATION
CITY OF FONTANA
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Job No.
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THER. Clear Cloudy Windy Rain Snow Other ge3 L
Temp. Extremes Only
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COSTR.AC-JR: �'/' C-^�"' 1 fC)Cta/U PROJECT: tiliattlf414WS 5 i r'
Location of Work: l5 Q /0/I�y l411�
•
EQUIPMENT AND/OR LABOR PRESENT DURING INSPECTION
No.
Equip.
No.
glen
Description
(Equipment or Labor)
No.
Equip.
No.
Men
Description
(Equipment or _abcr)
/
0—Cref
5114'
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•
RtMARKS: TOTAL HOURS PER INSPECTION:
INSPECTION ACTIVITIES WERE: W.) 5A 3161110 41 "JVo
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THER. C1e'ar Cloudy Windy Rain Snow Other:
Temp. Extremes Oniy."High
CONTRACTOR: (f"/ ` Go"5 fCx27(4v
Location of work: / 53(
PROJECT:
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EOCIPMENT AND/OR LABOR PRESENT DCRING INSPECTION
No.
Equip.
No.
Men
Description
(Equipment or Labor)
No.
Equip.
No.
Men
'.t Description
(Equipment or labor)
/
,
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(AY5114'
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Rt.MARKS
INSPECTION ACTIVITIES WERE:
TOTAL HOURS-PER:INSPECTION:
$! / 3 5AT 4\
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Ccccrac:or Title
Inspector
Community Development Department:
FROM: ,/1/1'rudy L. Lohse, Administrative Clerk II
1
SUBJECT: Ins. Claim Report #92-75 - SHARP, JOE W.
DATE: September 4, 1992
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A claim has been filed against the City of Fontana involving your department.
Please prepare a report on this matter at your earliest convenience and forward
to the Clerk's office for processing.
Thank you for your cooperation regarding this matter.
cc: Ward-THK
Risk Management. Division
Attachment: Claim
tl
GARY E. BOYLES
MAYOR
PATRICIA M. MURRAY
MAYOR PRO TEM
BEN L. ABERNATHY
COUNCIL MEMBER
DAVID R. ESHLEMAN
COUNCIL MEMBER
BILL FREEMAN
COUNCIL MEMBER
Mr. Joe Sharp
15836 Torrey Street
Fontana, CA 92336
KATHY MONTOYA
CITY CLERK
DR. CHARLES A. KOEHLER
C i t y of Fontana CITY TREASURER
JAY M. COREY
CITY MANAGER
CALIFORNIA
September 9, 1992
RE: Claim #92-75
Dear Mr. Sharp:
This will acknowledge receipt of your claim dated August 28, 1992 for alleged
personal injuries resulting from a fall into a trench at the above address.
Your claim has been forwarded to our Risk Management Division for appropriate
action. If you should have any questions regarding this matter, please call
350-7668.
Sincgrely,
Linda S. Nunn, CMC
Deputy City Clerk
LSN:tll
cc: Ward-THK,
Risk Management Department
8353 SIERRA AVENUE (P.O. BOX 518) • FONTANA, CALIFORNIA 92334.0518 • (714) 350.7600
SISTER CITY- KAMLOOPS, B.C. CANADA
•
CLAIM AGAINST THE CITY OF FONTANA
CALIFORNIA
CITY CLERK'S DEPARTMENT
NOTE: Certain procedures governing the filing of claims for mone
are set forth in Title 1, Division 3.6, Part 3 (Sections 900, et
Government Code, State of California. This claim form has been pr
accordance with California Government Code, Section 910.4. When this
used, please submit to the City Clerk's Department, City Hall, 8353
Avenue, (P.O. Box 518), Fontana, California, 92335.
I Original Filing
Name of Claimant:
Post Office Address of Claimant:
Je
_ V)
_I Amendment
Sierra
to previous claim
Address to which notices regarding this claim are to be seat:
0n (date of occurrence or transaction): 8 -- 1 -- C)Z.
At (place of occurrence or transaction): IS , (07.r M.G.\k bo)(
General description of the indebtedness, obligation, injur , damage or loss
incurred so far as it is known at the time of presenting this claim: ( G,c
N2c c�11& .1-�: ,k- hand �0,t. 0 ' a �� P ).
Nke_&, ' ca�
Resulting from (including, but not limited to, circumstances of the Recurrence
of transaction which gave rise to the claim asserted):
6-0c (�
r,,� �9.nc� Q . ►&,l l\ahC \ NrAI NX k o or Nta\ \ b6
The names of any City employees claimed to have caused the
loss (if known) are as follows: Lee. 1A A hc. 0 \-
\® Pu-bl 4\0., \ k. zn5r aA.- .h s �v-� P.
Amoun
t claimed as of date of this claim (incl
prospective injury, damage or loss, insofar as
njury, dama
or
hk►
P_ �$ iemi\
ding the estimated amount of any
may be known at this time):
Computed as follows (set forth basis of computation of th a unt claimed,
attach bills, invoices, statements, etc. if available): 1 �` KY\owy\
(07 V.V-42__".,e.r--11YV\-4L.,
•
Name& andaaddresses of known witnesses to occurrence or transaction:
XidIV rf
SI%nature of
Cla mant
Da ed
Phone Number: th-C72-(t. Messag • e:
Qi?)5 0
NOTE: If sufficient space is not provided for information, please attach
additional sheets securely to this form.
ADBERNARDINO COUNTY MEDICAL CEN141)
EMERGENCY DEPARTMENT -AFTERCARE INSTRUCTIONS TO THE PATIENT
NOTE: The examination and treatment you have received in the Emergency Department has been provided on an emergency basis
only, and should not be a substitute for complete medical care. As instructed, be sure to see your own physician for follow-up care.
At this time, we will be happy to make you an appointment with one of our Primary Care physicians. It is important that you let
him check you and that you report to him, any new or remaining problems at the time, because it is impossible to recognize and
treat all elements of injury or illness in a single Emergency Department visit. Meanwhile, FOLLOW ONLY THE INSTRUCTIONS
CHECKED BELOW.
TREATMENT RENDERED:.
El Sutured
❑ X-ray
❑ EKG
El 'Lab Test
❑ Tetanus Booster
El Hypertet and Tetanus Booster
El Medication
0 Exam and Evaluation
MEDICATION: Follow label instructions for any prescription
given by the Emergency Physician. -
IMPORTANT NOTICE: Your X-rays have been interpreted on
a temporary basis pending final reading by our radiologist. If
there is any change in interpretation, you will be notified.
WITHIN THE NEX G S p sSi445+,
PLEASE CHECK WITH YOUR PHYS CIA FOR:
Exam and re-evaluation. ForvreiNikr
Wound evaluation.: 1 / 5;5-
❑ Removal of sutures. •
❑ Further treatment of the condition which brought you here.
❑ You may return to work/school:'' 0 Yes • 0 No
❑ You will need re-evaluation by your own doctor or.
compensation doctor prior to returning to work or school.
OTHER SPECIFIC INSTRUCTIONS:
FOR YOUR OWN SAFETY, YOU SHOULD FOLLOW ALL INSTRUCTIONS GIVEN BY THE EMERGENCY ROOM DOCTOR
HEAD INJURY INSTRUCTIONS:
❑ You have had a head injury, which at this time does not
require hospitalization. In a small number of cases however,
symptoms may appear which could mean a serious condition
and therefore should be checked by a doctor. These symptoms
are:
1. Continuing severe headaches.
2. Nausea and vomiting.
3. Excessive sleepiness or difficulty in awakening the patient
from sleep.
4. Unequal pupil size (black central portion of the eyes not
the same size).
5 Weakness, paralysis or numbness of the arm or leg on the
same side of the body.
6 Mental confusion.
If any or all of the above symptoms occur, contact your
doctor immediately, and if he is unavailable, return to the
Emergency Room of this hospital.
You should be awakened every 2-3 hours from sleep
during the first night of sleep after your head injury.
Avoid all sedatives, (sleeping pills, nerve pills); alcohol,
wine, beer, and narc ' . Aspirin may be used.
Other Instructions:
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mrbiGaq%f oN Ct. S are/tar
y PICGGTicif, r.a..310
ar_k % i a 1NJ
Wound Care (cuts, abrasions, burns,:etc.)
❑ Keep the dressings clean and dry.
❑ Elevate the wound to help relieve soreness and speed
wound healing.
Despite the greatest care, any wound can be infected. If
your wound becomes red, swollen, shows pus or red
streaks, or feels more sore instead of Tess sore as. days go
by, you must report to your doctor right away.
❑ If dressings need to be changed; you should:
0 Change them 0 Call your doctor
Sprain and Fracture, Severe Bruises
❑ Keep injured part elevated above the level of your heart
for day(s);
❑ Ice packs also help prevent swelling, especially during the
first 48 hours. Place ice in plastic or rubber bag, cloth
cover. ,
0 If you have an elastic bandage, rewrap if too tight or
loose.
❑ If you have a cast, keep it perfectly dry at all times.
❑ Wait 48 hours for the cast to become strong before you
allow pressure or weight on any part of the cast.
0 Wiggle toes or fingers to help prevent swelling in the cast
— this should be done often if it does not cause pain:
if'
If the part swells in any way or gets cold, blue, or numb,
or if pain increases markedly, have it checked promptly.
❑ Return for cast check on:
THIS IS VERY IMPORTANT.
have received the instructions checked above. I understand that I have had emergency treatment only, and that I may be released
before all of my medical problems are known or treated. I was given the above instructions for patients witead injuries. I
will arra e for foll w uprF 7
•.re as instructed above:
Date
. Patient; ID G 2 8
05-I_-1» 41 fl
11447J4 FP u
11-14191.731 Rev. 12/81
Nurse's or Doctor's Signature
Doctor:
Nurse:
Was -treated at: San Bernardino County Medical Center
780 E. Gilbert Street
San Bernardino, CP 92.404 .
414
Spanish Translation Received by Patient,
•
INSTRUCTIONS FOR GENERAL CONDITIONS
VOMITING AND/OR DIARRHEA ROUTINE:
1. Give nothing by mouth for 1 hour.
�.` Offer"clear flulds.oplit�for 24 hours. This includes.`water, Kool-aid, and weak tea. If desired, adtt'1 teaspoon of
- - sugar to 4 ounces of liquid. If diarrhea is not severe,.you.may continue with Gingerale, 7-Up and the cola drinks
and other pop, diluted at first with water, half and half.
Give 1 ounce during the first half hour, then 2 ounces during the second half hour, then 3 ounces the third half
hour. Offer by the teaspoon or through a straw. : a
If this is retained, wait '/2 hour and then offer 1 to 2 ounces every half hour, then 2 to 3 ounces every hour, and
then 3 to 4 ounces every 2 hours.
If vomiting occurs, wait 1 hour and start over.
3. Start low -residue solids only when the stools have begunto slow down and become firm. St t with, rice`or''
barley cereal and %their• banana and pears (Puffed Rice or. Rice Krispies and mashed banana and pears if the
youngster is oilier). Slowly go on to Jello (solid or liquidh, unseasonedapplesauce, mashed potatoes, custard,
crackers, pretzels, soft- boiled eggs, beef, chicken or veal. Also, clear soups, apple and pear juice maybe added.
Keep on just afew. of the above foods and low -fat milk until the stools are normal for 5 to 7 days: If the stools
remain liquid or you have other concerns, call and talk with us.
If your child is under 6 months of age,
If he/she has fever,..
If f1e/sh'$ is, P t t1dti �i�tti;
1f he/she, is . rM1 thig cgntiihuously ,CA
CARE AFTER TREATMENT OFSIISPECTED POISONING.
Encourage inereasid fluid intake.
2. Should be arras every hour for 3 to 4 hours. ff wteble t arouse, call Emergency Room Doctor.
j ri
3. Keep warm and propped on sidein case -of vomiting t S•j
• ill' •
4: If vomiting persists.„, contact Lis..„, : ,;..
5.. If any unusuatpcdbtems occur. plecontact us.
COOLING MEASURES FOR HIGH T RATURE
1. Give acetaminophf (Tyt a'i al or aspirin as directed by doctor, every 4 hours for temperature of
101° or over.
. Try to maintain ngrmiai,amotntit*
3 - De not force an eAcessive ar,rtountiblkficittidss
4. } Dd notwrap~.Itildttp in blart.l • pr dtlot
5. If temperature rernpins very high (104°or more), sponge vlth cool water and fan child until temperature drops.
likkh
* ASE%cAtL°38/T8d1O E - GENCY DEPARTMENT