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I JACKSON LEWIS P.C.
JAMES T. JONES (SBN 167967)
2 KELSEY F. MORRIS (SBN 311117)
400 Capitol Mall, Suite 1600 FfLED/ENOORSED
3 Sacramento, Califomia 95814
Telephone: (916) 341 -0404 MAY 2 7 2C22
4 Facsimile: (916) 341-0141
Email: james. iQnes@iacksonlewis.com
5 kelsev.monis(5iiacksonlewis.com By:. S. Cads
OciSL'l)' Cterk
6 Attomeys for Defendant
LIQUI-BOX CORPORATION
7
8 SUPERIOR COURT OF THE STATE OF CALIFORNIA
9 COUNTY OF SACRAMENTO
10 SAJIDA ZAMAN, CASE NO. 34-2019-00252121-CU-WT-GDS
11 Plaintiff, DECLARATION OF ANGELA KENYON
TN SUPPORT OF DEFENDANT LIQUI-
12 vs. BOX CORPORATION'S MOTION FOR
SUMMARY JUDGIVIENT AND/OR
13 LIQUI-BOX CORPORATION, and DOES 1 SUMMARY ADJUDICATION O F
through 20, inclusive, ISSUES
14
Defendants. Date: August 10, 2022
15 Time: 1:30 p.m. DV CAY
Dept: 53 °^ ""^
16 Reservation No.: 2644651
17 Complaint Filed: March 8, 2019
Trial Date: September 12, 2022
18
19 I , Angela Kenyon, declare and state as follows:
20 1. I have personal knowledge of the matters stated herein, and i f called to
21 testify on these matters, I could and would do so competently.
22 2. I am Chief Human Resources Officer for Defendant Liqui-Box Corporation
23 ("Defendant"). Defendant employed Plaintiff Sajida Zaman as a "Packer" in Defendant's
24 Sacramento facility until her employment was terminated on January 10, 2019. During PlaintifPs
25 period of employment, I was employed as the Director of Human Resources and I participated in
26 the decision to terminate Plaintiffs employment.
27 3. In or about June 2018, Defendant implemented its "Critical Safety
28 Behaviors Policy." A true and correct copy of that policy is attached hereto as Exhibit A.
1
DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUI-BOX CORPORATION'S
MOTION FOR SUMMARY JUDGMENT AND/OR SUMMARY ADJUDICATION OF ISSUES
1 According to the Critical Safety Behaviors Policy, employees must, among other requirements,
2 report all safety incidents to a supervisor or management team member, even if they are minor.
3 There are no exceptions to the reporting requirement. Pursuant to the policy, a violation of the
4 Critical Safety Behaviors Policy is grounds for termination. I was involved in creating and
5 implementing the Critical Safety Behaviors Policy and know the reason why it was issued and
6 implemented. The purpose of the policy is to promote safety in the workplace by encouraging
7 employees to report all safety incidents including injuries or "near misses," no matter how minor.
8 Defendant issued the policy so that employees will report unsafe conditions in the workplace and
9 workplace injuries as soon as possible after they know about them, which allows Defendant to
10 remedy unsafe conditions to protect workers and to arrange for prompt treatment of workplace
11 injuries. If an employee is not aware that he or she was injured on the job, or if an employee is
12 not aware that a safety incident or near miss incident occurred, Defendant does not expect the
13 employee to report any such incident unless and until they become aware of such an incident.
14 Under those circumstances. Defendant expects employees to report such incidents as soon as they
15 are reasonably able to do so.
16 4. Defendant also has a Standard Operating Procedure AS 1025, issued on
17 March 6, 2017, that sets forth Defendant's practices for investigating all incidents which require
18 medical attention, including first aid cases, near miss incidents, and fires. Standard Operating
19 Procedure AS 1025 defines "near miss" to mean the "potential for injury or property damage."
20 Standard Operating Procedure AS 1025 states that "Any incident requiring any type of treatment
21 to any employee or contractor, a near miss, or any incident resulting in equipment damage, or fue
22 shall be reported immediately to a shift leader." Standard Operating Procediue AS 1025 states
23 that if a shift leader is not available a report can be made to the Plant Manager, EH&S
24 (Envirormiental Health & Safety) Manager, or the Human Resources Manager. Standard
25 Operating Procedure AS 1025 also sets forth additional steps that must be taken to investigate and
26 report on safety incidents, including the preparation of a "4 Panel Review for any employee who
27 sustains an injury resulting in medical treatment, restricted workdays or lost workdays . . . ." A
28 true and correct copy of Standard Operating Procedure AS 1025 is attached hereto as Exhibit B.
2
DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUI-BOX CORPORATION'S
MOTION FOR SUMMARY JUDGMENT AND/OR SUMMARY ADJUDICATION OF ISSUES
1 5. Defendant issued Standard Operating Procedure AS 1025, conducts
2 employee training, and obtains employee acknowledgments regarding awareness of the Critical
3 Safety Behaviors policy in order to promote workplace safety. On or about October 10, 2017,
4 Plaintiff signed an acknowledgment that she had been trained and understood that all injuries,
5 incidents, and near misses must be promptly reported to a supervisor or leadership. A true and
6 correct copy of the acknowledgment signed by Plaintiff is attached hereto as Exhibit C. On or
7 about June 4, 2018, Plaintiff signed an acknowledgment that she had been given a copy ofthe
8 Critical Safety Behaviors policy, that it had been explained to her, she agreed to comply with it,
9 and she knew that violating the policy would "lead to immediate termination of employment."
10 See Exhibit A.
11 6. On January 3, 2019, Defendant became aware that Plaintiffhad suffered an
12 injury that she believed had occurred at work. On that day. Plaintiff filled out a "Liqui-Box
13 Sacramento AS 1059 Employee INVESTIGATION FORM" indicating she was injured pushing a
14 "mega tote." A mega tote is a type of cart used in the workplace to move boxes. A tme and
15 correct copy of Plaintiffs January 3, 2019, AS 1059 Employee INVESTIGATION FORM is
16 attached hereto as Exhibit D. On that form, she identified the date of her incident to be "Decmeb
17 I week." I was involved in the decision to terminate PlaintifFs employment, and I reviewed the
18 AS 1059 form. I understood it to mean that the incident that led to PlaintifFs injury occurred
19 during the first week of December 2018. On the January 3, 2019, AS 1059 "Employee
20 INVESTIGATION FORM" Plaintiff described the injury as "muscle swelling" and she noted that
21 she received medical treatment for her injury on December 31, 2018.
22 7. Defendant uses an outside vendor, Medcor, to conduct an initial evaluation
23 of workplace injuries (triage) so that injured employees can be promptly provided with proper
24 medical care. Medcor uses healthcare professionals, such as Registered Nurses, to conduct the
25 "initial evaluation. Defendant received a copy of the notes documenting Medcor's triage of
26 PlaintifFs injury on January 3, 2019. A tme and correct copy of the Medcor "Workplace Injury
27 Triage & Reporting Incident Report received by Defendant is attached hereto as Exhibit E. The
28 Medcor "Workplace Injury Triage & Reporting" incident report related to Plaintiffs injury states
3
DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUT-BOX CORPORATION'S
MOTION FOR SUMMARY JUDGMENT AND/OR SUMMARY ADJUDICATION OF ISSUES
1 that "about a month ago she was pushing a box on wheels when she developed pain in her left
2 knee. She sought care at Methodist Hospital emergency room in Sacramento, CA on 12/31/18
3 where she was treated for knee injury and was advised to follow up with her PMD if pain did not
4 improve."
5 8. Following Medcor's triage of PlaintifFs injury. Defendant transported
6 Plaintiff to U.S. Health Works Medical Group where she was further examined. Defendant
7 received a "Work Status Report" from U.S. Health Works Medical Group related to Plaintiff that
8 indicated she was examined on January 3, 2019 and was diagnosed with "Strain of left knee" and
9 "Strain of left hamstring muscle." A true and correct copy of that Work Status Report is attached
10 hereto as Exhibit F. The Work Status Report from the January 3, 2019, examination stated
11 "DOI: 12-03-2018". When I reviewed the Work Stams Report, I interpreted that to mean the date
12 ofthe incident that caused PlaintifFs injury was on or about December 3, 2018. Based upon my
13 review of PlaintifFs clocking records, in December 2018, Plaintiff worked on December 3-7, 10-
14 14, 17-19, and 21. She also worked on January 2, 2019.
15 9. Pursuant to Defendant's Standard Operating Procedure AS 1025,
16 Defendant conducted the "4 Panel Review" related to PlaintifFs injury. The "4 Panel Review"
17 summarizes the incident as follows:
18 "Sajida indicated that she was pushing a mega tote cart with about 400 bags 3-4 weeks ago.
19 Sajida stated that the wheel(s) on the cart were not working properly so she overcompensated to
20 push the cart. Sajida stated that over the last weeks she incurred swelling and knee pain - taking
21 over the counter ibuprofen." The "4 Panel Review" noted that Sajida was triaged through
22 Medcor and sent to US Healthworks for a post-injury evaluation. A true and correct copy of
23 Defendant's 4 Panel Review is attached hereto as Exhibit G.
24 10. After the 4 Panel Review was completed. Defendant's Chief Operating
25 Officer (COO), Andrew McLeLand, and I reviewed the contents of the written 4 Panel Review. I
26 also reviewed Exhibits A through F attached hereto and I spoke to Janene Whitoey, the Human
27 Resources Manager of the Sacramento facility, who had transported Plaintiff to U.S. Health
28 Works Medical Group on January 3, 2019 after she reported her injury. Together with COO
4
DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUI-BOX CORPORATION'S
MOTION FOR SUMMARY JUDGMENT AND/OR SUMMARY ADJUDICATION OF ISSUES
1 Andrew McLeLand, I determined that, based on the contents of the foregoing exhibits (A through
2 F), and based upon the information described to me by Janene Whitaey, which also confirmed
3 that Plaintiff reported a workplace injury on January 3, 2019, weeks after the injury occurred,
4 Plaintiff had violated Defendant's Critical Safety Behaviors Policy. Accordingly, I made the
5 decision that Defendant would terminate PlaintifFs employment on January 10, 2019, because
6 Plaintiff had violated the Critical Safety Behaviors policy. Defendant's "HR Statos Change
7 Form" which documents the reason for the termination of PlaintifFs employment states,
8 "Involuntary - Violation of Critical Safety Behaviors - Neglected to report injury timely." A true
9 and correct copy of Defendant's "HR Status Change Form" documenting the reason for PlaintifFs
10 termination is attached hereto as Exhibit H. The only reason Defendant terminated PlaintifFs
11 employment was because she had not timely reported her workplace injury, which Defendant
12 became aware of for the first time on January 3, 2019.
13 I declare under penalty of perjury, under the laws of the State of Califomia, that the
14 foregoing is true and correct.
^5 Executed May 26, 2022, in Richmond, Virginia.
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DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUI-BOX CORPORATION'S
MOTION FOR SUMMARY JUDGMENT AND/OR SUMMARY ADJUDICATION OF ISSUES
EXHIBIT A
CRITICAL SAFETY BEHAVIORS m LIQU.-BOX
DESIGN. CONNECT. DELIVa.
1. immediately report all incidents to your supervisor, management team member no matter how minor or
without exception.
2. Proper Lock-Out/Tag-Out (LOTO) procedures must be followed.
a. Always LOTO when working on electrical equipment. Only authorized personnel with proper
training may work on hot/"live" panels or energized circuits and must always follow proper
protection procedures.
b. Always LOTO equipment prior to servicing or performing maintenance work.
3. Only enter a "permit required" confined space with an approved permit.
4. Body parts can only be placed In equipment (I.e. rollers, chains, belts, reciprocating bars, pinch points)
when it is not moving and with LOTO procedure followed. The only exception to this rule is when
following a documented Standard Operating Procedure or Job Safety Analysis.
5. Do not bypass any safety devices or remove guards. The only exception to this is during authorized
troubleshooting procedures.
6. Follow ali site specific fall protection procedures (I.e. when climbing on top of railcar to gain access,
operating scissor lifts or man lifts, climbing silos, etc.)
7. All semi-trailers must be wheel chocked and/or secured with a trailer restraint (e.g. Doc-Lock if so
equipped) during the loading and unloading operations, Trailer safety stands/jacks must be utilized
when the tractor is removed and the trailer is "free standing." Powered industrial truck operators must
verify these conditions.
8. Only authorized and trained employees can operate powered industrial trucks or any other motorized
vehicles. Never drive powered industrial tmcks or motorized vehicles recklessly.
9. Only authorized and trained employees can perfomi work in any electrical control box.
10. Horseplay or unacceptable practices that place you or fellow co-workers at risk of injury are not
acceptable.
Any violation of these Critical Safety Behaviors will result in immediate termination of employment.
I hereby acknowledge that a copy of the Critical Safety Behaviors has been given and explained to me. I agree to comply
with this policy at all times and understand that if any of these are violated, it will lead to immediate tennination of
employment.
Printed Name:^/)k/'A/) ?/)AlfiA^ Signature: ^^;..(Vy6.2f^^v\^vv Date: L -l^- I?
Revised: 5/30/2018
EXHIBIT B
Liqui-Box LIOUI-BOX
Standard Operating Procedure CORPORATION
SECTION: Safety/PSM/Occupational Health DATE ISSUED: 3/6/2017
and Environmental
SUBSECTION: Fire, Environmental, PSM, and REVISION #: 005
Incident Reporting Investigation
PROCEDURE ID: AS 1025 PAGE: 1 of 3
REVIEW DATE: 3/5/2020
1.0 PURPOSE / SCOPE
1.1 This procedure documents the Liqui-Box - practice for investigating all incidents which
require medical attention, including first aid cases, and near miss incidents and Fire.
2.0 RESPONSIBLE CARE
2.1 All site safety procedures must be followed.
2.2 All site PPE must be worn.
2.3 All PSM requirements shall be followed.
2.4 Environmental impacts shall be considered, and actions taken shall ensure the integrity of
those impacts.
3.0 DEFINITIONS
3.1 Near Miss- Potential for injury or property damage
4.0 REFERENCES
4.1 AS 1059 Employee Report
4.2 4 Panel Review
5.0 RESPONSIBILITIES
5.1 Management is responsible for implementing this procedure.
5.2 Shift Leaders are responsible for training on this procedure.
5.3 EH&S Manager is responsible for training the shift leaders.
5.4 Management, Shift Leaders, Production Lead, and EH&S Manager are responsible for
auditing this procedure.
6.0 TOOLS AND EQUIPMENT
6.1 N/A
7.0 PROCEDURE
7.1 Any incident requiring any type of treatment to any employee or contractor, a near miss, or
any incident resulting in equipment damage, or fire shall be reported immediately to a shift
leader.
7.2 If the shift leader is not available contact the Plant Manager, EH&S Manager or the Human
Resources Manager. Phone numbers can be found in the First Aid Cabinets located in the
Extrusion, Lamination, and Bag Departments.
7.2.1 Plant Manager
7.2.2 EH&S Manager
7.2.3 HR.
7.3 The shift lead shall immediately assess the situation to determine the severity of any injuries
that may require medical attention.
7.4 Any equipment involved in the incident is to be shut down and everything left as is until the
shift lead or someone from Management authorizes equipment to be restarted.
7.5 Emergency response shall be contacted via outside telephone (9-1-1) immediately if needed.
DOCUMENT CONTROLLED WHEN PRINT IS IN RED
VERIFIED BY SITES'FOOD SAFETY PRACTITIONERS
Liqui-Box LIOUI-BOX
SECTION:
and Environmental
Standard Operating Procedure
Safety/PSM/Occupational Health DATE ISSUED:
m
3/6/2017
CORPORATION
SUBSECTION: Fire, Environmental, PSM, and REVISION #: 005
Incident Reporting Investigation
PROCEDURE ID: AS 1025 PAGE: 2 of 3
REVIEW DATE: 3/5/2020
7.6 The Shift Lead shall immediately take action to administer any first-aid deemed necessary
until emergency and/or other trained emergency response personnel are on-site.
7.7 First-aid shall be administered by the shift lead or lead operator if medical treatment has been
ruled out.
7.8 Incidents resulting in near-miss fire or equipment damage shall be investigated by the
supervisor as soon as possible after determining that no employees have been injured.
7.9 At a minimum, the first page ofthe "AS 1059 Employee Report or AS1060C Near Miss shall
be initially filled out by the attending shift lead and the employee(s) involved, within 24 hours.
One report for each employee shall be initiated.
7.10 As soon as possible, the Plant Manager, Human Resources Manager and the EH&S
Manager shall be notified of all incidents by the attending supervisor.
7.11 The Plant Manager, Human Resources Manager, attending supervisor, and EH&S
Manager shall initiate an investigation of any incident as soon as possible after a report has
been issued. This shall occur within 48 hours.
7.12 A 4 Panel Review for any employee who sustains an injury resulting in medical treatment,
restricted work days or lost work days shall be issued by the site after final review by the
Plant Manager, Human Resources Manager and EH&S Manager. The report shall be issued
within 7 days.
7.13 All other incident reports (near-miss, first-aid, equipment damage) shall be documented
and placed on file within 72 hours in the EH&S Manager office.
7.14 Initial Injury Reporting
7.14.1 A fatality shall be reported to OSHA within 8 hours.
7.14.2 A fatality, whether employee, contractor, or visitor, occurring on company
property shall be reported immediately to Liqui-Box Leadership by the site's Plant
Manager.
7.15 Incident Reporting Fire:
7.15.1 All fire incidents shall be reported within 24 hours to Liqui-Box Leadership by the
site's Plant Manager.
8.0 RECORD
RECORD TITLE RETENTION
AS 1059 Employee Report 3Years Plus 1
AS 1060C Near Miss Incident Form 3Years Plus 1
4 Panel Review 3Years Plus 1
9.0 REVISION HISTORY
REVISION # DATE REASON
000 12/10/2005 Initial Issue
001 3/23/2009 Format modification
002 12/7/2010 Update Procedure
003 3/29/2011 Update Procedure
004 1/17/2014 Update Procedure
DOCUMENT CONTROLLED WHEN PRINT IS IN RED
VERIFIED BY SITES'FOOD SAFETY PRACTITIONERS
Liqui-Box LIOUI-BOX
Standard Operating Procedure CORPORATION
SECTION: Safety/PSM/Occupational Health DATE ISSUED: 3/6/2017
and Environmental
SUBSECTION: Fire, Environmental, PSM, and REVISION #: 005
Incident Reporting Investigation
PROCEDURE ID: AS 1025 PAGE: 3 of 3
REVIEW DATE: 3/5/2020
005 3/6/2017 Update procedure
10.0 AUTHORIZATION
ISSUED BY TITLE DATE
David Fruth EH&S Manager 3/6/2017
11.0 APPROVALS
11.1 This operating procedure has been routed to those individuals that are responsible for
reviewing, approving, and/or communicating the requirements defined within at the
Ashland site.
11.2 Electronic approval of this operating procedure denotes it has been reviewed and is
consistent with the process technology.
11.3 At a minimum, this operating procedure shall be routed to the EH&S Manager, the Plant
Manager, Production Manager, and Quality Facilitator / SQF Practitioner, and/or the PSM
element owner.
12.0 ATTACHMENTS
Document # DATE Title
DOCUMENT CONTROLLED WHEN PRINT IS IN RED
VERIFIED BY SITES'FOOD SAFETY PRACTITIONERS
EXHIBIT C
LIQUI-BOX
Required! Employe Injuryi Incident Near Miss Reporting
Employee Print Name: Date
\ O _ 2*0/7
Employee Signature:
I ^=V,^^^v/^• yo^\j.u3^^ , have been trained and understand that all
injuries, incidents or near misses must be reported at the tinne and shift that it
occurs and that it must be reported to a supervisor or leadership.
I understand that not reporting all Injuries, incidents or near misses will result in
disciplinary actions.
EXHIBIT D
LIQUI-BOX SACRAMENTO
AS 1069 Employee INVESTIGATION FORM
Incident Report Number
Employee Report of Accident, Injury, Illness, Incident or Near Miss
Employee information
Name: ^fiiX\'Qr:\ f^t Date of Incident: pc^^c^vw^b X i...Ks.
Patient must wear spllnL L knee.
In the event that your employee has restrictions and no modified work is made available, employer must keep
employee off work unless, and until, such modified work is made available.
TREATWO PROVtDEB
Name: Aitgela. SerpaJW. Ua«:1067B Signature (Or^nal)
Specialty: OccupsHonal Uedtelne Date ot Exam: 01 •03-2019
NEXT APPOINTMENT
Next Appointment with Agrawal Bella on 01-09-2019 02:00 pm.
Page 1 , SAJIDA ZAMAN, Case » 08B2264S9, Dale of seivice 01-O3-2019
EXHIBIT G
4 Panel EHS Disciplinary Review
Incident Summary: Employee Information:
• Employee: Sajida Zaman
• The exact date of injui7 is unknown because Sajida did • Hire date: Dec. 09, 2002
not report the injury timely. • Dept: Production - Inspector/Packer 1'*
shift
• Sajida indicated that she was pushing a mega tote cart • Doctors Name: Angela Serpa, N.P.
with about 400 bags 3-4 weeks ago. Sajida stated that • Treatment Facility: U.S. Health works
the wheel(s) on the cart were not working properly so she • Address: 1675 Alhambra Blvd. Ste. B Sac,
overcompensated to push the cart. Sajida stated that CA 95816
over the last weeks she incurred swelling and knee pain • Previous incidents: unknown
- taking over the counter ibuprofen.
Incident Investigation: Prior Training & Work Record:
Due to the injury not being reported timely, we are unable to
complete a verifiable investigation.
Sajida has been trained on the required Liqui-Box
* Sajida stated that she was working on L1 a few weeks ago Employee Injury, Incident and Near Miss Reporting
and was pushing a mega tote cart. She said the wheel(s) on which she signed and acknowledged.
the cart were not working so she overcompensated to push
the cart.
Mega tote carts can be heavy and can only move in two
directions - forward or backwards; but cannot be pushed side to
side. All ofthe mega tote cart wheels were replaced 3 months
ago and none of them have been reported as broken or needing
to be replaced. Sajida has been trained on how to properly push
mega tote carts when working on the line.
' Sajida reported back to work from the plant
closure/holidays on 1/2/2019. Her supervisor, Rafael
Zuniga disclosed that he did not observe her in any pain
or walking with any discomfort. She initially reported her
injury to Chance Williamson on 1/3/2019.
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EXHIBIT H
I.IQUI-BO>
DESIGN. CONNECT. OELIV -
HR Status Change horm
Employee Name: Sajida Zaman
SECTION 1 - EMPLOYEE
Date of Hire: 12/09/2003 Birth Date: M/D/Y Sex (M or F):
Social Insurance Number. Home Phone Number.
Direct Deposit info
Home Address:
Emergency Contact (Name, Relationship, Address and Phone):
SECTION 2 - JOB INFORMATION
Effective Date: Position Title: Inspector - Packer
Department Production
SECTION 3 - EMPLOYMENT STATUS
Previous Employment Status - Check one: New Employment Status - Check one:
H Fulltime • Temporary/Contract • Fulltime • Temporary/Contract
• Part time • Other • Part time • Other Exempt
SECTION 4 - WAGE/SALARY
Effective Date: M/D/Y
Current Wage / Salary: New Wage / Salary:
SECTION 5 • REASON FOR CHANGE
• New Hire/Rehire • Illness/Disability (not covered by WC)
• Wage / salary increase • Illness/Disability (covered under WC)
• Unpaid Leave (type: • Promotion/Transfer
• Employee Initiated personal info change El Temiination/Reslgnation
SECTION 6 - TERMINATION/LEAVE
Date of actual last day worked: 01/03/2019 Termination Date: 01/10/2019
Vacation Owing: Termination Pay, if applicable:
Leave or Termination Reason: See bebw Date of planned retum, if applicable:
• All company property has been returned
Additional Comments: Involuntary - Violation of Critical Safety Behaviors - Neglec^ted to report injury timely
SECTION 7 - AUTHORIZATION
Immediate Manager's Signature: Date: \ \
Employee Signature: Date:
1 PROOF OF S E R V I C E
2 I am employed in the County of Sacramento, State of Califomia. I am over the age of
eighteen years and not a party to the within action; my business address is Jackson Lewis P.C,
3 400 Capitol Mall, Suite 1600, Sacramento, Califomia 95814.
4 On May 21, 2022,1 served the within:
5 DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT
LIQUI-BOX CORPORATION'S MOTION FOR SUMMARY JUDGMENT AND/OR
6 SUMMARY ADJUDICATION OF ISSUES
7 on all interested parties in said action, through their attomeys of record as listed below, by placing
a tme and correct copy thereof, addressed as shown below, by the following means:
8
[3c| PERSONAL SERVICE - by causing personal delivery of a tme and correct copy
9 thereof to the person at the address set forth below, in accordance with Code of Civil
Procedure section 1011(a)..
10
I I M A I L - by placing a true and correct copy thereof enclosed in a sealed envelope with
11 postage thereon fully prepaid for deposit in the United States Post Office mailbox, at
my business address shown above, following Jackson Lewis P.C.'s ordinary business
12 practices for the collection and processing of mail, of which I am readily familiar, and
addressed as set forth below. On the same day correspondence is placecl for collection
13 and mailing, it is deposited in the ordinary course of business with the United States
Postal Service.
14
|~| OVERNIGHT DELIVERY - by depositing a tme and correct copy thereof enclosed
15 in a sealed envelope with delivery fees thereon fully prepaid in a box or other facility
regularly maintained by UPS or delivering to an authorized courier or driver
16 authorized by UPS to receive documents, addressed as set forth below.
17 Q E-MAIL OR ELECTRONIC TRANSMISSION - Based on Califomia Code of Civil
Procedure Section 1010.6(e)(l)(2), 1 caused the document(s) described above to be
18 sent from e-mail address kelly.asano(a),iacksonlewis.com to the person(s) at the e-mail
address(es) listed below. I did not receive, within a reasonable time after the
19 transmission, any electronic message or other indication that the transmission was
unsuccessful.
20
Arash S. Khosrowshahi (SBN 293246)
21 LIBERTY MAN LAW, P.C.
1010 F Street, Suite 300
22 Sacramento, CA 95814
Telephone: (916) 573-0469
23 Facsimile: (866) 700-0787
Email: ash@libertvmanlaw.com
24 I declare under penalty of perjury under the laws of the State of Califomia that the
25 foregoing is true and correct, and that this declaration was executed on May 27, 2022 at
2g Sacramento, Califomia. j ^ ^ M ^ T
27 Kelly Asano
28
PROOF OF SERVICE
PROOF OF S E R V I C E
2 I am employed in the County of Sacramento, State of Califomia. I am over the age of
eighteen years and not a party to the within action; my business address is Jackson Lewis P.C,
3 400 Capitol Mall, Suite 1600, Sacramento, Califomia 95814.
4 On May 27, 2022,1 served the within:
5 DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT
LIQUI-BOX CORPORATION'S MOTION FOR SUMMARY JUDGMENT AND/OR
6 SUMMARY ADJUDICATION OF ISSUES
7 on all interested parties in said action, through their attomeys of record as listed below, by placing
a tme and correct copy thereof, addressed as shown below, by the following means:
8
|~| PERSONAL SERVICE - by causing personal delivery of a true and correct copy
9 thereof to the person at the address set forth below, in accordance with Code of Civil
Procedure section 1011(a)..
10
M A I L - by placing a true and correct copy thereof enclosed in a sealed envelope with
11 • postage thereon fully prepaid for deposit in the United States Post Office mailbox, at
my business address shown above, following Jackson Lewis P.C.'s ordinary business
12 practices for the collection and processing of mail, of which I am readily familiar, and
addressed as set forth below. On the same day correspondence is placed for collection
13 and mailing, it is deposited in the ordinary course of business with the United States
Postal Service.
14
OVERNIGHT DELIVERY - by depositing a tme and correct copy thereof enclosed
15 in a sealed envelope with delivery fees thereon fully prepaid in a box or other facility
regularly maintained by UPS or delivering to an authorized courier or driver
16 authorized by UPS to receive documents, addressed as set forth below.
17 E-MAIL OR ELECTRONIC TRANSMISSION - Based on Califomia Code of Civil
Procedure Section 1010.6(e)(l)(2), I caused the document(s) described above to be
18 sent from e-mail address kellv.asano(S),iacksonlewis.com to the person(s) at the e-mail
address(es) listed below. I did not receive, within a reasonable time after the
19 transmission, any electronic message or other indication that the transmission was
unsuccessful.
20
Joshua F. Falakassa (SBN 295045) Arash S. Khosrowshahi (SBN 293246)
21 FALAKASSA LAW, P.C. LIBERTY MAN LAW, P.C.
1901 Avenue of the Stars, Suite 450 1010 F Street, Suite 300
22 Los Angeles, CA 90067 Sacramento, CA 95814
Telephone: (818)456-6168 Telephone: (916) 573-0469
23 Facsimile: (888) 505-0868 Facsimile: (866) 700-0787
Email: Josh(a),Falakassalaw.com Email: ash(a),libertvmanlaw.com
24
25 1 declare under penalty of perjury under the laws of the State of Califomia that the
foregoing is tme and correct, and that this declaration was executed on May 27, 2022 at
26 Sacramento, Califomia. |^^[^^l>t^^^
27
Kelly Asano
28
PROOF OF SERVICE
Preview
I JACKSON LEWIS P.C. JAMES T. JONES (SBN 167967) 2 KELSEY F. MORRIS (SBN 311117) 400 Capitol Mall, Suite 1600 FfLED/ENOORSED 3 Sacramento, Califomia 95814 Telephone: (916) 341 -0404 MAY 2 7 2C22 4 Facsimile: (916) 341-0141 Email: james. iQnes@iacksonlewis.com 5 kelsev.monis(5iiacksonlewis.com By:. S. Cads OciSL'l)' Cterk 6 Attomeys for Defendant LIQUI-BOX CORPORATION 7 8 SUPERIOR COURT OF THE STATE OF CALIFORNIA 9 COUNTY OF SACRAMENTO 10 SAJIDA ZAMAN, CASE NO. 34-2019-00252121-CU-WT-GDS 11 Plaintiff, DECLARATION OF ANGELA KENYON TN SUPPORT OF DEFENDANT LIQUI- 12 vs. BOX CORPORATION'S MOTION FOR SUMMARY JUDGIVIENT AND/OR 13 LIQUI-BOX CORPORATION, and DOES 1 SUMMARY ADJUDICATION O F through 20, inclusive, ISSUES 14 Defendants. Date: August 10, 2022 15 Time: 1:30 p.m. DV CAY Dept: 53 °^ ""^ 16 Reservation No.: 2644651 17 Complaint Filed: March 8, 2019 Trial Date: September 12, 2022 18 19 I , Angela Kenyon, declare and state as follows: 20 1. I have personal knowledge of the matters stated herein, and i f called to 21 testify on these matters, I could and would do so competently. 22 2. I am Chief Human Resources Officer for Defendant Liqui-Box Corporation 23 ("Defendant"). Defendant employed Plaintiff Sajida Zaman as a "Packer" in Defendant's 24 Sacramento facility until her employment was terminated on January 10, 2019. During PlaintifPs 25 period of employment, I was employed as the Director of Human Resources and I participated in 26 the decision to terminate Plaintiffs employment. 27 3. In or about June 2018, Defendant implemented its "Critical Safety 28 Behaviors Policy." A true and correct copy of that policy is attached hereto as Exhibit A. 1 DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUI-BOX CORPORATION'S MOTION FOR SUMMARY JUDGMENT AND/OR SUMMARY ADJUDICATION OF ISSUES 1 According to the Critical Safety Behaviors Policy, employees must, among other requirements, 2 report all safety incidents to a supervisor or management team member, even if they are minor. 3 There are no exceptions to the reporting requirement. Pursuant to the policy, a violation of the 4 Critical Safety Behaviors Policy is grounds for termination. I was involved in creating and 5 implementing the Critical Safety Behaviors Policy and know the reason why it was issued and 6 implemented. The purpose of the policy is to promote safety in the workplace by encouraging 7 employees to report all safety incidents including injuries or "near misses," no matter how minor. 8 Defendant issued the policy so that employees will report unsafe conditions in the workplace and 9 workplace injuries as soon as possible after they know about them, which allows Defendant to 10 remedy unsafe conditions to protect workers and to arrange for prompt treatment of workplace 11 injuries. If an employee is not aware that he or she was injured on the job, or if an employee is 12 not aware that a safety incident or near miss incident occurred, Defendant does not expect the 13 employee to report any such incident unless and until they become aware of such an incident. 14 Under those circumstances. Defendant expects employees to report such incidents as soon as they 15 are reasonably able to do so. 16 4. Defendant also has a Standard Operating Procedure AS 1025, issued on 17 March 6, 2017, that sets forth Defendant's practices for investigating all incidents which require 18 medical attention, including first aid cases, near miss incidents, and fires. Standard Operating 19 Procedure AS 1025 defines "near miss" to mean the "potential for injury or property damage." 20 Standard Operating Procedure AS 1025 states that "Any incident requiring any type of treatment 21 to any employee or contractor, a near miss, or any incident resulting in equipment damage, or fue 22 shall be reported immediately to a shift leader." Standard Operating Procediue AS 1025 states 23 that if a shift leader is not available a report can be made to the Plant Manager, EH&S 24 (Envirormiental Health & Safety) Manager, or the Human Resources Manager. Standard 25 Operating Procedure AS 1025 also sets forth additional steps that must be taken to investigate and 26 report on safety incidents, including the preparation of a "4 Panel Review for any employee who 27 sustains an injury resulting in medical treatment, restricted workdays or lost workdays . . . ." A 28 true and correct copy of Standard Operating Procedure AS 1025 is attached hereto as Exhibit B. 2 DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUI-BOX CORPORATION'S MOTION FOR SUMMARY JUDGMENT AND/OR SUMMARY ADJUDICATION OF ISSUES 1 5. Defendant issued Standard Operating Procedure AS 1025, conducts 2 employee training, and obtains employee acknowledgments regarding awareness of the Critical 3 Safety Behaviors policy in order to promote workplace safety. On or about October 10, 2017, 4 Plaintiff signed an acknowledgment that she had been trained and understood that all injuries, 5 incidents, and near misses must be promptly reported to a supervisor or leadership. A true and 6 correct copy of the acknowledgment signed by Plaintiff is attached hereto as Exhibit C. On or 7 about June 4, 2018, Plaintiff signed an acknowledgment that she had been given a copy ofthe 8 Critical Safety Behaviors policy, that it had been explained to her, she agreed to comply with it, 9 and she knew that violating the policy would "lead to immediate termination of employment." 10 See Exhibit A. 11 6. On January 3, 2019, Defendant became aware that Plaintiffhad suffered an 12 injury that she believed had occurred at work. On that day. Plaintiff filled out a "Liqui-Box 13 Sacramento AS 1059 Employee INVESTIGATION FORM" indicating she was injured pushing a 14 "mega tote." A mega tote is a type of cart used in the workplace to move boxes. A tme and 15 correct copy of Plaintiffs January 3, 2019, AS 1059 Employee INVESTIGATION FORM is 16 attached hereto as Exhibit D. On that form, she identified the date of her incident to be "Decmeb 17 I week." I was involved in the decision to terminate PlaintifFs employment, and I reviewed the 18 AS 1059 form. I understood it to mean that the incident that led to PlaintifFs injury occurred 19 during the first week of December 2018. On the January 3, 2019, AS 1059 "Employee 20 INVESTIGATION FORM" Plaintiff described the injury as "muscle swelling" and she noted that 21 she received medical treatment for her injury on December 31, 2018. 22 7. Defendant uses an outside vendor, Medcor, to conduct an initial evaluation 23 of workplace injuries (triage) so that injured employees can be promptly provided with proper 24 medical care. Medcor uses healthcare professionals, such as Registered Nurses, to conduct the 25 "initial evaluation. Defendant received a copy of the notes documenting Medcor's triage of 26 PlaintifFs injury on January 3, 2019. A tme and correct copy of the Medcor "Workplace Injury 27 Triage & Reporting Incident Report received by Defendant is attached hereto as Exhibit E. The 28 Medcor "Workplace Injury Triage & Reporting" incident report related to Plaintiffs injury states 3 DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUT-BOX CORPORATION'S MOTION FOR SUMMARY JUDGMENT AND/OR SUMMARY ADJUDICATION OF ISSUES 1 that "about a month ago she was pushing a box on wheels when she developed pain in her left 2 knee. She sought care at Methodist Hospital emergency room in Sacramento, CA on 12/31/18 3 where she was treated for knee injury and was advised to follow up with her PMD if pain did not 4 improve." 5 8. Following Medcor's triage of PlaintifFs injury. Defendant transported 6 Plaintiff to U.S. Health Works Medical Group where she was further examined. Defendant 7 received a "Work Status Report" from U.S. Health Works Medical Group related to Plaintiff that 8 indicated she was examined on January 3, 2019 and was diagnosed with "Strain of left knee" and 9 "Strain of left hamstring muscle." A true and correct copy of that Work Status Report is attached 10 hereto as Exhibit F. The Work Status Report from the January 3, 2019, examination stated 11 "DOI: 12-03-2018". When I reviewed the Work Stams Report, I interpreted that to mean the date 12 ofthe incident that caused PlaintifFs injury was on or about December 3, 2018. Based upon my 13 review of PlaintifFs clocking records, in December 2018, Plaintiff worked on December 3-7, 10- 14 14, 17-19, and 21. She also worked on January 2, 2019. 15 9. Pursuant to Defendant's Standard Operating Procedure AS 1025, 16 Defendant conducted the "4 Panel Review" related to PlaintifFs injury. The "4 Panel Review" 17 summarizes the incident as follows: 18 "Sajida indicated that she was pushing a mega tote cart with about 400 bags 3-4 weeks ago. 19 Sajida stated that the wheel(s) on the cart were not working properly so she overcompensated to 20 push the cart. Sajida stated that over the last weeks she incurred swelling and knee pain - taking 21 over the counter ibuprofen." The "4 Panel Review" noted that Sajida was triaged through 22 Medcor and sent to US Healthworks for a post-injury evaluation. A true and correct copy of 23 Defendant's 4 Panel Review is attached hereto as Exhibit G. 24 10. After the 4 Panel Review was completed. Defendant's Chief Operating 25 Officer (COO), Andrew McLeLand, and I reviewed the contents of the written 4 Panel Review. I 26 also reviewed Exhibits A through F attached hereto and I spoke to Janene Whitoey, the Human 27 Resources Manager of the Sacramento facility, who had transported Plaintiff to U.S. Health 28 Works Medical Group on January 3, 2019 after she reported her injury. Together with COO 4 DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUI-BOX CORPORATION'S MOTION FOR SUMMARY JUDGMENT AND/OR SUMMARY ADJUDICATION OF ISSUES 1 Andrew McLeLand, I determined that, based on the contents of the foregoing exhibits (A through 2 F), and based upon the information described to me by Janene Whitaey, which also confirmed 3 that Plaintiff reported a workplace injury on January 3, 2019, weeks after the injury occurred, 4 Plaintiff had violated Defendant's Critical Safety Behaviors Policy. Accordingly, I made the 5 decision that Defendant would terminate PlaintifFs employment on January 10, 2019, because 6 Plaintiff had violated the Critical Safety Behaviors policy. Defendant's "HR Statos Change 7 Form" which documents the reason for the termination of PlaintifFs employment states, 8 "Involuntary - Violation of Critical Safety Behaviors - Neglected to report injury timely." A true 9 and correct copy of Defendant's "HR Status Change Form" documenting the reason for PlaintifFs 10 termination is attached hereto as Exhibit H. The only reason Defendant terminated PlaintifFs 11 employment was because she had not timely reported her workplace injury, which Defendant 12 became aware of for the first time on January 3, 2019. 13 I declare under penalty of perjury, under the laws of the State of Califomia, that the 14 foregoing is true and correct. ^5 Executed May 26, 2022, in Richmond, Virginia. 16 J 17 18 • ^rrr-- AN0ELAKENY 19 20 21 22 23 24 25 26 27 28 DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUI-BOX CORPORATION'S MOTION FOR SUMMARY JUDGMENT AND/OR SUMMARY ADJUDICATION OF ISSUES EXHIBIT A CRITICAL SAFETY BEHAVIORS m LIQU.-BOX DESIGN. CONNECT. DELIVa. 1. immediately report all incidents to your supervisor, management team member no matter how minor or without exception. 2. Proper Lock-Out/Tag-Out (LOTO) procedures must be followed. a. Always LOTO when working on electrical equipment. Only authorized personnel with proper training may work on hot/"live" panels or energized circuits and must always follow proper protection procedures. b. Always LOTO equipment prior to servicing or performing maintenance work. 3. Only enter a "permit required" confined space with an approved permit. 4. Body parts can only be placed In equipment (I.e. rollers, chains, belts, reciprocating bars, pinch points) when it is not moving and with LOTO procedure followed. The only exception to this rule is when following a documented Standard Operating Procedure or Job Safety Analysis. 5. Do not bypass any safety devices or remove guards. The only exception to this is during authorized troubleshooting procedures. 6. Follow ali site specific fall protection procedures (I.e. when climbing on top of railcar to gain access, operating scissor lifts or man lifts, climbing silos, etc.) 7. All semi-trailers must be wheel chocked and/or secured with a trailer restraint (e.g. Doc-Lock if so equipped) during the loading and unloading operations, Trailer safety stands/jacks must be utilized when the tractor is removed and the trailer is "free standing." Powered industrial truck operators must verify these conditions. 8. Only authorized and trained employees can operate powered industrial trucks or any other motorized vehicles. Never drive powered industrial tmcks or motorized vehicles recklessly. 9. Only authorized and trained employees can perfomi work in any electrical control box. 10. Horseplay or unacceptable practices that place you or fellow co-workers at risk of injury are not acceptable. Any violation of these Critical Safety Behaviors will result in immediate termination of employment. I hereby acknowledge that a copy of the Critical Safety Behaviors has been given and explained to me. I agree to comply with this policy at all times and understand that if any of these are violated, it will lead to immediate tennination of employment. Printed Name:^/)k/'A/) ?/)AlfiA^ Signature: ^^;..(Vy6.2f^^v\^vv Date: L -l^- I? Revised: 5/30/2018 EXHIBIT B Liqui-Box LIOUI-BOX Standard Operating Procedure CORPORATION SECTION: Safety/PSM/Occupational Health DATE ISSUED: 3/6/2017 and Environmental SUBSECTION: Fire, Environmental, PSM, and REVISION #: 005 Incident Reporting Investigation PROCEDURE ID: AS 1025 PAGE: 1 of 3 REVIEW DATE: 3/5/2020 1.0 PURPOSE / SCOPE 1.1 This procedure documents the Liqui-Box - practice for investigating all incidents which require medical attention, including first aid cases, and near miss incidents and Fire. 2.0 RESPONSIBLE CARE 2.1 All site safety procedures must be followed. 2.2 All site PPE must be worn. 2.3 All PSM requirements shall be followed. 2.4 Environmental impacts shall be considered, and actions taken shall ensure the integrity of those impacts. 3.0 DEFINITIONS 3.1 Near Miss- Potential for injury or property damage 4.0 REFERENCES 4.1 AS 1059 Employee Report 4.2 4 Panel Review 5.0 RESPONSIBILITIES 5.1 Management is responsible for implementing this procedure. 5.2 Shift Leaders are responsible for training on this procedure. 5.3 EH&S Manager is responsible for training the shift leaders. 5.4 Management, Shift Leaders, Production Lead, and EH&S Manager are responsible for auditing this procedure. 6.0 TOOLS AND EQUIPMENT 6.1 N/A 7.0 PROCEDURE 7.1 Any incident requiring any type of treatment to any employee or contractor, a near miss, or any incident resulting in equipment damage, or fire shall be reported immediately to a shift leader. 7.2 If the shift leader is not available contact the Plant Manager, EH&S Manager or the Human Resources Manager. Phone numbers can be found in the First Aid Cabinets located in the Extrusion, Lamination, and Bag Departments. 7.2.1 Plant Manager 7.2.2 EH&S Manager 7.2.3 HR. 7.3 The shift lead shall immediately assess the situation to determine the severity of any injuries that may require medical attention. 7.4 Any equipment involved in the incident is to be shut down and everything left as is until the shift lead or someone from Management authorizes equipment to be restarted. 7.5 Emergency response shall be contacted via outside telephone (9-1-1) immediately if needed. DOCUMENT CONTROLLED WHEN PRINT IS IN RED VERIFIED BY SITES'FOOD SAFETY PRACTITIONERS Liqui-Box LIOUI-BOX SECTION: and Environmental Standard Operating Procedure Safety/PSM/Occupational Health DATE ISSUED: m 3/6/2017 CORPORATION SUBSECTION: Fire, Environmental, PSM, and REVISION #: 005 Incident Reporting Investigation PROCEDURE ID: AS 1025 PAGE: 2 of 3 REVIEW DATE: 3/5/2020 7.6 The Shift Lead shall immediately take action to administer any first-aid deemed necessary until emergency and/or other trained emergency response personnel are on-site. 7.7 First-aid shall be administered by the shift lead or lead operator if medical treatment has been ruled out. 7.8 Incidents resulting in near-miss fire or equipment damage shall be investigated by the supervisor as soon as possible after determining that no employees have been injured. 7.9 At a minimum, the first page ofthe "AS 1059 Employee Report or AS1060C Near Miss shall be initially filled out by the attending shift lead and the employee(s) involved, within 24 hours. One report for each employee shall be initiated. 7.10 As soon as possible, the Plant Manager, Human Resources Manager and the EH&S Manager shall be notified of all incidents by the attending supervisor. 7.11 The Plant Manager, Human Resources Manager, attending supervisor, and EH&S Manager shall initiate an investigation of any incident as soon as possible after a report has been issued. This shall occur within 48 hours. 7.12 A 4 Panel Review for any employee who sustains an injury resulting in medical treatment, restricted work days or lost work days shall be issued by the site after final review by the Plant Manager, Human Resources Manager and EH&S Manager. The report shall be issued within 7 days. 7.13 All other incident reports (near-miss, first-aid, equipment damage) shall be documented and placed on file within 72 hours in the EH&S Manager office. 7.14 Initial Injury Reporting 7.14.1 A fatality shall be reported to OSHA within 8 hours. 7.14.2 A fatality, whether employee, contractor, or visitor, occurring on company property shall be reported immediately to Liqui-Box Leadership by the site's Plant Manager. 7.15 Incident Reporting Fire: 7.15.1 All fire incidents shall be reported within 24 hours to Liqui-Box Leadership by the site's Plant Manager. 8.0 RECORD RECORD TITLE RETENTION AS 1059 Employee Report 3Years Plus 1 AS 1060C Near Miss Incident Form 3Years Plus 1 4 Panel Review 3Years Plus 1 9.0 REVISION HISTORY REVISION # DATE REASON 000 12/10/2005 Initial Issue 001 3/23/2009 Format modification 002 12/7/2010 Update Procedure 003 3/29/2011 Update Procedure 004 1/17/2014 Update Procedure DOCUMENT CONTROLLED WHEN PRINT IS IN RED VERIFIED BY SITES'FOOD SAFETY PRACTITIONERS Liqui-Box LIOUI-BOX Standard Operating Procedure CORPORATION SECTION: Safety/PSM/Occupational Health DATE ISSUED: 3/6/2017 and Environmental SUBSECTION: Fire, Environmental, PSM, and REVISION #: 005 Incident Reporting Investigation PROCEDURE ID: AS 1025 PAGE: 3 of 3 REVIEW DATE: 3/5/2020 005 3/6/2017 Update procedure 10.0 AUTHORIZATION ISSUED BY TITLE DATE David Fruth EH&S Manager 3/6/2017 11.0 APPROVALS 11.1 This operating procedure has been routed to those individuals that are responsible for reviewing, approving, and/or communicating the requirements defined within at the Ashland site. 11.2 Electronic approval of this operating procedure denotes it has been reviewed and is consistent with the process technology. 11.3 At a minimum, this operating procedure shall be routed to the EH&S Manager, the Plant Manager, Production Manager, and Quality Facilitator / SQF Practitioner, and/or the PSM element owner. 12.0 ATTACHMENTS Document # DATE Title DOCUMENT CONTROLLED WHEN PRINT IS IN RED VERIFIED BY SITES'FOOD SAFETY PRACTITIONERS EXHIBIT C LIQUI-BOX Required! Employe Injuryi Incident Near Miss Reporting Employee Print Name: Date \ O _ 2*0/7 Employee Signature: I ^=V,^^^v/^• yo^\j.u3^^ , have been trained and understand that all injuries, incidents or near misses must be reported at the tinne and shift that it occurs and that it must be reported to a supervisor or leadership. I understand that not reporting all Injuries, incidents or near misses will result in disciplinary actions. EXHIBIT D LIQUI-BOX SACRAMENTO AS 1069 Employee INVESTIGATION FORM Incident Report Number Employee Report of Accident, Injury, Illness, Incident or Near Miss Employee information Name: ^fiiX\'Qr:\ f^t Date of Incident: pc^^c^vw^b X i...Ks. Patient must wear spllnL L knee. In the event that your employee has restrictions and no modified work is made available, employer must keep employee off work unless, and until, such modified work is made available. TREATWO PROVtDEB Name: Aitgela. SerpaJW. Ua«:1067B Signature (Or^nal) Specialty: OccupsHonal Uedtelne Date ot Exam: 01 •03-2019 NEXT APPOINTMENT Next Appointment with Agrawal Bella on 01-09-2019 02:00 pm. Page 1 , SAJIDA ZAMAN, Case » 08B2264S9, Dale of seivice 01-O3-2019 EXHIBIT G 4 Panel EHS Disciplinary Review Incident Summary: Employee Information: • Employee: Sajida Zaman • The exact date of injui7 is unknown because Sajida did • Hire date: Dec. 09, 2002 not report the injury timely. • Dept: Production - Inspector/Packer 1'* shift • Sajida indicated that she was pushing a mega tote cart • Doctors Name: Angela Serpa, N.P. with about 400 bags 3-4 weeks ago. Sajida stated that • Treatment Facility: U.S. Health works the wheel(s) on the cart were not working properly so she • Address: 1675 Alhambra Blvd. Ste. B Sac, overcompensated to push the cart. Sajida stated that CA 95816 over the last weeks she incurred swelling and knee pain • Previous incidents: unknown - taking over the counter ibuprofen. Incident Investigation: Prior Training & Work Record: Due to the injury not being reported timely, we are unable to complete a verifiable investigation. Sajida has been trained on the required Liqui-Box * Sajida stated that she was working on L1 a few weeks ago Employee Injury, Incident and Near Miss Reporting and was pushing a mega tote cart. She said the wheel(s) on which she signed and acknowledged. the cart were not working so she overcompensated to push the cart. Mega tote carts can be heavy and can only move in two directions - forward or backwards; but cannot be pushed side to side. All ofthe mega tote cart wheels were replaced 3 months ago and none of them have been reported as broken or needing to be replaced. Sajida has been trained on how to properly push mega tote carts when working on the line. ' Sajida reported back to work from the plant closure/holidays on 1/2/2019. Her supervisor, Rafael Zuniga disclosed that he did not observe her in any pain or walking with any discomfort. She initially reported her injury to Chance Williamson on 1/3/2019. u 7J a. sr ^ » S Q. O ^ . - CO < < CT 0) '2 ju 5 ffl 1 o 0) (D 5" 3 2 o ffl O =r CD O X o D- 3 §•0O S.- 5 S (D T 3 o as O ^ 5 CD 5" f O Q. 9: i" ffl o < I o sr. (D i» •sr W 5^ V cQ -1 =^°'a w :g CD 0) CO CO - -r O" — • So" g Q. fl) 3- 3- O) Q . (D W ;* ® 5 = : Q. O ffl 3 Q. CD CD o CO Q. fl) o> ro o o .ffl. coS 0 0 0 « ST (0 3" 3 ^ CO fl) M J3 ffl CD —• 3 O _ C 0) o -,. O © 3 - 0 . ffl CD 13 f CT ^ 0) 5 - S5. > C CO CO ^ §-m8 S ffl CD 3 • 7" a ^ 0 fl> a. o to < < -1 o ro 2. (D -1 y> CO V> < a. 01 5' o (D a c_ < tt •o T3 O (0 3 cr EXHIBIT H I.IQUI-BO> DESIGN. CONNECT. OELIV - HR Status Change horm Employee Name: Sajida Zaman SECTION 1 - EMPLOYEE Date of Hire: 12/09/2003 Birth Date: M/D/Y Sex (M or F): Social Insurance Number. Home Phone Number. Direct Deposit info Home Address: Emergency Contact (Name, Relationship, Address and Phone): SECTION 2 - JOB INFORMATION Effective Date: Position Title: Inspector - Packer Department Production SECTION 3 - EMPLOYMENT STATUS Previous Employment Status - Check one: New Employment Status - Check one: H Fulltime • Temporary/Contract • Fulltime • Temporary/Contract • Part time • Other • Part time • Other Exempt SECTION 4 - WAGE/SALARY Effective Date: M/D/Y Current Wage / Salary: New Wage / Salary: SECTION 5 • REASON FOR CHANGE • New Hire/Rehire • Illness/Disability (not covered by WC) • Wage / salary increase • Illness/Disability (covered under WC) • Unpaid Leave (type: • Promotion/Transfer • Employee Initiated personal info change El Temiination/Reslgnation SECTION 6 - TERMINATION/LEAVE Date of actual last day worked: 01/03/2019 Termination Date: 01/10/2019 Vacation Owing: Termination Pay, if applicable: Leave or Termination Reason: See bebw Date of planned retum, if applicable: • All company property has been returned Additional Comments: Involuntary - Violation of Critical Safety Behaviors - Neglec^ted to report injury timely SECTION 7 - AUTHORIZATION Immediate Manager's Signature: Date: \ \ Employee Signature: Date: 1 PROOF OF S E R V I C E 2 I am employed in the County of Sacramento, State of Califomia. I am over the age of eighteen years and not a party to the within action; my business address is Jackson Lewis P.C, 3 400 Capitol Mall, Suite 1600, Sacramento, Califomia 95814. 4 On May 21, 2022,1 served the within: 5 DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUI-BOX CORPORATION'S MOTION FOR SUMMARY JUDGMENT AND/OR 6 SUMMARY ADJUDICATION OF ISSUES 7 on all interested parties in said action, through their attomeys of record as listed below, by placing a tme and correct copy thereof, addressed as shown below, by the following means: 8 [3c| PERSONAL SERVICE - by causing personal delivery of a tme and correct copy 9 thereof to the person at the address set forth below, in accordance with Code of Civil Procedure section 1011(a).. 10 I I M A I L - by placing a true and correct copy thereof enclosed in a sealed envelope with 11 postage thereon fully prepaid for deposit in the United States Post Office mailbox, at my business address shown above, following Jackson Lewis P.C.'s ordinary business 12 practices for the collection and processing of mail, of which I am readily familiar, and addressed as set forth below. On the same day correspondence is placecl for collection 13 and mailing, it is deposited in the ordinary course of business with the United States Postal Service. 14 |~| OVERNIGHT DELIVERY - by depositing a tme and correct copy thereof enclosed 15 in a sealed envelope with delivery fees thereon fully prepaid in a box or other facility regularly maintained by UPS or delivering to an authorized courier or driver 16 authorized by UPS to receive documents, addressed as set forth below. 17 Q E-MAIL OR ELECTRONIC TRANSMISSION - Based on Califomia Code of Civil Procedure Section 1010.6(e)(l)(2), 1 caused the document(s) described above to be 18 sent from e-mail address kelly.asano(a),iacksonlewis.com to the person(s) at the e-mail address(es) listed below. I did not receive, within a reasonable time after the 19 transmission, any electronic message or other indication that the transmission was unsuccessful. 20 Arash S. Khosrowshahi (SBN 293246) 21 LIBERTY MAN LAW, P.C. 1010 F Street, Suite 300 22 Sacramento, CA 95814 Telephone: (916) 573-0469 23 Facsimile: (866) 700-0787 Email: ash@libertvmanlaw.com 24 I declare under penalty of perjury under the laws of the State of Califomia that the 25 foregoing is true and correct, and that this declaration was executed on May 27, 2022 at 2g Sacramento, Califomia. j ^ ^ M ^ T 27 Kelly Asano 28 PROOF OF SERVICE PROOF OF S E R V I C E 2 I am employed in the County of Sacramento, State of Califomia. I am over the age of eighteen years and not a party to the within action; my business address is Jackson Lewis P.C, 3 400 Capitol Mall, Suite 1600, Sacramento, Califomia 95814. 4 On May 27, 2022,1 served the within: 5 DECLARATION OF ANGELA KENYON IN SUPPORT OF DEFENDANT LIQUI-BOX CORPORATION'S MOTION FOR SUMMARY JUDGMENT AND/OR 6 SUMMARY ADJUDICATION OF ISSUES 7 on all interested parties in said action, through their attomeys of record as listed below, by placing a tme and correct copy thereof, addressed as shown below, by the following means: 8 |~| PERSONAL SERVICE - by causing personal delivery of a true and correct copy 9 thereof to the person at the address set forth below, in accordance with Code of Civil Procedure section 1011(a).. 10 M A I L - by placing a true and correct copy thereof enclosed in a sealed envelope with 11 • postage thereon fully prepaid for deposit in the United States Post Office mailbox, at my business address shown above, following Jackson Lewis P.C.'s ordinary business 12 practices for the collection and processing of mail, of which I am readily familiar, and addressed as set forth below. On the same day correspondence is placed for collection 13 and mailing, it is deposited in the ordinary course of business with the United States Postal Service. 14 OVERNIGHT DELIVERY - by depositing a tme and correct copy thereof enclosed 15 in a sealed envelope with delivery fees thereon fully prepaid in a box or other facility regularly maintained by UPS or delivering to an authorized courier or driver 16 authorized by UPS to receive documents, addressed as set forth below. 17 E-MAIL OR ELECTRONIC TRANSMISSION - Based on Califomia Code of Civil Procedure Section 1010.6(e)(l)(2), I caused the document(s) described above to be 18 sent from e-mail address kellv.asano(S),iacksonlewis.com to the person(s) at the e-mail address(es) listed below. I did not receive, within a reasonable time after the 19 transmission, any electronic message or other indication that the transmission was unsuccessful. 20 Joshua F. Falakassa (SBN 295045) Arash S. Khosrowshahi (SBN 293246) 21 FALAKASSA LAW, P.C. LIBERTY MAN LAW, P.C. 1901 Avenue of the Stars, Suite 450 1010 F Street, Suite 300 22 Los Angeles, CA 90067 Sacramento, CA 95814 Telephone: (818)456-6168 Telephone: (916) 573-0469 23 Facsimile: (888) 505-0868 Facsimile: (866) 700-0787 Email: Josh(a),Falakassalaw.com Email: ash(a),libertvmanlaw.com 24 25 1 declare under penalty of perjury under the laws of the State of Califomia that the foregoing is tme and correct, and that this declaration was executed on May 27, 2022 at 26 Sacramento, Califomia. |^^[^^l>t^^^ 27 Kelly Asano 28 PROOF OF SERVICE