Governor's Office Emergency Services
Hazardous Materials Spill Report

DATE: 11/22/2022
TIME: 1358
RECEIVED BY: CONTROL#:
Cal OES - 22-6879
NRC -
1.a. PERSON NOTIFYING Cal OES:
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
LAX Environmental Program Group
1.b. PERSON REPORTING SPILL (If different from above):
1. NAME:2. AGENCY:3. PHONE#:4. Ext:5. PAG/CELL:
2. SUBSTANCE TYPE:
2. a. SUBSTANCE:b.QTY:>=<Amount Measurec. TYPE:d. OTHER:e. PIPELINEf. VESSEL
>= 300 Tons
1. Carbon Dioxide <18,000 Cu.Ft.CHEMICALNoNo
2. = NoNo
3. = NoNo
g. DESCRIPTION: RP States: One LAX sub-contractor was working in Terminal 8 Room 102 basement electrical vault when the fire suppression system went off, causing the contractor to fall off the ladder. Do to his injuries he was unable to move as the Carbon Dioxide fire suppression system was going off. The sub-contractor was transported to a near by medical facility but passed away a few days later. Two other sub-contractors where in the room and sustained minor injuries.
h. STOPPAGE/CONTAINMENT:i. WATER INVOLVED: j. WATERWAY:k. DRINKING WATER IMPACTED
Stopped, ContainedNoNoneNo
l. MARITIME VESSEL
No
m. KNOWN IMPACT
None
3. a. INCIDENT LOCATION: 800 World Way
b. CITY:c. COUNTY: d. ZIP:
Los Angeles
Los Angeles County90045SOUTH COAST AQMD
4. INCIDENT DESCRIPTION:
a. DATE:b. TIME (Military):c. SITE:d. REPORTED CAUSE
10/31/20221000 Airport Other
Description for Other : Under Investigation
e. INJURIESf. FATALITY g. EVACUATIONh. CLEANUP BY:
Yes
Injuries #: 2
Yes
Fatals #: 1
NoLA City Fire
6. NOTIFICATION INFORMATION:
a. ON SCENE:b. OTHER ON SCENE: c. OTHER NOTIFIED:
Fire Dept., Police Dept., OtherCAL-OSHALAXPD
d. ADMIN. AGENCY: Los Angeles City Fire Departmente. SEC. AGENCY: LACoFD Health Haz-Mat
f. ADDITIONAL COUNTY: g. ADMIN. AGENCY:
h. NOTIFICATION LIST:
Cal GEM:
RWQCB Unit:

4
Cal OES Region:
AA/CUPA, DTSC, RWQCB, US EPA, USFWS, DFW-OSPR, AIR RESOURCES BD, CDPH-D.O., Co/WP, Co/Hlth, Co/E-Hlth
Photo Attachment:
11. Cal OES Reg.
********* Control No: 22-6879 *********

Created by: Warning Center on: 11/22/2022 01:58:29 PM Last Modified by: Warning Center on: 11/22/2022 02:20:09 PM