The federal government on Wednesday hit Inc. with worker-safety related citations and penalties at three more warehouses, two weeks after issuing citations at the company’s warehouses in three different states.

The latest citations are the result of the Occupational Safety and Health Administration’s investigation of Amazon

warehouses stemming from referrals from the U.S. Attorney’s Office for the Southern District of New York. At all six locations, OSHA investigators cited the company for exposing warehouse workers to a high risk of low back injuries and other musculoskeletal disorders and asked for a multitude of changes and corrections.

“Amazon’s operating methods are creating hazardous work conditions and processes, leading to serious worker injuries,” said OSHA Assistant Secretary Doug Parker in a statement Wednesday. “They need to take these injuries seriously and implement a company-wide strategy to protect their employees from these well-known and preventable hazards.”

See: Amazon cited for warehouse working conditions ‘designed for speed but not safety’

The newest citations come from investigations into Amazon warehouses in Aurora, Colo.; Nampa, Idaho; and Castleton, N.Y. At all three sites, OSHA inspectors concluded that workers are suffering from musculoskeletal injuries “as a result of lifting heavy items while attempting to meet pace of work and production quotas,” according to each of the hazard letters that were sent to those warehouses’ operations managers. Those concerns were similar to those raised by OSHA at the three other Amazon warehouses in Florida, Illinois and a different warehouse in New York a couple of weeks ago.

In Aurora and Nampa, inspectors also found evidence that injuries may not have been reported because Amazon’s on-site first-aid clinic “was not staffed appropriately.” In Castleton, staffers at the company’s on-site clinic, known as AmCare, “question whether workers are actually injured, pressure injured workers to work through their injuries, and steer injured workers to Amazon-preferred doctors,” Rita Young, OSHA area director, wrote in the hazard letter.

The penalties associated with the citations at the three sites total $46,875. OSHA also asked Amazon to detail the changes it makes in response, and said the company’s response will determine whether more evaluation is needed. In addition, the agency’s inspectors may do follow-up visits within the next six months.

Just like with the first three citations, Amazon intends to appeal.

“We take the safety and health of our employees very seriously, and we don’t believe the government’s allegations reflect the reality of safety at our sites,” Amazon spokeswoman Kelly Nantel said in an emailed statement.

A company spokeswoman also referred to several safety-related efforts by the company, including its partnership with the National Safety Council; equipment that’s supposed to help reduce the need for twisting, bending and reaching; and “process improvements” designed by Amazon’s robotics team.

In anticipation of Wednesday’s OSHA citations, a group of worker advocates held a virtual news conference Tuesday. Among the panelists was Debbie Berkowitz, a former chief of staff at OSHA and now a fellow at the Kalmanovitz Initiative for Labor and the Working Poor at Georgetown University.

“I want to make it clear to everybody that these OSHA citations are incredibly historic and significant,” Berkowitz said. “Don’t get thrown by the low amount of penalties,” she added, saying the Occupational Safety and Health Act is a “weak law.”

She went on to say that “OSHA really grounded their investigations using doctors, experts, and what to do to mitigate the hazards… They show that Amazon needs to take action.”

Also present on the news conference was Amazon warehouse worker Jennifer Crane, from St. Peters, Mo.

“I’m glad to see OSHA investigate the safety crisis at Amazon,” she said. “The company blames us for getting injured. They push us to work at unrealistic speeds.”

Also: As Amazon shareholders call for audit of warehouse working conditions, report finds more than double the rate of injuries than at other warehouses

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