Accident Report Detail

Accident: 109673.015 - Employee Incurs Unspecified Injuries In Concrete Form Struct

**Accident: 109673.015 -- Report ID: 0636900 -- Event Date: 09/29/2018**
Inspection	Open Date	SIC	Establishment Name
1350505.015	10/01/2018		Capform, Inc.

At 8:15 a.m. on September 29, 2018, an employee was working to dismantle concret e tower forms. While working, a portion of the form structure fell over and stru ck the employee who was hospitalized with unspecified injuries.

Keywords: collapse, concrete form work, dismantling, fall, falling object, struck by, structural collapse

Accident Details
End Use		Proj Type		Proj Cost	Stories	NonBldgHt	Fatality
Commercial building		New project or new addition			1	0

Employee Details
Employee #	Inspection	Age	Sex	Degree	Nature	Occupation	Construction
1	1350505.015	42	M	Hospitalized injury		Construction laborers	FallDist: FallHt: Cause: Pouring concrete foundations and walls FatCause:

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