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Occupational Safety and Health Administration OSHA

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
InspectionOpen DateSICEstablishment Name
1350505.01510/01/2018Capform, 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:
Cause: Pouring concrete foundations and walls

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