Accident Report Detail

Accident Summary Nr: 116286.015 - Employee receives multiple injuries when concrete forms fall

Accident Summary Nr: 116286.015 -- Report ID: 0552651 -- Event Date: 05/07/2019
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
1400198.015	05/14/2019		238110	Advanced Poured Walls, Inc

Abstract: At 10:30 a.m. on May 7, 2019, an employee worked to unload concrete forms from a cage. While working, the forms fell onto the employee who received fractures to several ribs and vertebrae, and a laceration to the back of the head. The employee was hospitalized to treat the injuries.

Keywords: Concrete Form Work, Falling Object, Fracture, Head, Laceration, Manual Mat Handling, Rib, Struck By, Vertebra

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Single family or duplex dwelling		New project or new addition				8

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Construction
1	1400198.015	42	M	Hospitalized injury		Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Forming Fatality Cause:

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