Accident Report Detail

Accident Summary Nr: 118969.015 - Employee suffers broken leg in fall from form work

Accident Summary Nr: 118969.015 -- Report ID: 0830500 -- Event Date: 08/09/2019
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
1423432.015	08/13/2019		237310	Sema Construction

Abstract: At 4:00 p.m. on August 9, 2019, an employee was working as a laborer for a firm that engaged in highway, street, and bridge construction. He was erecting steel form work. The employee did not latch his pelican hooks or stabilizing chain hook to the formwork as he was working on the formwork. He slipped and fell some 10 to 12 feet (3.0 to 3.7 meters) to the ground. He suffered a broken leg and a laceration to his face. He was hospitalized for two or more days.

Keywords: Attachment Hook, Bridge, Broken Bone, Construction, Dislocated, Face, Fall, Fall From Elevation, Fall Protection, Form work, Fracture, Highway, Laborer, Laceration, Leg, Slip, Work at Elevation

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Other heavy construction		New project or new addition				12

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Occupation	Construction
1	1423432.015	40	M	Hospitalized injury		Laborers, except construction	Distance of Fall: 12 feet Worker Height Above Ground/Floor: 12 feet Cause: Forming Fatality Cause:

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