Accident Report Detail

Accident Summary Nr: 120536.015 - Three employees are injured in structure collapse

Accident Summary Nr: 120536.015 -- Report ID: 0728900 -- Event Date: 10/04/2019
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
1436494.015	10/07/2019		238110	Stephens & Smith Construction Co., Inc.

Abstract: At 10:30 p.m. on October 4, 2019, employees were removing pins from the gang form in order to install a form liner that had been forgotten during the initial standing of the form when the form collapsed on top of three employees. Employee #1 suffered back injuries that required hospitalization. Employee #2 also suffered a back injury but was treated and released. Employee #3 was hospitalized to treat a fractured left ankle.

Keywords: Ankle, Back, Collapse, Cotter Pin, Crushed, Crushing, Falling Object, Form work, Forming, Fracture, Removing, Struck By

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Commercial building		New project or new addition			3	42

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Construction
1	1436494.015	37	M	Hospitalized injury	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Pouring concrete foundations and walls Fatality Cause:
2	1436494.015	40	M	Hospitalized injury	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Pouring concrete foundations and walls Fatality Cause:
3	1436494.015	34	M	Non Hospitalized injury	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Pouring concrete foundations and walls Fatality Cause:

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