Accident Report Detail

Accident Summary Nr: 122723.015 - Employee is killed when concrete form tips over and falls to

Accident Summary Nr: 122723.015 -- Report ID: 0728900 -- Event Date: 12/20/2019
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
1452624.015	12/20/2019		236115	Hausmann Construction Inc

Abstract: At 1:30 p.m. on December 20, 2019, Employee #1, employed by a construction company, was engaged in concrete form work at 15-story commercial building. After climbing a 13-foot vertical form, he tied off at the top of the form. The form tipped over and fell to the ground with the attached employee. Employee #1 struck his head on the ground and, simultaneously, was struck by the 1,500-pound form. He was killed.

Keywords: Climbing, Construction, Falling Object, Form work, Head, Roll-Over, Skull, Struck Against, Struck By, Tie-Off, Unsecured

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Commercial building		Alteration or rehabilitation			15	200	X

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Construction
1	1452624.015	40	M	Fatality		Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Pouring concrete for piers, and pylons Fatality Cause:

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