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Accident Summary Nr: 126453.015 - Employee falls from wooden concrete form and suffers head in

Accident Summary Nr: 126453.015 -- Report ID: 0454712 -- Event Date: 05/21/2020
Inspection NrDate OpenedSICNAICSEstablishment Name
1476481.01505/27/2020236220R.C. Mathews Contractor, Llc

Abstract: At 1:21 p.m. on May 20, 2020, Employee #1 was working for a general contractor. Employee #1 was wrecking forms on a concrete wall. Employee #1 fell from wooden concrete form and suffered a head laceration and skull fracture. Employee #1 was hospitalized for treatment.

Keywords: Concrete, Concrete Form Work, Elevated, Elevated Work Plat, Elevated Work Platform, Fall, Fall From Elevation, Fracture, Head, Laceration, Skull
Accident Details
End Use Project Type Project Cost Stories Non-building Height Fatality
Other building New project or new addition   7

Employee Details
Employee # Inspection Nr Age Sex Degree of Injury Nature of Injury Occupation Construction
1 1476481.015 52 M Hospitalized injury Carpenter Distance of Fall: 7 feet
Worker Height Above Ground/Floor: 7 feet
Cause:
Fatality Cause:

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