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Accident Report Detail

Accident Summary Nr: 127645.015 - Employee sustains head contusion when struck by falling form

Accident Summary Nr: 127645.015 -- Report ID: 0111400 -- Event Date: 07/10/2020
Inspection NrDate OpenedSICNAICSEstablishment Name
1482713.01507/10/2020238110Marguerite Concrete, Inc.

Abstract: At 8:00 a.m. on July 10, 2020, an employee working as a carpenter for a structural concrete contractor was on the ground tending to form climbers. The employee attached a Peri form tie pin to a rope so a coworker at the top of a form could hoist it up to put in place. The form pin got snagged on a metal object on the way up, turning over and sliding out of the knot, and striking the employee on his head. The employee received medical treatment without hospitalization for a contusion on his head.

Keywords: Carpenter, Commercial Building, Concrete Form Work, Construction, Contusion, Falling Object, Form work, Head, Hoist, Hoisting Mechanism, Hoistline, Misjudgment, Misjudgment of Hazardous Situation, Pin, Struck By
Accident Details
End Use Project Type Project Cost Stories Non-building Height Fatality
Commercial building New project or new addition   3 30

Employee Details
Employee # Inspection Nr Age Sex Degree of Injury Nature of Injury Occupation Construction
1 1482713.015 30 M Non Hospitalized injury Carpenters Distance of Fall: feet
Worker Height Above Ground/Floor: feet
Cause: Pouring concrete foundations and walls
Fatality Cause:

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