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Accident Summary Nr: 170152631 - Employee injured when struck by falling wooden form

Accident Summary Nr: 170152631 -- Report ID: 0950645 -- Event Date: 07/08/1991
Inspection NrDate OpenedSICNAICSEstablishment Name
11222166807/16/199116230Jfj Construction Inc

Abstract: Employee #1 was supervising the vertical stacking of a 5,000 lb, 8 ft by 40 ft wooden concrete form. It was temporarily leaning against a structure while the crane needed for the job was moved to avoid power lines. Once the crane had been repositioned, Employee #1 signaled the crane operator to 'pick,' and then climbed onto the form to hook up the pick ring. Employee #1's weight caused the form to fall forward and on top of him. He suffered a broken nose, bruised ribs, a cracked tooth, and a hemorrhage of the left eye. Employee #1 was treated at a local hospital and released.

Keywords: EYE, CONCRETE FORM WORK, FRACTURE, HEMORRHAGE, CONSTRUCTION, NOSE, RIB, STRUCK BY, FALLING OBJECT, UNSTABLE POSITION

Employee Details
Employee # Inspection Nr Age Sex Degree of Injury Nature of Injury Occupation
1 112221668 Hospitalized injury Other Supervisors; carpenters and related workers

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