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Accident Summary Nr: 200122455 - Employee is killed in fall from form work being dismantled

Accident Summary Nr: 200122455 -- Report ID: 0523400 -- Event Date: 08/04/2003
Inspection NrDate OpenedSICNAICSEstablishment Name
30527911908/05/20031542236220C.D. Smith Construction, Inc.

Abstract: On August 4, 2003, Employee #1 fell 25 feet from concrete form work being dismantled at a pumping station and died later that same evening.

Keywords: CONCRETE FORM WORK, HEAD, DISMANTLING, CONSTRUCTION, FALL, CONCUSSION, PUMPING STATION
Accident Details
End Use Project Type Project Cost Stories Non-building Height Fatality
Sewer/water treatment plant New project or new addition $5,000,000 to $20,000,000 2 25 X

Employee Details
Employee # Inspection Nr Age Sex Degree of Injury Nature of Injury Occupation Construction
1 305279119 Fatality Other Construction laborers Distance of Fall: feet
Worker Height Above Ground/Floor: 25 feet
Cause: Forming
Fatality Cause: Fall from/with structure (other than roof)

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