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Accident Summary Nr: 200211522 - Employee killed when struck by falling mass of concrete

Accident Summary Nr: 200211522 -- Report ID: 0626000 -- Event Date: 10/12/2004
Inspection NrDate OpenedSICNAICSEstablishment Name
30808071210/12/20041771238110Keystone Structural Concrete Ltd.

Abstract: On October 12, 2004, Employee #1 was removing plywood sheeting from an overhead, hollow, inverted concrete pan. The pan form had accidentally became filled with concrete. Employee #1 was taking off the sheeting when the concrete mass that was in the form and supported by the plywood fell out and struck him. Employee #1 was killed.

Keywords: CONCRETE FORM WORK, WORK RULES, CONSTRUCTION, STRUCK BY, FALLING OBJECT, ACCIDENTAL DISCHARGE
Accident Details
End Use Project Type Project Cost Stories Non-building Height Fatality
Other building New project or new addition $1,000,000 to $5,000,000 2 6 X

Employee Details
Employee # Inspection Nr Age Sex Degree of Injury Nature of Injury Occupation Construction
1 308080712 Fatality Other Laborers, except construction Distance of Fall: feet
Worker Height Above Ground/Floor: feet
Cause: Pouring or installing floor decks
Fatality Cause: Struck by falling object/projectile

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