Accident Report Detail

Accident Summary Nr: 200373264 - Formwork structure collapses and kills employee

Accident Summary Nr: 200373264 -- Report ID: 0454510 -- Event Date: 10/05/2004
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
308231349	10/06/2004	1771	238140	Jaguar Aquatics, Inc.

Abstract: Employee #1 and five other coworkers, working for a concrete and masonry company, were assisting another contractor's four employees to complete the pour of a new elevated pool deck in a residential area. As the concrete was poured mainly on one end of the formwork, the weight caused the structure to collapse causing some of the employees to slide down as the deck formwork tilted. An emergency medical services unit was called on site to administer first aid and all injuries were treated as minor. After treatment was administered, a head count was done and it was determined that Employee #1 was missing. He was found beneath rubble of collapsed deck and formwork. The EMS unit attempted to revive him, but Employee #1 died at the scene.

Keywords: DECKING, COLLAPSE, CRUSHED, POOL, CONCRETE

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Multi-family dwelling		New project or new addition		$500,000 to $1,000,000	2	24	X

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Occupation	Construction
1	308231349			Fatality	Asphyxia	Construction laborers	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Forming Fatality Cause: Collapse of structure

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