Accident Report Detail

Accident Summary Nr: 200671865 - Employee killed in fall with concrete column form

Accident Summary Nr: 200671865 -- Report ID: 0418800 -- Event Date: 05/20/1999
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
301885216	05/21/1999	1771	0	Southland Forming, Inc.

Abstract: Employee #1, a carpenter and laborer, was placing pins at the top of a column form on the 12th floor level. The safety lanyard of his full body harness was looped around the steel rebar sticking up from the top of the form. The form and Employee #1 fell approximately 130 ft to the ground level deck. He was killed.

Keywords: CONCRETE FORM WORK, UNSECURED, WORK RULES, CONSTRUCTION, FALL, FALL PROTECTION, TIE-OFF

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	21		X

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Occupation	Construction
1	301885216			Fatality	Bruise/Contus/Abras	Carpenters	Distance of Fall: feet Worker Height Above Ground/Floor: 10 feet Cause: Forming Fatality Cause: Fall from/with structure (other than roof)

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