Accident Report Detail

Accident Summary Nr: 201023421 - Employee Falls and Receives Severe Bruising

Accident Summary Nr: 201023421 -- Report ID: 0950615 -- Event Date: 06/17/2011
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
300753563	07/08/2011	1522	236118	Custom Home Industries, Inc

Abstract: On June 17, 2011, Employee #1 was working as a laborer for a construction company working at a private residence that was being remodeled. Employee #1 was assisting coworkers to prepare the site for a concrete pour in the backyard of the residence. Employee #1 tripped on a wooden form and fell on to his left thigh and buttock, causing bruising. Employee #1 went home and noticed that the bruised area had turned red. Three days later, the injured area was swollen, and Employee #1 went to the Kaiser Santa Rosa Occupational Medicine Clinic. Employee #1 was hospitalized and received antibiotics. He was discharged on June 28, 2011. The Santa Rosa District Occupational Safety and Health Office was notified of the accident on July 1, 2011, and initiated an investigation on July 8, 2011.

Keywords: BUTTOCKS, THIGH, TRIPPED, ABRASION, FALL, CONTUSION

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Single family or duplex dwelling		Alteration or rehabilitation		Under $50,000	1

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Occupation	Construction
1	300753563			Hospitalized injury	Bruise/Contus/Abras	Occupation not reported	Distance of Fall: feet Worker Height Above Ground/Floor: 1 feet Cause: Pouring concrete floor at grade Fatality Cause: Fall, other

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