Accident Report Detail

Accident Summary Nr: 201032752 - Employee injures head in fall from concrete form

Accident Summary Nr: 201032752 -- Report ID: 0950635 -- Event Date: 11/18/1999
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
126066943	12/07/1999	1771	0	Sure Forming System

Abstract: At approximately 1:30 p.m. on November 18, 1999, Employee #1, a carpenter, was hanging a plumb bob on a concrete form high above the ground. His hands slipped and he fell about 12 ft, landing in a concrete hopper. Employee #1 suffered a contusion on his head and was transported by Los Angeles County paramedics to Harbor General Hospital, where he remained for five days. As his release, he was treated as an outpatient and underwent therapy.

Keywords: CONCRETE FORM WORK, HEAD, CARPENTER, WORK RULES, SLIP, CONSTRUCTION, CLIMBING ON COLUMN, FALL, FALL PROTECTION, CONTUSION

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Single family or duplex dwelling		New project or new addition		Under $50,000	2	5

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	126066943			Hospitalized injury	Bruise/Contus/Abras	Carpenters

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