Accident Report Detail

Accident Summary Nr: 201042520 - Employee Is Injured in Fall from Cement Form

Accident Summary Nr: 201042520 -- Report ID: 0953220 -- Event Date: 01/09/2006
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
309410413	01/10/2006	1799	238990	Technicoat Management, Inc.

Abstract: Employee #1 fell 21 ft to the ground when the metal concrete form he was standing on shifted, causing him to fall. Employee #1 suffered a fracture and was hospitalized.

Keywords: CONCRETE FORM WORK, FRACTURE, UNSTABLE SURFACE, FALL

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Multi-family dwelling		New project or new addition		$20,000,000 and over	21	21

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Occupation	Construction
1	309410413			Hospitalized injury	Fracture	Construction laborers	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Waterproofing Fatality Cause: Struck by falling object/projectile

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