Accident Report Detail
Accident Summary Nr: 201114527 - Employee falls while removing concrete form
| Inspection Nr | Date Opened | SIC | NAICS | Establishment Name |
|---|---|---|---|---|
| 120310347 | 06/27/2002 | 1799 | 562910 | San-Mar Construction |
Abstract: On June 6, 2002, Employee #1 was working for a concrete forming construction company. While removing a concrete form, Employee #1 fell approximately 20 ft from the perimeter of a structure. Employee #1 suffered multiple fractures to his pelvis and ribs and was hospitalized. Employee #1 was not wearing his fall protection.
| End Use | Project Type | Project Cost | Stories | Non-building Height | Fatality | ||
|---|---|---|---|---|---|---|---|
| Other building | New project or new addition | $5,000,000 to $20,000,000 | 4 | 60 | |||
| Employee # | Inspection Nr | Age | Sex | Degree of Injury | Nature of Injury | Occupation | Construction |
|---|---|---|---|---|---|---|---|
| 1 | 120310347 | Hospitalized injury | Fracture | Supervisors; carpenters and related workers | Distance of Fall: feet Worker Height Above Ground/Floor: 20 feet Cause: Forming Fatality Cause: Fall from/with structure (other than roof) |
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