Accident Report Detail

Accident Summary Nr: 201140365 - Employee injured when struck by falling concrete form

Accident Summary Nr: 201140365 -- Report ID: 0950631 -- Event Date: 08/19/1997
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
125908384	08/25/1997	1541	0	Mc Carthy

Abstract: At approximately 10:00 a.m. on August 19, 1997, Employee #1 and a coworker were unloading metal concrete beam forms from a flatbed truck. The coworker was operating a forklift, and Employee #1 was standing on the flatbed, guiding it. The forklift was picking up one of the forms when it pushed against the form next to it and the whole stack tipped over. Employee #1 saw this happening and jumped 9 ft off the flatbed. At the same time, three of the forms fell to the ground. One struck Employee #1, causing serious injuries to his right leg. He also sustained a broken left leg in his jump off the truck. Employee #1 was taken to Riverside General Hospital and was later transferred to Western Medical Center in Santa Ana.

Keywords: FRACTURE, UNSECURED, WORK RULES, CONSTRUCTION, INDUSTRIAL TRUCK, OFF LOADING, STRUCK BY, FALLING OBJECT, FLATBED TRUCK, LEG

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Other building		Other		$1,000,000 to $5,000,000	3	40

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Occupation	Construction
1	125908384			Hospitalized injury	Fracture	Miscellaneous material moving equipment operators	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Loading dock forming and pouring Fatality Cause: Other

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