Accident Report Detail

Accident Summary Nr: 201523966 - Four Employees Are Injured When Concrete Form Falls Over

Accident Summary Nr: 201523966 -- Report ID: 0111500 -- Event Date: 10/19/2011
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
315974121	10/19/2011	1771	238110	G & C Concrete Construction Inc.

Abstract: On October 19, 2011, Employee #1, of G & C Concrete Construction Incorporated, was dismantling a PERI CB 240 climbing scaffold section. Employee #1 removed a brace before setting the form in its complete upright position. The concrete form fell over and pinned him between the form and the ground. Three coworkers came to his aid and lifted the heavy form off Employee #1. Employee #1 was transported to the hospital and treated for head, neck, shoulder and ankle injuries, which resulted from the incident. In addition, the three coworkers sustained back sprains, which resulted from lifting the heavy form.

Keywords: CONCRETE FORM WORK, HEAD, SHOULDER, PINNED, NECK, CONCRETE, SPRAIN, ANKLE, SCAFFOLD, UNSTABLE LOAD

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

Employee Details
Employee #	Inspection Nr	Degree of Injury	Nature of Injury	Occupation	Construction
1	315974121	Hospitalized injury	Bruise/Contus/Abras	Carpenters	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Forming Fatality Cause: Collapse of structure
2	315974121	Non Hospitalized injury	Strain/Sprain	Construction laborers	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Forming Fatality Cause: Lifting operations
3	315974121	Non Hospitalized injury	Strain/Sprain	Construction laborers	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Forming Fatality Cause: Lifting operations
4	315974121	Non Hospitalized injury	Strain/Sprain	Construction laborers	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Forming Fatality Cause: Lifting operations

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