Accident Report Detail

Accident Summary Nr: 202289484 - Large form falls on employee

Accident Summary Nr: 202289484 -- Report ID: 0420600 -- Event Date: 01/05/2000
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
303155550	01/05/2000	1542	0	Capform, Inc.

Abstract: Employee #1 used a positioning lanyard hooked to a metal concrete form in a reclined support position while waiting for the crane to deposit a previously rigged form. While waiting he leaned back and moved back and forth. The movement caused the form to become unstable and the 1,500 lb. form fell onto him. He was declared dead at the scene.

Keywords: CRUSHED, LANYARD, CRANE, UNSTABLE LOAD

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Commercial building		New project or new addition		$1,000,000 to $5,000,000	5		X

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Occupation	Construction
1	303155550			Fatality	Other	Construction laborers	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Forming Fatality Cause: Other

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