Accident Report Detail

Accident Summary Nr: 84254.015 - Employee falls from wooden concrete form and is killed

Accident Summary Nr: 84254.015 -- Report ID: 0653510 -- Event Date: 04/04/2016
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
1138183.015	04/04/2016		238120	Gill Con Inc.

Abstract: At 7:00 a.m. on April 4, 2016, an employee was preparing to install rebar on top of a wooden concrete mold. The employee fell off a 12-ft tall wooden concrete form and is killed from head trauma

Keywords: Concrete, Concrete Form Work, Elevated Work Platform, Fall, Head, Laceration

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Highway, road, street		Other			0	12	X

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Occupation	Construction
1	1138183.015	36	M	Fatality		Strctural Iron /& Steel Worker	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Emplacing reinforcing steel Fatality Cause:

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