Inspection Detail
Inspection: 111979027 - Concrete Form Constructors
Inspection Information - Office: Santa Ana District Office
Site Address:
Concrete Form Constructors
1621 S. Douglas Rd
Anaheim, CA 92806
Mailing Address:
2855 Campus Dr., Suite 215, San Mateo, CA 94403
Union Status: Union
SIC:1541
NAICS: 0
Inspection Type: Accident
Scope: Complete
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 09/03/1991
Emphasis:
Case Closed: 12/20/1991
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 361341068 |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 2 | 2 | ||||
| Current Violations | ||||||
| Initial Penalty | $4,000 | $0 | $0 | $0 | $0 | $4,000 |
| Current Penalty | $0 | $0 | $0 | $0 | $0 | $0 |
| FTA Penalty | $0 | $0 | $0 | $0 | $0 | $0 |
| # | Citation ID | Citaton Type | Standard Cited | Issuance Date | Abatement Due Date | Current Penalty | Initial Penalty | FTA Penalty | Contest | Latest Event | Note |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. | 01001 | Serious | 1670 C | 09/11/1991 | 08/30/1991 | $2,000 | $2,000 | $0 | 2 - Appeals Court | Citation has been deleted. | |
| 2. | 02001 | Serious | 1670 C | 08/30/1991 | 08/30/1991 | $2,000 | $2,000 | $0 | 09/01/1991 | 2 - Appeals Court | Citation has been deleted. |
Investigation Summary
At approximately 1:30 p.m. on August 27, 1991, Employee #1 was working on a concrete form approximately 20 to 24 feet above the ground. The employee looped the ring portion of his lanyard over a piece of vertical rebar instead of securely attaching the lanyard to a substantial part of the structure or form. The lanyard became dislodged while he moved around and he fell to the ground. The employee was transported to the hospital for treatment of a compound fracture of his right arm. He remained in the hospital for further surgery on the arm.
Keywords: CONCRETE FORM WORK, FRACTURE, WORK RULES, CONSTRUCTION, FALL, ARM, TIE-OFF
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 111979027 | Hospitalized injury | Fracture | Occupation not reported |
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