Inspection Detail

Inspection: 119627800 - W.R. Forde Associates

Inspection Information - Office: American Canyon District Office

Inspection Nr: 119627800

Report ID: 0950615

Date Opened: 07/18/2003

Site Address:
W.R. Forde Associates
761 Hillary Drive
Tiburon, CA 94920

Mailing Address:
984 Hensley Street, Richmond, CA 94801

Union Status: Union

SIC:1799

NAICS: 238910/Site Preparation Contractors

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 07/31/2003

Planning Guide: Safety-Construction

Emphasis: S:Construction (Cship)

Case Closed: 04/24/2006

Related Activity
Type	Activity Nr	Safety	Health
Accident	361600091

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations				1		1
Current Violations				1		1
Initial Penalty	$0	$0	$0	$300	$0	$300
Current Penalty	$0	$0	$0	$300	$0	$300
FTA Penalty	$0	$0	$0	$0	$0	$0

Violation Items
#	Citation ID	Citaton Type	Standard Cited	Issuance Date	Abatement Due Date	Current Penalty	Initial Penalty	FTA Penalty	Contest	Latest Event	Note
1.	01001	Other	4999 C02	08/07/2003	08/12/2003	$300	$300	$0		-

Investigation Summary

Investigation Nr: 170838098

Event: 07/18/2003

Employee sustained broken ribs after being struck by pole

At approximate 10:00 a.m. on July 18, 2003, Employee #1 was gathering and stacking brush next to a chipper, to be used to chip up the brush. An excavator was loading debris removed from the hillside and the parking lot of a church expansion project into a dump truck to be offhauled from the jobsite. The excavator was a Komatsu PC 200LC boom-type excavator. The employee had his back to the excavator. The operator of the excavator picked up an aluminum pipe light pole, about 30 ft. long, from the ground to put it in the truck. After picking it up, when he closed the claw onto the pole it swung in the bucket and hit Employee #1 in the back. Employee #1 sustained three broken ribs and was hospitalized.

Keywords: FRACTURE, LIGHTING FIXTURE, RIB, EXCAVATOR, STRUCK BY

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	119627800			Hospitalized injury	Fracture	Construction laborers

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