Inspection Detail

Inspection: 120315056 - Lausd Maint.& Opers.Dist.A

Inspection Information - Office: Van Nuys District Office

Investigation Summary

On August 13, 2004, Employee #1 and a coworker were assigned to enlarge and frame an opening in the roof of the auditorium of the Vintage Elementary School in North Hollywood, CA, for installation of a new HVAC system. Two pieces of plywood had been nailed over the 12 ft long by 3 ft wide opening. Employee #1 and the coworker lifted off the first piece of plywood, which was near an area covered by the roof joists and ceiling. Employee #1 was near the middle and the coworker was at one end. They raised the piece to an approximately 45-degree angle. Employee #1 then let go and the coworker continued lifting it up and over, leaning it against the parapet of the roof. Then they began lifting the second, 4 ft by 8 ft by 3/4 in. thick sheet of plywood, which covered an area where there were no roof joists or ceiling. The coworker was at one corner, as before, and Employee #1 was near the end. The coworker felt Employee #1 let go of the plywood, so he continued lifting up his end until he saw Employee #1 fall, feet first, through the hole. He dropped 11 ft, 6 in. onto the floor of the fan room. The coworker looked down and saw Employee on his back, moaning, with his eyes fluttering. He climbed down a ladder and asked Employee #1 if he was okay. When he got no response, the coworker went outside and used his cell phone to call 911. The then returned inside to find Employee #1 sitting up on his knees. Employee #1 was dazed and asked what happened and where he was. With the help of paramedics, he eventually climbed down the ladder to the auditorium floor and was transported to Northridge Hospital, where he was treated for a fractured back and a fractured coccye. Employee #1 underwent surgery after 7 days to insert two metal plates and screws into his back; he was hospitalized for a total of 11 days. The project had been started by two other employees about a week before. One of the two employees was replaced by another employee after several days. Employee #1 came to the site for the first time on the day of the accident to replace the other employee. It was unclear in Employee #1 stepped forward from his position approximately 18 in. from the edge of the hole, or if he slipped and lost his footing when he let go of the plywood. The employer was issued an accident-related citation,serious, for T8CCR 1670(a), Personal Fall Arrest Systems, Personal Fall Restraint Systems and Positioning Devices.

Keywords: FRACTURE, WORK RULES, SLIP, CONSTRUCTION, BACK, MANUAL MAT HANDLING, FALL, FALL PROTECTION, ROOF OPENING, LOST BALANCE