Inspection Detail

Case Status: CLOSED

Inspection: 1214386.015 - 133804 - American Coatings And Insulation Systems, Inc.

Inspection Information - Office: Nc Department Of Labor - Winston-Salem

Inspection Nr: 1214386.015

Report ID: 0453720

Date Opened: 03/02/2017

Site Address:
133804 - American Coatings And Insulation Systems, Inc.
7617 Boeing Drive
Greensboro, NC 27409

Mailing Address:
P.O. Box 19706, Greensboro, NC 27419

Union Status: NonUnion

SIC:5033

NAICS: 444190/Other Building Material Dealers

Inspection Type: Fat/Cat

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 04/11/2017

Emphasis:

Case Closed: 05/25/2017

Related Activity
Type	Activity Nr	Safety	Health
Accident	1187787

Case Status: CLOSED

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations				3		3
Current Violations				3		3
Initial Penalty	$0	$0	$0	$2,200	$0	$2,200
Current Penalty	$0	$0	$0	$1,450	$0	$1,450
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	Latest Event
1.	01001	Other	19040004 A	04/12/2017	04/21/2017	$150	$200	$0	I - Informal Settlement
2.	01002	Other	19040039 A01	04/12/2017	04/17/2017	$650	$1,000	$0	I - Informal Settlement
3.	01003	Other	19040039 A02	04/12/2017	04/17/2017	$650	$1,000	$0	I - Informal Settlement

Investigation Summary

Investigation Nr: 93618.015

Event: 12/13/2016

Employee trips, falls, fractures skull and is killed

At 12:00 a.m. on December 13, 2016, an employee was taking out recycling at a facility. As he stomped on a card board box to break it down, he lost his balance, fell, and hit his head. He suffered a skull facture and bleeding on the brain. He later died of complications from the fall on January 12, 2017.

Keywords: Fall, Head, Tripped

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	1214386.015	83	M	Fatality		Occupation not reported

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