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Inspection Detail
Inspection: 1224113.015 - Peri Formwork Systems, Inc.
Inspection Information - Office: Oakland District Office
Site Address:
Peri Formwork Systems, Inc.
3500 Boulder Street
Pleasanton, CA 94566
Mailing Address:
3500 Boulder Street, Pleasanton, CA 94566
Union Status: NonUnion
SIC:
NAICS: 444210/Outdoor Power Equipment Stores
Inspection Type: Accident
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 06/12/2017
Emphasis:
Case Closed: 08/07/2017
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 1199316 | ||
| Inspection | 1224313 | Yes |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 1 | 2 | 3 | |||
| Current Violations | 1 | 2 | 3 | |||
| Initial Penalty | $8,435 | $0 | $0 | $5,935 | $0 | $14,370 |
| Current Penalty | $5,400 | $0 | $0 | $5,600 | $0 | $11,000 |
| FTA Penalty | $0 | $0 | $0 | $0 | $0 | $0 |
| # | Citation ID | Citation Type | Standard Cited | Issuance Date | Abatement Due Date | Current Penalty | Initial Penalty | FTA Penalty | Contest | Latest Event | Note |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. | 01001 | Other | 342(A) | 06/14/2017 | $5,000 | $5,000 | $0 | I - Informal Settlement | |||
| 2. | 01002 | Other | 3203(A)(6) | 06/14/2017 | $600 | $935 | $0 | I - Informal Settlement | |||
| 3. | 02001 | Serious | 3203(A)(7) | 06/14/2017 | $5,400 | $8,435 | $0 | I - Informal Settlement |
Investigation Summary
At 9:00 a.m. on March 24, 2017, an employee was covering a wooden formwork panel that loaded on a flatbed trailer with a tarpaulin. The employee was kneeling and spreading the tarpaulin and stood up, lost their balance, and fell approximately 7 feet to the ground. The employee was admitted to the Eden Medical Center and treated for fractured ribs and a left shoulder separation. The employee was released on March 29, 2017.
Keywords: Fall, Fracture, Lost Balance, Material Handling, Rib, Shoulder, Trailer
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1224113.015 | 65 | M | Hospitalized injury | Managers and administrators, n.e.c |