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Inspection Detail
Inspection: 1333491 - Adjustable Forms Inc
Inspection Information - Office: Chicago North Area Office
Site Address:
Adjustable Forms Inc
22nd & Wolf Road
Westchester, IL 60153
Mailing Address:
1 East Progress Road, Lombard, IL 60148
Union Status: Union
SIC:1799
NAICS: 0
Inspection Type: Accident
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 09/07/1984
Planning Guide: Safety-Construction
Emphasis:
Case Closed: 12/26/1984
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 360539027 |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 1 | 1 | ||||
| Current Violations | 1 | 1 | ||||
| Initial Penalty | $0 | $7,000 | $0 | $0 | $0 | $7,000 |
| Current Penalty | $0 | $2,500 | $0 | $0 | $0 | $2,500 |
| 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 | Willful | 19260550 A15 I | 10/10/1984 | 10/19/1984 | $2,500 | $7,000 | $0 | I - Informal Settlement |
Investigation Summary
A CARPENTER WAS MAKING CONCRETE, METAL, AND WOOD FORMS AT A CONSTRUCTION SITE. HE WAS WORKING NEAR THE RIGHT REAR OUTRIGGER OF A TRUCK CRANE (GRAVE MODEL NO. 64256, SERIAL NO. LG1513025) ALONG WITH TWO OTHER EMPLOYEES. A FOURTH EMPLOYEE, WHO WAS HOOKING BEAMS NORTH OF THE RIGHT FRONT OUTRIGGER, DRAGGED THE LOAD LINE INTO A 7000-VOLT OVERHEAD POWER LINE. AS THE LOAD LINE CONTACTED THE POWER LINE, SPARKS AND NOISES WERE HEARD, CAUSING THE TWO EMPLOYEES WORKING WITH THE CARPENTER TO RUN FROM THE CRANE. THE CARPENTER CONTACTED THE OUTRIGGER AND WAS ELECTROCUTED. (NO INJURY TO THE FOURTH EMPLOYEE WAS REPORTED.)
Keywords: ELECTRICAL, TRUCK CRANE, ELECTROCUTED, LOAD LINE, OVERHEAD POWER LINE, E C, OUTRIGGER, CRANE
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1333491 | Fatality | Electric Shock | Carpenters |