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Inspection Detail
Inspection: 1340331.015 - Adjustable Forms, Inc.
Inspection Information - Office: Chicago North Area Office
Site Address:
Adjustable Forms, Inc.
1000 Lake St.
Oak Park, IL 60301
Mailing Address:
One East Progress Road, Lombard, IL 60148
Union Status: Union
SIC:
NAICS: 238110/Poured Concrete Foundation and Structure Contractors
Inspection Type: Referral
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 08/21/2018
Emphasis: L:Fall
Case Closed: 09/19/2018
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Referral | 1373323 | Yes | |
| Inspection | 1340335 | Yes |
Investigation Summary
On August 21, 2018, Employee #1, employed by a concrete construction company, was working at a multiemployer construction project, a new four-story commercial building. He was working from a ladder made onsite and performing carpentry work in preparation for installing concrete forms. Employee #1 leaned back and fell from the ladder, a fall height of approximately 5 feet. He was transported to the hospital, where he was admitted and treated for fractures to eight ribs.
Keywords: Carpenter, Concrete Form Work, Construction, Fall, Fall Protection, Fracture, Installing, Ladder, Leaning over, Rib
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1340331.015 | 63 | M | Hospitalized injury | Carpenters |