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Inspection Detail
Inspection: 304009269 - J B Carpenters Inc
Inspection Information - Office: Appleton Area Office
Inspection Nr: 304009269
Report ID: 0521100
Date Opened: 04/27/2001
Site Address:
J B Carpenters Inc
East 1210 Church Road
Luxemburg, WI 54311
Mailing Address:
3190 Water Division Road, Denmark, WI 54208
Union Status: NonUnion
SIC:1531
NAICS: 0
Inspection Type: Accident
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 05/09/2001
Planning Guide: Safety-Construction
Emphasis: N:Trench, S:Construction, S:Construction Fatalities
Case Closed: 11/13/2001
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 100650274 | ||
| Referral | 200650497 | Yes |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 8 | 1 | 9 | |||
| Current Violations | 6 | 2 | 8 | |||
| Initial Penalty | $6,750 | $0 | $0 | $0 | $0 | $6,750 |
| Current Penalty | $4,175 | $0 | $0 | $0 | $0 | $4,175 |
| 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 | Serious | 19260021 B02 | 05/24/2001 | 07/26/2001 | $750 | $750 | $0 | I - Informal Settlement | ||
| 2. | 01002 | Serious | 19260102 A01 | 05/24/2001 | 06/21/2001 | $375 | $750 | $0 | I - Informal Settlement | ||
| 3. | 01003 | Serious | 19260651 C02 | 05/24/2001 | 05/24/2001 | $100 | $750 | $0 | I - Informal Settlement | ||
| 4. | 01004 | Serious | 19260651 E | 05/24/2001 | 06/01/2001 | $0 | $750 | $0 | I - Informal Settlement | Citation has been deleted. | |
| 5. | 01005 | Serious | 19260652 A01 | 05/24/2001 | 05/24/2001 | $750 | $750 | $0 | - | ||
| 6. | 01006 | Serious | 19260703 A01 | 05/24/2001 | 05/24/2001 | $2,100 | $2,100 | $0 | - | ||
| 7. | 01007 | Other | 19260703 A02 | 05/24/2001 | 05/24/2001 | $0 | $450 | $0 | I - Informal Settlement | ||
| 8. | 01008A | Serious | 19101200 E01 | 05/24/2001 | 07/26/2001 | $100 | $450 | $0 | I - Informal Settlement | ||
| 9. | 01008B | Serious | 19101200 F05 II | 05/24/2001 | 07/26/2001 | $0 | $0 | $0 | - | ||
| 10. | 01008C | Serious | 19101200 G01 | 05/24/2001 | 07/26/2001 | $0 | $0 | $0 | - | ||
| 11. | 01008D | Serious | 19101200 H | 05/24/2001 | 07/26/2001 | $0 | $0 | $0 | - | ||
| 12. | 02001 | Other | 19040002 A | 05/24/2001 | 06/26/2001 | $0 | $0 | $0 | - |
Investigation Summary
Investigation Nr: 200650448
Event: 04/26/2001
Employee Dies from Asphyxiation - Struck by Concrete Forms
Employee #1 died from asphyxiation after being struck by a concrete form not adequately braced.
Keywords: CONCRETE FORM WORK, ASPHYXIATED, UNSECURED, STRUCK BY
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 304009269 | Fatality | Asphyxia | Construction laborers |