Inspection Detail
Inspection: 306748476 - United Form Services, Inc.
Inspection Information - Office: Jacksonville Area Office
Site Address:
United Form Services, Inc.
6089 West Highway 98
Panama City, FL 32401
Mailing Address:
P.O. Box 28, 417 Main, Neodesha, KS 66757
Union Status: NonUnion
SIC:8711
NAICS: 541330/Engineering Services
Inspection Type: Unprog Rel
Scope: Complete
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 01/07/2004
Emphasis: L:Fall, S:Construction Fatalities
Case Closed: 06/29/2004
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 101353175 |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 1 | 1 | ||||
| Current Violations | 1 | 1 | ||||
| Initial Penalty | $4,900 | $0 | $0 | $0 | $0 | $4,900 |
| Current Penalty | $2,695 | $0 | $0 | $0 | $0 | $2,695 |
| 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 | 19260451 A01 | 01/15/2004 | 01/21/2004 | $2,695 | $4,900 | $0 | I - Informal Settlement |
Investigation Summary
Employees #1, 2, 3, and 4 were working on a Custom Cantilever Style Finishing Work Platform which is a self-contained adjustable scaffold. The top portion of this scaffold was on a newly constructed bridge, and the lower portion was under the bridge. Employee #1 and his coworkers were loading bags of grout from the top of the bridge to the lower scaffold platform. Employee #1 and his coworkers were on the lower scaffold platform. There was also a mixer, wooden frames and other tools on the scaffold platform. Approximately 89 bags of grout were placed on the scaffold platform. Each bag weighed about 50 lbs. Employee #1 and his coworkers were going to mix the grout in the mixer, and then apply the mix inside the bridge which was a hollow structure. The capacity of the scaffold was posted as 2,000 lbs. This load capacity was exceeded by the weight of the materials and men on the scaffold platform. The scaffold failed, and fell approximately 60 ft from the bridge into the water. Employee #1 and his coworkers fell with the scaffold. Employee #1 was the only one who had secured his lanyard to the scaffold. Consequently, Employee #1 sank with the scaffold, and drowned. Employees #2, 3, and 4 were rescued, taken to the hospital, and treated for their injuries. It was later discovered that the scaffold had not been designed to support four times its intended load without failure.
Keywords: BRIDGE, MIXER, FALL, DROWN, SCAFFOLD, WATER
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 306748476 | Occupation not reported |
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