Inspection Detail

Inspection: 307519710 - Primary Structures, Inc. Of Clearwater

Inspection Information - Office: Tampa Area Office

Inspection Nr: 307519710

Report ID: 0420600

Date Opened: 03/29/2004

Site Address:
Primary Structures, Inc. Of Clearwater
1200 Gulf Blvd
Treasure Island, FL 33706

Mailing Address:
13131 56th Court Suite 301, Clearwater, FL 33760

Union Status: NonUnion

SIC:1771

NAICS: 238140/Masonry Contractors

Inspection Type: Accident

Scope: Complete

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 05/11/2004

Planning Guide: Safety-Construction

Emphasis: L:Fall, S:Construction Fatalities

Case Closed: 02/01/2005

Related Activity
Type	Activity Nr	Safety	Health
Accident	102408721

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations	3		3	1		7
Current Violations	3		3			6
Initial Penalty	$8,000	$0	$30,400	$0	$0	$38,400
Current Penalty	$4,750	$0	$22,050	$0	$0	$26,800
FTA Penalty	$0	$0	$0	$0	$0	$0

Violation Items
#	Citation ID	Citaton Type	Standard Cited	Issuance Date	Abatement Due Date	Current Penalty	Initial Penalty	FTA Penalty	Contest	Latest Event	Note
1.	01001A	Serious	19260501 B05	08/03/2004	08/06/2004	$2,500	$4,000	$0	08/17/2004	F - Formal Settlement
2.	01001B	Serious	19260451 G01	08/03/2004	08/06/2004	$0	$0	$0	08/17/2004	F - Formal Settlement
3.	01002	Serious	19260502 D16 III	08/03/2004	08/06/2004	$1,125	$2,000	$0	08/17/2004	F - Formal Settlement
4.	01003A	Serious	19260502 D05	08/03/2004	08/06/2004	$1,125	$2,000	$0	08/17/2004	F - Formal Settlement
5.	01003B	Serious	19260502 D21	08/03/2004	08/06/2004	$0	$0	$0	08/17/2004	F - Formal Settlement
6.	02001	Repeat	19260501 B01	08/03/2004	08/06/2004	$9,025	$11,200	$0	08/17/2004	F - Formal Settlement
7.	02002	Repeat	19260503 A01	08/03/2004	09/05/2004	$9,025	$11,200	$0	08/17/2004	F - Formal Settlement
8.	02003	Repeat	19260701 B	08/03/2004	08/06/2004	$4,000	$8,000	$0	08/17/2004	F - Formal Settlement
9.	03001	Other	19260405 A02 III	08/03/2004	08/09/2004	$0	$0	$0	08/17/2004	F - Formal Settlement	Citation has been deleted.

Investigation Summary

Investigation Nr: 202344362

Event: 03/29/2004

Employee dies after falling from an elevation

On March 29, 2004, Employee #1 was removing concrete pouring forms at the edge of the third floor of a building undergoing construction. He had removed the guard railing and was using a 2-in by 4-ft wooden board to push the form off the post tension cables. The concrete pouring form was approximately 16-ft long. After removing one side of the wall, he attempted to dislodge the other side with the wooden board. But, as he struck the form using the board, he lost his balance and stepped upon greasy cables causing him to fall. He was killed when he struck the ground approximately 30-ft below.

Keywords: CONCRETE FORM WORK, GUARDRAIL, BUILDING, CONSTRUCTION, FALL, FALL PROTECTION, LOST BALANCE, WORK PLATFORM

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	307519710			Fatality	Fracture	Construction laborers

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