Inspection Detail

Inspection: 308228147 - Peri Formwork Systems, Inc.

Inspection Information - Office: Department Of Labor, Licensing, And Regulation Division Of Labor And Industry Maryland Occupational Safety And Health

Inspection Nr: 308228147

Report ID: 0352440

Date Opened: 01/26/2005

Site Address:
Peri Formwork Systems, Inc.
7141 Dorsey Run Road
Elkridge, MD 21075

Mailing Address:
7272 Park Circle Drive, Hanover, MD 21076

Union Status: NonUnion

SIC:5039

NAICS: 423390/Other Construction Material Merchant Wholesalers

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 04/08/2005

Emphasis:

Case Closed: 07/15/2005

Related Activity
Type	Activity Nr	Safety	Health
Accident	102357225

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations	2			1		3
Current Violations	2			1		3
Initial Penalty	$9,600	$0	$0	$0	$0	$9,600
Current Penalty	$4,000	$0	$0	$0	$0	$4,000
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	Latest Event
1.	01001	Serious	19100178 L01 I	05/17/2005	05/20/2005	$2,000	$4,800	$0	I - Informal Settlement
2.	01002	Serious	19100178 N04	05/17/2005	05/20/2005	$2,000	$4,800	$0	I - Informal Settlement
3.	02001	Other	19100178 L06	05/17/2005	05/20/2005	$0	$0	$0	-

Investigation Summary

Investigation Nr: 202353587

Event: 01/26/2005

Employee is killed when struck by forklift

On January 26, 2009, Employee #1, a worker for a form work distributor, was walking through the lay-down yard, owned by the distributor, when he was struck by a forklift. He became trapped beneath the vehicle and was dragged 30 feet. Employee #1 was killed.

Keywords: FRACTURE, TRAFFIC CONTROL, DRAGGED, INDUSTRIAL TRUCK, STRUCK BY, RUN OVER, CONCRETE, INATTENTION

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	308228147			Fatality	Fracture	Supervisors; distrib., sched'g & adjusting clerks

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