Inspection Detail
Inspection: 311369821 - Adjustable Forms, Inc.
Inspection Information - Office: Chicago South Area Office
Site Address:
Adjustable Forms, Inc.
111 W. Wacker Dr.
Chicago, IL 60601
Mailing Address:
1 East Progress Rd., Lombard, IL 60147
Union Status: Union
SIC:1771
NAICS: 238110/Poured Concrete Foundation and Structure Contractors
Inspection Type: Accident
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 12/18/2007
Planning Guide: Safety-Construction
Emphasis: L:Fall, L:Hirise, S:Commercial Constr, S:Fall From Height
Case Closed: 01/03/2008
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 100033778 |
Investigation Summary
At approximately 10:00 a.m. on November 21, 2007, Employee #1, a carpenter with Adjustable Forms, Inc., was part of a three-man crew raising an elevator shaft cover from the 10th floor to the 12th floor. A coworker on the 10th floor tied a rope to the shaft cover and pried the cover loose, preparing it to be raised. The coworker on the 13th floor told Employee #1 to wait until he came down to help pull the cover up. Apparently Employee #1 started to pull the cover up by himself because the coworker on the 10th floor later stated that the cover began to rise. Once the full weight of the cover came off the 10th floor, it began to fall. Employee #1 was pulled through the guardrail system and briefly held onto the rope, but eventually fell through the shaft opening. He crashed through the permanent cover on the first floor and landed in the elevator pit, approximately four stories below ground level. Employee #1 was killed.
Keywords: COVER, GUARDRAIL, CARPENTER, WORK RULES, CONSTRUCTION, FALL, FALL PROTECTION, FLOOR OPENING, ELEVATOR SHAFT
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 311369821 | Fatality | Other | Occupation not reported |
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