Accident Report Detail

Accident Summary Nr: 109673.015 - Employee incurs unspecified injuries in concrete form struct

Accident Summary Nr: 109673.015 -- Report ID: 0636900 -- Event Date: 09/29/2018
Inspection Nr	Date Opened	SIC	NAICS	Establishment Name
1350505.015	10/01/2018		238110	Capform, Inc.

Abstract: At 8:15 a.m. on September 29, 2018, an employee was working to dismantle concrete tower forms. While working, a portion of the form structure fell over and struck the employee who was hospitalized with unspecified injuries.

Keywords: Collapse, Concrete Form Work, Dismantling, Fall, Falling Object, Struck By, Structural Collapse

Accident Details
End Use		Project Type		Project Cost	Stories	Non-building Height	Fatality
Commercial building		New project or new addition			1	0

Employee Details
Employee #	Inspection Nr	Age	Sex	Degree of Injury	Nature of Injury	Occupation	Construction
1	1350505.015	42	M	Hospitalized injury		Construction laborers	Distance of Fall: feet Worker Height Above Ground/Floor: feet Cause: Pouring concrete foundations and walls Fatality Cause:

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