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Accident: 109673.015 - Employee Incurs Unspecified Injuries In Concrete Form Struct

Accident: 109673.015 -- Report ID: 0636900 -- Event Date: 09/29/2018
InspectionOpen DateSICEstablishment Name
1350505.01510/01/2018Capform, Inc.
At 8:15 a.m. on September 29, 2018, an employee was working to dismantle concret e tower forms. While working, a portion of the form structure fell over and stru ck the employee who was hospitalized with unspecified injuries.
Keywords: collapse, concrete form work, dismantling, fall, falling object, struck by, structural collapse
End Use Proj Type Proj Cost Stories NonBldgHt Fatality
Commercial building New project or new addition   1 0
Employee # Inspection Age Sex Degree Nature Occupation Construction
1 1350505.015 42 M Hospitalized injury Construction laborers FallDist:
FallHt:
Cause: Pouring concrete foundations and walls
FatCause:

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