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Occupational Safety and Health Administration OSHA

Accident Report Detail

Accident: 122723.015 - Employee Is Killed When Concrete Form Tips Over And Falls To

Accident: 122723.015 -- Report ID: 0728900 -- Event Date: 12/20/2019
InspectionOpen DateSICEstablishment Name
1452624.01512/20/2019Hausmann Construction Inc
At 1:30 p.m. on December 20, 2019, Employee #1, employed by a construction company, was engaged in concrete form work at 15-story commercial building. After climbing a 13-foot vertical form, he tied off at the top of the form. The form tipped over and fell to the ground with the attached employee. Employee #1 struck his head on the ground and, simultaneously, was struck by the 1,500-pound form. He was killed.
Keywords: struck by, falling object, roll-over, head, construction, struck against, unsecured, climbing, form work, tie-off, skull
End Use Proj Type Proj Cost Stories NonBldgHt Fatality
Commercial building Alteration or rehabilitation   15 200 X
Employee # Inspection Age Sex Degree Nature Construction
1 1452624.015 40 M Fatality Other FallDist:
FatCause: Fall from/with platform catwalk (attached to struc

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