Abstract: At approximately 8:30 a.m. on January 4, 2013, Employee #1, a 31-year-old laborer employed by Pacific Hydrotech, was working at a public works project, a water and sewer treatment plant where his employer was building a new underground sewer pump house and pit. Employee #1 had climbed to a height of approximately 13 feet on a 20-foot-high concrete form and had tied off to the form. Coworkers #1 and #2 were working on the opposite side of the concrete wall to remove a 4-foot section of the forms. Employee #1 was told to remove two taper ties on his side of the wall by hammering them back through the concrete toward the two coworkers. After Employee #1 removed the last of the two ties, there was nothing holding the form onto the concrete wall. Other pins that should have still been in place on the formworks, and that would have held it in place after the taper ties were removed, had been removed previously. The concrete form to which Employee #1 was tied came loose and tipped backward approximately 7 feet onto the steel beam and plate shoring on the opposite side, pinning him against the steel wall and causing injuries. Employee #1 was transported to Scripps Mercy Hospital, where he was hospitalized and treated for a back injury and fractured ribs. The employer reported this event to Cal/OSHA at 4:45 p.m. on January 4, 2013. Employee #1 was released from the hospital on January 5, 2013.