Abstract: At approximately 2:35 p.m. on October 11, 2012, Employee #1, a laborer, and a coworker were covering an open-air atrium in a hospital with rolled poly plastic sheeting. The hospital was undergoing renovations. The plastic sheet was placed over the atrium to maintain negative pressure and prevent construction dust from entering the nearby and connected VA Medical Center, which was an active location in the hospital. The open-air atrium measured approximately 24 ft by 45 ft. Second floor and roof deck guardrails had surrounded the top of the atrium, but had been demolished over the summer. Additionally, DBI-Sala anchors that employees had used to demolish the guardrail had been removed. After demolishing the guardrail, the top of the atrium was enclosed by a locked construction fence. During a prejob meeting that occurred at approximately 11:00 a.m. on October 11, 2012, a crew attached plastic poly sheeting under the existing sheeting drooping inside the building. The crew used a scissor lift to attach this plastic to the inside edge of a 2in by 4 ft wood frame around the atrium, instead of the second floor and roof deck surrounding the edge of the atrium opening. Further, the crew did not discuss what would be required for employees that access and work from second floor and roof deck. Employee #1 and the coworker were instructed to stay in the scissors lift and install the plastic from below. However, they were not told that this was because no guardrails or approved fall protection anchors were in the area around the atrium opening. When Employee #1, his coworker and the rest of the crew were assembled to discuss the job, they informed the foreman that the job could not be accomplished from below the existing plastic using the scissors lifts. The foreman then directed the crew to install the rolled poly plastic over the existing plastic and from the second floor and roof deck. The foreman stated that he did not discuss or receive permission for this change in the work procedure with the operations manager. The site superintendent was also not aware of the change in the work procedure. Further, the foreman and others had not been on the roof before the work commenced. The foreman directed Employees #1 and a coworker to wear and use fall protection. Employee #1 was wearing a Miller (Model Number E650) full body harness with a Rebel Protecta 10 ft long retractable lanyard device attached the harness. Employee #1 and the coworker pulled the plastic over the open atrium, when Employee #1 fell. Even though Employee #1 was wearing fall protection, his fall was not arrested due to the failure of the DBI-Sala anchors. He fell approximately 20 ft from the roof atrium opening onto the floor and was killed.