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Occupational Safety and Health Administration OSHA

Accident Report Detail

Accident: 201523966 - Four Employees Are Injured When Concrete Form Falls Over

Accident: 201523966 -- Report ID: 0111500 -- Event Date: 10/19/2011
InspectionOpen DateSICEstablishment Name
31597412110/19/20111771G & C Concrete Construction Inc.
On October 19, 2011, Employee #1, of G & C Concrete Construction Incorporated, was dismantling a PERI CB 240 climbing scaffold section. Employee #1 removed a brace before setting the form in its complete upright position. The concrete form fell over and pinned him between the form and the ground. Three coworkers came to his aid and lifted the heavy form off Employee #1. Employee #1 was transported to the hospital and treated for head, neck, shoulder and ankle injuries, which resulted from the incident. In addition, the three coworkers sustained back sprains, which resulted from lifting the heavy form.
Keywords: concrete form work, head, shoulder, pinned, neck, concrete, sprain, ankle, scaffold, unstable load
End Use Proj Type Proj Cost Stories NonBldgHt Fatality
Other building New project or new addition $20,000,000 and over
Employee # Inspection Age Sex Degree Nature Occupation Construction
1 315974121 Hospitalized injury Bruise/Contus/Abras Carpenters FallDist:
FallHt:
Cause: Forming
FatCause: Collapse of structure
2 315974121 Non Hospitalized injury Strain/Sprain Construction laborers FallDist:
FallHt:
Cause: Forming
FatCause: Lifting operations
3 315974121 Non Hospitalized injury Strain/Sprain Construction laborers FallDist:
FallHt:
Cause: Forming
FatCause: Lifting operations
4 315974121 Non Hospitalized injury Strain/Sprain Construction laborers FallDist:
FallHt:
Cause: Forming
FatCause: Lifting operations

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