Inspection Detail

Inspection: 111979027 - Concrete Form Constructors

Inspection Information - Office: Santa Ana District Office

Inspection Nr: 111979027

Report ID: 0950631

Date Opened: 08/30/1991

Site Address:
Concrete Form Constructors
1621 S. Douglas Rd
Anaheim, CA 92806

Mailing Address:
2855 Campus Dr., Suite 215, San Mateo, CA 94403

Union Status: Union

SIC:1541

NAICS: 0

Inspection Type: Accident

Scope: Complete

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 09/03/1991

Emphasis:

Case Closed: 12/20/1991

Related Activity
Type	Activity Nr	Safety	Health
Accident	361341068

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations	2					2
Current Violations
Initial Penalty	$4,000	$0	$0	$0	$0	$4,000
Current Penalty	$0	$0	$0	$0	$0	$0
FTA Penalty	$0	$0	$0	$0	$0	$0

Violation Items
#	Citation ID	Citaton Type	Standard Cited	Issuance Date	Abatement Due Date	Current Penalty	Initial Penalty	FTA Penalty	Contest	Latest Event	Note
1.	01001	Serious	1670 C	09/11/1991	08/30/1991	$2,000	$2,000	$0		2 - Appeals Court	Citation has been deleted.
2.	02001	Serious	1670 C	08/30/1991	08/30/1991	$2,000	$2,000	$0	09/01/1991	2 - Appeals Court	Citation has been deleted.

Investigation Summary

Investigation Nr: 170165021

Event: 08/27/1991

Employee sustains compound fracture of right arm in fall

At approximately 1:30 p.m. on August 27, 1991, Employee #1 was working on a concrete form approximately 20 to 24 feet above the ground. The employee looped the ring portion of his lanyard over a piece of vertical rebar instead of securely attaching the lanyard to a substantial part of the structure or form. The lanyard became dislodged while he moved around and he fell to the ground. The employee was transported to the hospital for treatment of a compound fracture of his right arm. He remained in the hospital for further surgery on the arm.

Keywords: CONCRETE FORM WORK, FRACTURE, WORK RULES, CONSTRUCTION, FALL, ARM, TIE-OFF

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	111979027			Hospitalized injury	Fracture	Occupation not reported

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