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Inspection Detail
Inspection: 1164964.015 - Duo Form Acquisition Corp.
Inspection Information - Office: Miosha General Industry Safety & Health Division
Site Address:
Duo Form Acquisition Corp.
69836 Kraus Rd
Edwardsburg, MI 49112
Mailing Address:
69836 Kraus Rd, Edwardsburg, MI 49112
Union Status: NonUnion
SIC:
NAICS: 325211/Plastics Material and Resin Manufacturing
Inspection Type: Fat/Cat
Scope: Partial
Advanced Notice: N
Ownership: Private
Safety/Health: Safety
Close Conference: 10/05/2016
Emphasis:
Case Closed: 03/22/2017
| Type | Activity Nr | Safety | Health |
|---|---|---|---|
| Accident | 1117836 | ||
| Inspection | 1009199 | Yes |
| Violations/Penalties | Serious | Willful | Repeat | Other | Unclass | Total |
|---|---|---|---|---|---|---|
| Initial Violations | 3 | 3 | ||||
| Current Violations | 3 | 3 | ||||
| Initial Penalty | $14,700 | $0 | $0 | $0 | $0 | $14,700 |
| Current Penalty | $14,700 | $0 | $0 | $0 | $0 | $14,700 |
| FTA Penalty | $0 | $0 | $0 | $0 | $0 | $0 |
| # | Citation ID | Citaton Type | Standard Cited | Issuance Date | Abatement Due Date | Current Penalty | Initial Penalty | FTA Penalty | Contest | Latest Event | Note |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. | 01001 | Serious | 408.16211(1) | 10/21/2016 | 11/29/2016 | $4,900 | $4,900 | $0 | I - Informal Settlement | ||
| 2. | 01002 | Serious | 408.16227(2) | 10/21/2016 | 11/29/2016 | $4,900 | $4,900 | $0 | I - Informal Settlement | ||
| 3. | 01003 | Serious | 408.16236(1) | 10/21/2016 | 11/29/2016 | $4,900 | $4,900 | $0 | I - Informal Settlement |
Investigation Summary
At 3:00 p.m. on July 27, 2016, an employee opened gated a area while a machine was in full operation to inspect the parts that came off the #6 rotary device. He stepped up on the bottom platen and his head and neck was caught between the rotary device and part of the platen frame work when the system cycled. The employee's head and neck were crushed and he was killed.
Keywords: Crushed, Head, Lockout/Tagout, Neck, Rotating Parts
| # | Inspection | Age | Sex | Degree of Injury | Nature of Injury | Occupation |
|---|---|---|---|---|---|---|
| 1 | 1164964.015 | 32 | M | Fatality | Quality Assurance Inspector |