Inspection Detail

Inspection: 126066943 - Sure Forming System

Inspection Information - Office: Long Beach District Office

Inspection Nr: 126066943

Report ID: 0950635

Date Opened: 12/07/1999

Site Address:
Sure Forming System
24501 South Figueroa Street
Carson, CA 90745

Mailing Address:
10602 Humblolt St, Los Alamitos, CA 90720

Union Status: Union

SIC:1771

NAICS: 0

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 02/04/2000

Emphasis:

Case Closed: 08/17/2004

Related Activity
Type	Activity Nr	Safety	Health
Accident	362400749

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations	2					2
Current Violations				1		1
Initial Penalty	$10,000	$0	$0	$0	$0	$10,000
Current Penalty	$0	$0	$0	$500	$0	$500
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	1548 A	02/08/2000	02/28/2000	$0	$5,000	$0	03/29/2000	J - ALJ Decision	Citation has been deleted.
2.	02001	Other	1670 A	02/08/2000	02/28/2000	$500	$5,000	$0	03/29/2000	J - ALJ Decision

Investigation Summary

Investigation Nr: 201032752

Event: 11/18/1999

Employee injures head in fall from concrete form

At approximately 1:30 p.m. on November 18, 1999, Employee #1, a carpenter, was hanging a plumb bob on a concrete form high above the ground. His hands slipped and he fell about 12 ft, landing in a concrete hopper. Employee #1 suffered a contusion on his head and was transported by Los Angeles County paramedics to Harbor General Hospital, where he remained for five days. As his release, he was treated as an outpatient and underwent therapy.

Keywords: CONCRETE FORM WORK, HEAD, CARPENTER, WORK RULES, SLIP, CONSTRUCTION, CLIMBING ON COLUMN, FALL, FALL PROTECTION, CONTUSION

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	126066943			Hospitalized injury	Bruise/Contus/Abras	Carpenters

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