Inspection Detail

Inspection: 306109737 - Brewer Concrete Flatwork, Inc.

Inspection Information - Office: Madison Area Office

Inspection Nr: 306109737

Report ID: 0523300

Date Opened: 02/18/2004

Site Address:
Brewer Concrete Flatwork, Inc.
1841 20th Avenue (Northern Bay)
Adams, WI 53910

Mailing Address:
N5951 County Road B, Plainfield, WI 54966

Union Status: NonUnion

SIC:1771

NAICS: 238110/Poured Concrete Foundation and Structure Contractors

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 02/18/2004

Emphasis: S:Construction Fatalities

Case Closed: 03/09/2004

Related Activity
Type	Activity Nr	Safety	Health
Accident	100800838

Investigation Summary

Investigation Nr: 200801090

Event: 02/14/2004

Employee killed in fall when bracket punctures head

On February 14, 2004, Employee #1 was performing his regular duties when a strong gust of wind blew over five, 8 ft long by 3 ft wide aluminum concrete forms, each weighing 80 lb, that were standing up in a form basket. As the forms fell, they knocked Employee #1 to the ground. His head struck a wale bracket that was extending out of a 5 gal bucket. The bracket penetrated Employee #1's skull, killing him.

Keywords: HEAD, HIGH WIND, STRUCK AGAINST, CONSTRUCTION, SKULL, FALL, STRUCK BY, OVERTURN, PUNCTURE

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	306109737			Fatality	Puncture	Occupation not reported

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