Inspection Detail

Inspection: 307057562 - Custom Structural, Incorporated

Inspection Information - Office: Milwaukee Area Office

Inspection Nr: 307057562

Report ID: 0523400

Date Opened: 09/13/2004

Site Address:
Custom Structural, Incorporated
N29 W23720 Woodgate Court East
Pewaukee, WI 53072

Mailing Address:
W224 S8502 Industrial Avenue, Big Bend, WI 53103

Union Status: NonUnion

SIC:1791

NAICS: 238120/Structural Steel and Precast Concrete Contractors

Inspection Type: Accident

Scope: Partial

Advanced Notice: N

Ownership: Private

Safety/Health: Safety

Close Conference: 11/02/2004

Planning Guide: Safety-Construction

Emphasis: L:Const, S:Construction Fatalities

Case Closed: 07/07/2005

Related Activity
Type	Activity Nr	Safety	Health
Accident	100121243
Referral	200125755	Yes

Violation Summary
Violations/Penalties	Serious	Willful	Repeat	Other	Unclass	Total
Initial Violations	2					2
Current Violations	1			1		2
Initial Penalty	$3,000	$0	$0	$0	$0	$3,000
Current Penalty	$1,000	$0	$0	$0	$0	$1,000
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	Other	19100178 L04 I	11/08/2004	12/11/2004	$0	$1,500	$0	11/29/2004	F - Formal Settlement
2.	01002	Serious	19260602 A09 II	11/08/2004	12/11/2004	$1,000	$1,500	$0	11/29/2004	F - Formal Settlement

Investigation Summary

Investigation Nr: 200122588

Event: 09/09/2004

Employee Is Run over and Killed by Fork Lift

At approximately 9:30 a.m. on September 9, 2004, Employee #1, an iron worker, was working on a 32,000-square-ft precast building. Employee #1 was bent over cutting rebar when a coworker backed over him with a Terex SS-1048 Turbo rough terrain forklift causing fatal injuries. At the time of the accident the back-up alarm was properly working on the forklift.

Keywords: BACK-UP ALARM, REBAR, CONSTRUCTION, INDUSTRIAL TRUCK, PRECAST, ABRASION, CONCRETE, BACKING UP, CONTUSION, INATTENTION

Investigated Inspection
#	Inspection	Age	Sex	Degree of Injury	Nature of Injury	Occupation
1	307057562			Fatality	Bruise/Contus/Abras	Occupation not reported

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