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Inspection Detail

Inspection: 311369821 - Adjustable Forms, Inc.

Inspection Information - Office: Chicago South Area Office

 

Inspection Nr: 311369821
Report ID: 0521700
Date Opened: 11/21/2007

Site Address:
Adjustable Forms, Inc.
111 W. Wacker Dr.
Chicago, IL 60601

Mailing Address:
1 East Progress Rd., Lombard, IL 60147

Union Status: Union

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: 12/18/2007

Planning Guide: Safety-Construction

Emphasis: L:Fall, L:Hirise, S:Commercial Constr, S:Fall From Height

Case Closed: 01/03/2008


Related Activity
Type Activity Nr Safety Health
Accident 100033778

Investigation Summary

Investigation Nr: 200033108
Event: 11/21/2007
Employee killed in fall down elevator shaft

At approximately 10:00 a.m. on November 21, 2007, Employee #1, a carpenter with Adjustable Forms, Inc., was part of a three-man crew raising an elevator shaft cover from the 10th floor to the 12th floor. A coworker on the 10th floor tied a rope to the shaft cover and pried the cover loose, preparing it to be raised. The coworker on the 13th floor told Employee #1 to wait until he came down to help pull the cover up. Apparently Employee #1 started to pull the cover up by himself because the coworker on the 10th floor later stated that the cover began to rise. Once the full weight of the cover came off the 10th floor, it began to fall. Employee #1 was pulled through the guardrail system and briefly held onto the rope, but eventually fell through the shaft opening. He crashed through the permanent cover on the first floor and landed in the elevator pit, approximately four stories below ground level. Employee #1 was killed.

Keywords: COVER, GUARDRAIL, CARPENTER, WORK RULES, CONSTRUCTION, FALL, FALL PROTECTION, FLOOR OPENING, ELEVATOR SHAFT

Investigated Inspection
# Inspection Age Sex Degree of Injury Nature of Injury Occupation
1 311369821 Fatality Other Occupation not reported
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