Incident date: 2016-04-01
NAICS industry code: 236220

An employee was removing whalers of gang form. While positioned on the form, he removed one nut, and the form slid backwards. He was still connected to the form when the form detached from the concrete wall and fell. He fell 8 feet 6 inches with the form to the ground, dislocating his hip and breaking his pelvis. He was hospitalized.

Hazard classification:
code_event: title: Other fall to lower level 6 to 10 feet
code_source: title: Structural elements, n.e.c.
code_nature: title: Fractures and dislocations
code_body: title: Multiple pelvic region locations
severity: moderate