Company Name __________________________ Job Name __________________________ Date________
Dear Sir.
I am responding to your request for additional information regarding how my
recent injury occurred. In block number 3 of your accident report form I put
"trying to do the job alone" as the cause of my accident. You said in
your letter that I should explain more fully. I trust that the following details
will be sufficient.
I am a bricklayer by trade. On the day of the accident I was working alone on
the roof of a new six story building. When I completed my work I discovered that
I had about 500 pounds of bricks left over. Rather than carry the bricks down by
hand, I decided to lower them in a barrel by using a pulley, which fortunately
was attached to the side of the building at the 6th floor.
Securing the rope at the ground level, I went up to the roof, swung the
barrel out, and loaded the bricks into it. Then I went back to the ground and
untied the rope, holding it tightly to ensure a slow descent of the 500 pounds
of bricks. You will note in Block number 2 of the accident report form that my
weight is 135 pounds.
Due to my surprise at being jerked off the ground so suddenly I lost my
presence-of-mind and didn’t let go of the rope. Needless to say, I proceeded at
a rather rapid rate up the side of the building.
In the vicinity of the third floor I met the barrel coming down. This
explains my fractured skull and collarbone.
Slowed only slightly, I continued my rapid ascent, not stopping until the
fingers of my right hand were two knuckles deep into the pulley.
Fortunately, by this time I had regained my presence of mind and was able to
hold tightly to the rope in spite of my pain.
At approximately the same time however, the barrel of bricks hit the ground
and the bottom fell out of the barrel. Devoid of the weight of bricks, the
barrel then weighed approximately 50 lbs.
I refer you again to the information in Block number 2. As you might imagine,
I began a rapid descent down the side of the building.
In the vicinity of the third floor, I met the barrel coming up. This accounts
for the two fractured ankles and the lacerations of my legs and lower body.
The encounter of the barrel slowed me enough to lessen my injuries when I
fell onto the pile of bricks and fortunately, only 3 vertebrae were cracked.
I am sorry to report, however, that as I lay in pain on the bricks, unable to
stand-up, and watching the empty barrel 6 stories above me, I again lost my
presence of mind and let go of the rope. The empty barrel weighed more than the
rope so it came down upon me and broke both of my legs.
I hope I have furnished the additional information you required as to how the
accident occurred.
P.S. We hope he isn’t working on your crew!
Safety Recommendations:________________________________________________________________________________
Job Specific Topics:_____________________________________________________________________________________
M.S.D.S Reviewed:_____________________________________________________________________________________
Attended By:
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