Scaffolds — Case Study PDF Version

Versión en español

Robin Baker, Robert Downey, Mary Ruth Gross, Charles Reiter
Labor Occupational Health Program (LOHP) School of Public Health,
University of California, Berkeley Ca.

These case studies are part of tailgate/toolbox talks that were developed for use under California OSHA regulations. The American Conference of Government Industrial Hygienists (ACGIH) has adapted these talks to apply to federal OSHA regulations.) To contact ACGIH, visit its website (

One Killed, Three Injured in Scaffold Accident

A 29-year-old hod carrier died and three co-workers were injured when they fell from the fourth story of a pump house building that was under construction at a reservoir.

The hod carrier and others had been spraying fireproof insulation onto the structural steel frame of the building. They used a rolling tower scaffold to gain access to the structural steel overhead.

Putlogs (types of trusses) had been added to the sides of the rolling tower scaffold, and an extension platform had been built there. This platform was used to reach the outer side of the structural steel.

On this day, a supervisor said a guardrail was needed on the scaffold. The hod carrier joined three coworkers on the extension platform to help install the guardrail. Their combined weight caused the scaffold to tip. They were all thrown to the concrete deck 44 feet below.

The scaffold had not been engineered for the extension platform. No counterweights, anchorage, or bracing were used. Neither the hod carrier nor his coworkers were wearing personal fall protection. The scaffold and platform had been constructed using parts from different manufacturers.

December 8, 1998

What should have been done to prevent this accident?

Preventive Measures

Cal/OSHA investigated this accident and made the following recommendations.

Employers should:

  • Ensure that scaffolds are assembled according to the manufacturer’s recommendations. If locally built, they must be properly designed and engineered.
  • Ensure that no extensions or auxiliary parts are added to scaffolds unless designed and approved by an engineer.
  • Ensure that workers follow safe work practices when constructing scaffolds.
  • Ensure that scaffold load limits given by the manufacturer or engineer are not exceeded.

This Case Study is based on an actual California incident. For
details, refer to California Dept. of Health Services, Occupational
Health Branch, Fatality Assessment and Control Evaluation
(FACE) Report #98CA017.

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