# Fractures and dislocations at WILLIAM H. LANE, INC.
> OSHA SIR `2016042737` · 4/1/2016 · MONTICELLO, NEW YORK
## Severity
- **1 hospitalization**
- **Body part:** Multiple pelvic region locations
- **Nature of injury:** Fractures and dislocations
## Cause
- **Event:** Other fall to lower level 6 to 10 feet
- **Source:** Structural elements, n.e.c.
## Employer
- **Name:** WILLIAM H. LANE, INC.
- **Location:** 261 Joyland Road, MONTICELLO, NEW YORK, 12701
- **NAICS:** 236220
- **Jurisdiction:** 1
## Narrative

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.

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*Source: [OSHA Severe Injury Reports](https://www.osha.gov/severe-injury-reports) · MORVS · CC0 1.0*