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Scaffolding Accident

Like Ladders and JLG's, Scaffolding (or Staging) is used quite often to reach high places in the Industrial field. When working on scaffolding one must be extremely cautious in order to prevent serious injury and death.

If you have suffered an injury due to a scaffolding accident you may be entitled to compensation. For a free evaluation of your accident fill out the "Scaffolding Accident Form" provided below. Upon reviewing your information a personal injury attorney may contact you for more information.

Free Scaffolding Accidents Consultation

Title:
First Name:	*
Middle Name:
Last Name:	*
Home Phone:	*
Cell Phone:
Work Phone:
Email Address:
Address:	*
City:	*
State, Zip:	* *
What is the best way to reach you? Please provide the best place, time and method for contacting you.

Injured Person Information:

Date of Birth / Age: (ex. mm/dd/yyyy or 54)
Were you injured?	Yes No
If not, who are you inquiring on behalf of?

If you are NOT inquiring on your own behalf,
what is your relationship to the injured person?

Is the person deceased?

Yes No

If deceased, what is the cause of death
as stated on the death certificate:

Date of Death: (ex. mm/dd/yyyy)
Was an autopsy performed?	Yes No
If not deceased, does the injury prevent you or the victim from working?	Yes No

If yes, when did you/victim stop working?
What is the approximate lost wages due to the injury?

Accident / Injury Information:

Date of Accident:	*
City where accident occured:	*
State where accident occured:	*
Occupation:

Name and Address of employer:

Describe Construction Site related injury:

Case Description*
Please explain exactly what happened, trying to state
as thoroughly as possible who you believe was responsible
and why you believe that person was negligent:

Please explain the full extent of the victims injuries:

Comments / Additional Information
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understanding the facts of your case?

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I understand that by filling out this free consultation form I am not forming an attorney client relationship. I understand that I may only retain an attorney by entering into a fee agreement and that by submitting this form I am not entering into a fee agreement. I understand that not all submissions may receive a response.
Yes No

I agree that the above does not constitute a request for legal advice. I agree that any information that I will receive in response to the above question is general information and I will not be charged for the response to this e-mail question. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. I agree that if this matter requires advice regarding my home state, local counsel may be contacted for referral of this matter. I understand that email is not secure and thus I am not forming a confidential relationship.
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Industrial-Accidents.info is a free service sponsored by:
Attorney Richard Callahan of Personal Injury Attorney.com
For a free legal consultation, fill out our free consultation form or call us toll free: (866) 529-8373

Industrial-Accidents.info is sponsored by:
Attorney Richard Callahan
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2 Pierro Terrace
Swampscott, MA 01907
Toll free: (866) 529-8373