Abstract: At 8:45 a.m. on July 20, 2018, Employee #1 was made aware of a water-damaged ceiling tile located in the TV room, approximately 9 foot 10 inches off the floor. Employee #1, with assistance from a coworker, proceeded to replace the ceiling tile. They retrieved a 6 foot Keller A-frame ladder from the maintenance closet. Employee #1 ascended the ladder, up to the third rung, while his coworker held the ladder in place. The employee attempted to remove a piece of the damaged ceiling tile that had become wedged. As he tried to hand the ceiling tile to the coworker, the employee leaned too far back and lost his balance. Employee #1 struck the wall, the A-frame ladder slipped out, and he fell to the floor. Employee #1 was hospitalized with a broken right ankle.