Abstract: At 8:00 a.m. on July 28, 2018, Employee #1, employed by a state department of transportation, was engaged in maintenance and clean-up of washout dirt along aa highway when he manifested symptoms of a lung infection. The employee was using heavy equipment (loader and backhoe), shovels, gloves, safety glasses, hard hat, and safety boots. The sites where he regularly worked varied, and his duties included moving dirt and rocks and filling pot holes. The employee was exposed to dust in the air, and it is possible it carried the fungus coccidioides immitis. The employee was hospitalized on July 28, 2018, and diagnosed with pneumonia. He returned to the hospital on September 5, 2018, and was hospitalized for 8 days with a diagnosis of coccidioidomycosis, known as Valley Fever. He returned to the hospital twice for a total of four hospitalizations, each requiring stays of 3 to 8 days. The medical report stated that the employee was reasonably likely, although not certain, to have breathed cocci spores during work activities that exposed him to soil dust in early July 2018. The investigation determined that the employer had not provided or required employees to use respiratory protection when they were involved in outdoor tasks where dust was generated.