Abstract: In early January 2020, an employee was working as a supervisor for a firm that manufactured architectural products and cement. At 6:45 p.m. on Thursday, January 2, 2020, he received a message from the day shift supervisor asking him to check every kiln at the facility where he worked, as plates had been dragged out during the day. At 1:45 a.m. on January 3, 2020, the employee was inspecting the gaps between plates of pavers. He thought that the gap between plates was not right, and he climbed the rack to look. Climbing back down, he lost his grip and fell from a height of 8 to 10 feet (2.4 to 3.0 meters). A coworker saw him lying unresponsive on the ground and yelled for help. Another coworker helped lift the employee out of the kiln and move him to the control room. The employee woke up in the control room. The first aid provider came to assist. The first aid provider contacted the site manager, who came to the facility and transported the injured employee to the hospital. The employee had suffered fractures of his left wrist and L1 lumbar vertebra. The latter injury required immediate surgery. The employee was hospitalized for two or more days. Company policy when someone was injured was, first, if the injury was serious enough to warrant emergency care, dial 911 and attempt to stabilize the individual until an ambulance arrived. Then, shut down all equipment at the site and gather all employees at a central location. This is not what occurred. No one called emergency medical services. Several minutes elapsed from the time the employee was found until he arrived at the hospital. It took the coworker who found the employee 10 to 15 minutes to call the first aid provider. It took the first aid provider about 10 minutes from the time he saw the employee until he called the site manager at home. It took the site manager about 15 minutes to drive 12 miles (19 km) to the company facility. It took about 10 minutes to drive the employee 5.4 miles (8.7 km) to the hospital.