Abstract: At 9:20 a.m. on June 7, 2020, an employee was working for a firm that manufactured fabricated structural metal. He was climbing a ladder to unhook a skid/mast, which is piece of oilfield equipment, from a chain. The ladder was 10 feet (3.1 meters) tall, and the hook was at the top of the ladder. The ladder was not tied down. The employee was not wearing a safety harness. The ladder slipped, and the employee fell off the ladder. He landed on the ground. The firm's owner and project manager arrived onsite to assist the employee. He called emergency medical services (EMS), which took the employee to the hospital. The employee suffered fractures of several vertebrae in his back and neck and of his clavicle. He was hospitalized. The firm's office manager made an online referral to OSHA on June 19, 2020. In the referral, she stated that she did not know she was supposed to notify OSHA within 24 hours of the hospitalization. The employer did not notify OSHA of the hospitalization within the required time.