Abstract: Employee #1 and a coworker were retrieving 12 ft long 2 by 6 lumber from the third level for use in constructing an exterior patio deck on the second floor of a residential unit. Employee #1 was on the third level handing down lumber to the coworker on the second level. Employee #1 descended a ladder made of 2 by 4s nailed to studs 14 in. apart. Employee #1 slipped on mud and/or ice on the bottom rung of the makeshift ladder, landing on unsecured 1 in. thick styrofoam insulation. He fell feet-first approximately 12 ft to the first level, landing on a cylindrically-shaped heater and deflecting to the cement floor where he hit the right side of his head, fracturing his skull and causing hemorrhaging. Employee #1 was killed. Causal factors include location of lumber, improper ladder, failure to provide a barrier for unsecured work platform, and ice and or mud on the ladder.