Abstract: Some time after 4:00 p.m. on September 23, 1994, Employee #1 was making four 3 ft square cutouts in a flat plywood roof. Three of the cutouts had been sawed and removed; the fourth had been cut but the piece remained in place. The next morning, Employee #1 was found dead on the floor below, haven apparently fallen 11 ft 8 in. through one of the roof holes. A type 16, skill saw with a 7 1/4 in. blade, serial #HC824656, and Employee #1's blue ice chest were on the roof near the cutouts. The autopsy indicated the cause of death as blunt force trauma to the head. Work at the job site had been shut down at 3:30 p.m. on September 23. The employer was unaware that Employee #1, a sheeter who worked on a per piece basis, had been working at the site after work was stopped. The employer was cited for a general violation of T8CCR 1621(a), for not providing fall protection railings on all open sides of the cutouts.