Abstract: On July 23, 2005, Employee #1 was working at a water treatment plant. The plant clean water discharge flume, made of concrete, was 23 inches wide and 29 inches deep. The water flowing in it was four inches deep. There was a 16-inch-high concrete wall along both sides. Employee #1 had apparently been taking a water sample, when he fell face-down into the flume. He was found in that position by a coworker. The coroner's report stated that the cause of death was blunt force injuries of the head and neck secondary to a fall. The cause of the fall could not be determined by an autopsy, but an epileptic seizure is one possibility. In an interview with Employee #1's mother, the CSHO was told that Employee #1 had a history of violent seizures going back to 1986. He had just had his medicine changed, and he had not responded well to the new medicine. The opinion of the CSHO is that Employee #1 had a seizure that resulted in his fall into the flume and that he was not able to get out.