Abstract: On April 7, 2014, Employee #1, a carpenter, and Coworkers #1 and #2, employed by Apartments Downtown, Inc., were installing equipment at a commercial building. Employee #1 was working with one leg and hip on an approximately 25-degree sloped metal awning. His other leg was standing on a Werner D-116-2 Type III aluminum extension ladder that was leaned against the sloped metal awning on the building's facade. The bottom edge of the awning was approximately 11 feet above a concrete sidewalk and projected out from the structure approximately 4 feet. The sidewalk where the ladder's feet were placed sloped downward to the right (when viewed facing the building) approximately .5-inch to .625-inch per foot. Employee #1 was boring two penetrations into the wall of the structure using a Milwaukee #0234 1.5-inch chuck pistol grip drill and a 4.25-inch hole saw bit. The wall penetrations were approximately 13 feet above the sidewalk. Coworkers #1 and #2 were assisting, with Coworker #1 holding the ladder. The hole saw became bound up, and the drill kicked back, throwing Employee #1 off balance. Employee #1 dropped the drill. Coworkers #1 and #2 may have backed away to avoid being struck by the falling drill. The ladder slid and tipped over to the right. Employee #1 fell down and toward the left, a fall height of 12 feet, and struck his head on the concrete sidewalk. Emergency services were called, and the Iowa City Police Department and Fire Department responded and also the Johnson County Ambulance Service. Employee #1 was transported to University of Iowa Hospital, admitted, and treated for a fractured skull and other injuries. He died on April 18, 2014. This work-related fatality was investigated by Iowa OSHA. The investigator determined that no personal fall arrest or restraint system was in place when Employee #1 fell. When the ladder was examined, its rails were bent to the side several feet up from the bottom. No blocking or ladder leveler devices had been used to compensate for the sloping surface on which the ladder had been placed. No side handle had been used with the drill.