Abstract: Employee #1, an apprentice sheet metal worker, and two coworkers were assigned to work on the duct installation of a new rooftop HVAC unit. The crew climbed to the roof using a 17-foot fixed metal ladder in an electrical closet. The distance between the rungs was approximately 12 inches. Employee #1 climbed up to the roof with his crew, left his tool bag, and went down the ladder to pick up the rest of the material. This material included rolls of caulking tape, a propane tanks for the heaters, and a couple of bags of hardware. There was no rope let down to raise materials to the roof, so Employee #1 decided to carry the materials up the ladder in the crook of his left arm, using his right hand to grasp the rungs of the ladder. As he reached for the top rung, he became distracted, and missed the rung. He fell backward, turned his body to the left, and landed on his left side on the concrete floor. He fractured both his left and right elbow and was hospitalized.