Abstract: At approximately 10:40 a.m. on April 29, 2013, Employee #1, of City of San Diego Fire Rescue Department, was performing training activities as a firefighter recruit at a training facility. The employee was participating in a roof sounding and roof ventilation exercise on a two-story structure with a sloped roof. Employee #1 placed a 24-ft metal extension ladder against the side of the building. A coworker was holding the ladder at the bottom while the employee climbed the ladder in full turnout gear, including SCBA turned on. Employee #1 was also carrying a roof hook tool while climbing. When he got near the top of the ladder near the roof's edge he stepped his right foot up onto the roof and began to sound the roof using the roof hook. After sounding the roof the employee attempted to step his left foot up off of the ladder and onto the roof, but misjudged the placement of his left foot causing the employee to lose his balance and fall. Employee #1 fell approximately 20-ft and landed on the concrete ground. Fire Rescue Department emergency medical response was call and the employee was transported to an area hospital, where he was treated for a fracture to his left ankle. Employee #1 remained hospitalized.