Abstract: Employee #1 had been working for his employer for six months as part of a power transmission tower maintenance and construction crew. He was then sent to the Bakersfield, CA, area to gain climbing experience for a towerman rating. The majority of his work was conducted in the southern San Joaquin Valley. It involved a crew of two climbers and a groundsman who inspected towers for housekeeping, footing defects, bent or rusted components, loose bolts, and guy tensions. The crews used all-terrain vehicles to access remote towers, which exposed them to a significant amount of dust. In June, 2006, after five weeks in this position,, Employee #1 developed a cough; in the sixth week, his supervisor restricted him to groundsman duties. The next weekend, he was seen by a physician, who diagnosed walking pneumonia and prescribed medication. Employee #1's condition deteriorated and his cough progressed enough that his supervisor and coworkers became concerned. On returning home, Employee #1 went to the hospital, where he was admitted for pneumonia. He called his lead supervisor on June 23, 2006, and left a message reporting that he was in the hospital. The morning of June 24, the lead supervisor contacted him to confirm hospitalization and was told that Employee #1 had been diagnosed with pneumonia. The lead supervisor visited Employee #1 in the hospital on June 26, and subsequently was informed that Employee #1 had contracted a fungal infection called Valley fever (Coccidioides immitis) while working in the Bakersfield area. Valley fever is a well-known endemic environmental health hazard in Kern County with increasing prevalence. The employer had an effective safety and health program, including hazard awareness training for Valley fever. In addition, employees received in-depth annual safety/health training for hazards to which they might be exposed. Employee #1 had not received this training, although adequate awareness training was documented in a tailboard meeting. The root cause of Employee #1's condition was determined to be misdiagnosis by the medical provider and failure to mitigate the progression of illness. A contributing factor was the fact that Employee #1 was a new employee without accumulated sick leave or the capacity to suffer financial hardship.