Abstract: At approximately 1:30 p.m. on July 13, 2010, an employee was standing on the fourth rung from the top of a 28-ft extension ladder when the ladder kicked back. The employee did not tie, block or secure the ladder in-place prior to climbing up. The employee tried to hold on to the ladder as it slid back and fell on the eaves of the garage then on to the driveway of the residence. The employee struck his head on the ground during the fall and had a brief loss of consciousness. The employee called his supervisor who was at another job site and informed him that he fell off a ladder. The employee's supervisor was at the job site approximately an hour before the incident to drop off some equipment. The 28-ft extension ladder used by the employee was manufactured by Sunset Ladder Company, Los Angeles, Model Number FE1A28 with a maximum working length of 25 feet. The employee's supervisor took him to Concentra Urgent Care, in San Francisco, where he was seen and evaluated by a physician. The employee was released after 2.5 hours. Later that night, the employee complained of a headache and nausea and was taken by his family to Sutter Roseville Medical Center in Roseville, California. In the Emergency Department, a CT scan showed that the employee had a small skull fracture and a small epidural hematoma. The employee was admitted in the Trauma-Neuro Intensive Care Unit at the hospital at approximately 12:30 a.m. on July 14, 2010. The employee was seen by neurosurgery, had serial exams and serial brain CTs. The employee was discharged at approximately 10:50 a.m. on July 15, 2010 and was ordered to have a follow-up CT scan after three weeks. The investigation concluded that the 28-foot extension ladder used by Employee #1 while installing a satellite dish was not tied, blocked, or secured in-place prior to use. The ladder kicked back and slid, and Employee #1 fell to the ground, where he suffered a skull fracture, a cut above his left eye and a right toe sprain.