Abstract: On August 20, 2009, Employee #1 and a coworker were painting inside a hospital when it was determined that they needed an extension ladder. Employee #1 went out to his van and pulled out a 4-foot step ladder. Employee #1 indicated that he did not remember any of the events of the incident. The coworker said that he saw Employee #1 ascend his step ladder but then walked away to complete his own work when he heard a noise. He turned around and saw Employee #1 on the floor. The step ladder had tipped to the side and was leaning against the van. He ran over and saw that Employee #1 was injured. The coworker helped him inside to receive treatment at the hospital where they were painting. Employee #1 underwent surgery for a fractured left wrist and was then released the following day. Employee #1 was a permanent, full-time employee of the employer with no other contracts. In the absence of an applicable standard, no accident related citations were issued. This incident was not reported to DOSH by the employer; however, it was reported by Employee #1's attorney on March 10, 2010. The employer is involved in painting and wall coverings for residential and commercial buildings.