Injury Line: John R. Jurgensen Co.
| Inspection Nr | 1700877.015 |
| Investigation Nr | 160440.015 |
| Line Nr | 1 |
| Age | 25 |
| Sex | M |
| Nature of Injury |   |
| Part of Body |   |
| Source of Injury |   |
| Event Type | Struck Against |
| Environmental Factor |   |
| Human Factor |   |
| Occupation |   |
| Degree of Injury | Fatality |
| Task Assigned |   |
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