Injury Line: Versa Grade
| Inspection Nr | 1475754.015 |
| Investigation Nr | 130591.015 |
| Line Nr | 1 |
| Age | 58 |
| Sex | M |
| Nature of Injury |   |
| Part of Body |   |
| Source of Injury |   |
| Event Type | Struck Against |
| Environmental Factor |   |
| Human Factor |   |
| Occupation | Construction Laborer |
| Degree of Injury | Fatality |
| Task Assigned | Task not regularly assigned |
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