Injury Line: 97540 - Dezurik Inc Dba Dezurik Apco Williamette
| Inspection Nr | 1319864.015 |
| Investigation Nr | 106338.015 |
| Line Nr | 1 |
| Age | 65 |
| Sex | M |
| Nature of Injury |   |
| Part of Body |   |
| Source of Injury |   |
| Event Type | Fall(From Elevation) |
| Environmental Factor |   |
| Human Factor |   |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned |   |
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