Injury Line: Green Valley Country Club
| Inspection Nr | 125751032 |
| Investigation Nr | 201484763 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Bruise/Contus/Abras |
| Part of Body | Head |
| Source of Injury | Bodily Motion |
| Event Type | Struck Against |
| Environmental Factor | Materials Handlg Equip./Method |
| Human Factor | Perception Malfunc,Task-Envir. |
| Occupation | Attendants, amusement and recreation facilities |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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