Injury Line: Duane Smelser Roofing Co
| Inspection Nr | 127030187 |
| Investigation Nr | 201404753 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Bruise/Contus/Abras |
| Part of Body | Back |
| Source of Injury | Bodily Motion |
| Event Type | Struck Against |
| Environmental Factor | Materials Handlg Equip./Method |
| Human Factor | Defective Equipment In Use |
| Occupation | Construction laborers |
| Degree of Injury | Non Hospitalized injury |
| Task Assigned | Task regularly assigned |
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