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| Inspection Nr | 125520718 |
| Investigation Nr | 201121308 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Bruise/Contus/Abras |
| Part of Body | Face |
| Source of Injury | Buildings/Structures |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Other |
| Human Factor | Defective Equipment In Use |
| Occupation | Misc. metal,plastic,stone&glass-working mach. op's |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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