Injury Line: Burlingame Industries, Inc., Dba Eagle Roofing Pro
| Inspection Nr | 119953057 |
| Investigation Nr | 201153392 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Other |
| Part of Body | Chest |
| Source of Injury | Machine |
| Event Type | Caught In Or Between |
| Environmental Factor | Pinch Point Action |
| Human Factor | Lockout/Tagout Proced Malfunc |
| Occupation | Miscellaneous material moving equipment operators |
| Degree of Injury | Fatality |
| Task Assigned | Task not regularly assigned |
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