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| Inspection Nr | 103271789 |
| Investigation Nr | 677021 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Fracture |
| Part of Body | Shoulder |
| Source of Injury | Motor Vehicle (Hwy) |
| Event Type | Struck By |
| Environmental Factor | Materials Handlg Equip./Method |
| Human Factor | Malfunc In Securing/Warning Op |
| Occupation | Occupation not reported |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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