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| Inspection Nr | 103378832 |
| Investigation Nr | 837690 |
| Line Nr | 4 |
| Age | |
| Sex | |
| Nature of Injury | Concussion |
| Part of Body | Chest |
| Source of Injury | Fire/Smoke |
| Event Type | Struck By |
| Environmental Factor | Other |
| Human Factor | Malfunc In Securing/Warning Op |
| Occupation | Carpenter apprentices |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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