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| Inspection Nr | 109692525 |
| Investigation Nr | 924704 |
| Line Nr | 4 |
| Age | |
| Sex | |
| Nature of Injury | Cut/Laceration |
| Part of Body | Head |
| Source of Injury | Fire/Smoke |
| Event Type | Struck By |
| Environmental Factor | Flying Object Action |
| Human Factor | Insuf/Lack/Protcv Wrk Clthg/Equip |
| Occupation | Occupation not reported |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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