Injury Line: S.W. Jack Drilling Company
| Inspection Nr | 116044900 | 
| Investigation Nr | 14321640 | 
| Line Nr | 1 | 
| Age | |
| Sex |   | 
| Nature of Injury | Fracture | 
| Part of Body | Head | 
| Source of Injury | Materials Handlg Eq. | 
| Event Type | Struck By | 
| Environmental Factor | Overhead Moving/Falling Obj Ac | 
| Human Factor | Mater-Handlg Proced. Inappropr | 
| Occupation | Occupation not reported | 
| Degree of Injury | Fatality | 
| Task Assigned | Task regularly assigned | 
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