Injury Line: A Five Star Flags Banners & Flag Pole Company
| Inspection Nr | 106104862 |
| Investigation Nr | 14341754 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Electric Shock |
| Part of Body | Bodysystem |
| Source of Injury | Elec Apparat/Wiring |
| Event Type | Shock |
| Environmental Factor | Weather, Earthquake, Etc. |
| Human Factor | Position Inapropriate For Task |
| Occupation | Laborers, except construction |
| Degree of Injury | Fatality |
| Task Assigned | Task not regularly assigned |
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