Injury Line: Wagner Brake, Division Of Cooper Industries
| Inspection Nr | 101886976 |
| Investigation Nr | 14423982 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Asphyxia |
| Part of Body | Othbodysys |
| Source of Injury | Dirt/Sand/Stone |
| Event Type | Other |
| Environmental Factor | Overhead Moving/Falling Obj Ac |
| Human Factor | Insuff/Lack/Writn Wrk Prac Prog. |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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