Injury Line: Champagne Webber, Inc
| Inspection Nr | 107556219 |
| Investigation Nr | 14398705 |
| Line Nr | 2 |
| Age | |
| Sex |   |
| Nature of Injury | Cut/Laceration |
| Part of Body | Chest |
| Source of Injury | Dirt/Sand/Stone |
| Event Type | Struck By |
| Environmental Factor | Catch Point/Puncture Action |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Construction trades, n.e.c. |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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