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| Inspection Nr | 815035 |
| Investigation Nr | 14478515 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Concussion |
| Part of Body | Head |
| Source of Injury | Fire/Smoke |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Flammable Liq/Solid Exposure |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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