Injury Line: Keith Black Roofing Inc
| Inspection Nr | 115649881 |
| Investigation Nr | 170053896 |
| Line Nr | 3 |
| Age | |
| Sex |   |
| Nature of Injury | Puncture |
| Part of Body | Back |
| Source of Injury | Buildings/Structures |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Work-Surface/Facil-Layout Cond |
| Human Factor | Malfunc In Securing/Warning Op |
| Occupation | Roofers |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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