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| Inspection Nr | 111919940 |
| Investigation Nr | 170196570 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Fracture |
| Part of Body | Back |
| Source of Injury | Dirt/Sand/Stone |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Materials Handlg Equip./Method |
| Human Factor | Safety Devices Removed/Inoper. |
| Occupation | Management related occupations, n.e.c. |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task not regularly assigned |
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