Injury Line: Cook Forms
| Inspection Nr | 111265989 |
| Investigation Nr | 170250849 |
| Line Nr | 2 |
| Age | |
| Sex |   |
| Nature of Injury | Fracture |
| Part of Body | Hip(S) |
| Source of Injury | Buildings/Structures |
| Event Type | Caught In Or Between |
| Environmental Factor | Work-Surface/Facil-Layout Cond |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Occupation not reported |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task not regularly assigned |
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