Injury Line: Ken Tire Service
| Inspection Nr | 111788378 |
| Investigation Nr | 170173579 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Cut/Laceration |
| Part of Body | Face |
| Source of Injury | Petroleum Products |
| Event Type | Struck By |
| Environmental Factor | Flammable Liq/Solid Exposure |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Occupation not reported |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task not regularly assigned |
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