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| Inspection Nr | 120020425 |
| Investigation Nr | 170204036 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Dislocation |
| Part of Body | Shoulder |
| Source of Injury | Working Surface |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Work-Surface/Facil-Layout Cond |
| Human Factor | Malfunc In Securing/Warning Op |
| Occupation | Concrete and terrazzo finishers |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task not regularly assigned |
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