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| Inspection Nr | 119835056 |
| Investigation Nr | 170183529 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Concussion |
| Part of Body | Head |
| Source of Injury | Drugs/Alcohol |
| Event Type | Fall(Same Level) |
| Environmental Factor | Other |
| Human Factor | Malfunc, Neuromuscular System |
| Occupation | Personal service occupations, n.e.c. |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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