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| Inspection Nr | 124005125 |
| Investigation Nr | 170390066 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Concussion |
| Part of Body | Bodysystem |
| Source of Injury | Buildings/Structures |
| Event Type | Struck By |
| Environmental Factor | Weather, Earthquake, Etc. |
| Human Factor | Other |
| Occupation | Supervisors; distrib., sched'g & adjusting clerks |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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