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| Inspection Nr | 124736240 |
| Investigation Nr | 170709026 |
| Line Nr | 3 |
| Age | |
| Sex | |
| Nature of Injury | Other |
| Part of Body | Head |
| Source of Injury | Materials Handlg Eq. |
| Event Type | Struck By |
| Environmental Factor | Overhead Moving/Falling Obj Ac |
| Human Factor | Mater-Handlg Proced. Inappropr |
| Occupation | Waiters and waitresses |
| Degree of Injury | Fatality |
| Task Assigned | Task not regularly assigned |
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