Injury Line: Mark Godfrey Sr Individual Dba United Iron Works
| Inspection Nr | 119918803 |
| Investigation Nr | 170627400 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Electric Shock |
| Part of Body | Bodysystem |
| Source of Injury | Hoisting Apparatus |
| Event Type | Shock |
| Environmental Factor | Materials Handlg Equip./Method |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Construction laborers |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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