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| Inspection Nr | 304440167 |
| Investigation Nr | 202356556 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Concussion |
| Part of Body | Multiple |
| Source of Injury | Bodily Motion |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Work-Surface/Facil-Layout Cond |
| Human Factor | Safety Devices Removed/Inoper. |
| Occupation | Roofers |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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