Injury Line: Mountain States Construction Co
| Inspection Nr | 303363576 |
| Investigation Nr | 171038953 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Electric Shock |
| Part of Body | Bodysystem |
| Source of Injury | Hoisting Apparatus |
| Event Type | Shock |
| Environmental Factor | Other |
| Human Factor | Insuff/Lack/Writn Wrk Prac Prog. |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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