Injury Line: Roman Asphalt, Inc.
| Inspection Nr | 303880223 |
| Investigation Nr | 200022069 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Fracture |
| Part of Body | Head |
| Source of Injury | Machine |
| Event Type | Struck By |
| Environmental Factor | Flying Object Action |
| Human Factor | Mater-Handlg Proced. Inappropr |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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