Injury Line: Don Chapin Company
| Inspection Nr | 125583211 |
| Investigation Nr | 170885024 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Fracture |
| Part of Body | Chest |
| Source of Injury | Air Pressure |
| Event Type | Struck By |
| Environmental Factor | Flying Object Action |
| Human Factor | Mater-Handlg Proced. Inappropr |
| Occupation | Supervisors, n.e.c. |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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