Injury Line: Sams Club Store No. 6602
| Inspection Nr | 310855317 |
| Investigation Nr | 201681970 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Other |
| Part of Body | Head |
| Source of Injury | Other |
| Event Type | Card-Vasc/Resp Fail. |
| Environmental Factor | Temperature +/- Tolerance Lev. |
| Human Factor | Malfunc, Neuromuscular System |
| Occupation | Stock and inventory clerks |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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