Injury Line: Pacific Retirement Services Inc
| Inspection Nr | 302965009 |
| Investigation Nr | 201620325 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Fracture |
| Part of Body | Arm-Mult |
| Source of Injury | Dirt/Sand/Stone |
| Event Type | Struck By |
| Environmental Factor | Overhead Moving/Falling Obj Ac |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Construction laborers |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task not regularly assigned |
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