Injury Line: William D. Hillen A Corp
| Inspection Nr | 302067509 |
| Investigation Nr | 201570231 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Concussion |
| Part of Body | Head |
| Source of Injury | Motor Vehicle(Indus) |
| Event Type | Struck Against |
| Environmental Factor | Work-Surface/Facil-Layout Cond |
| Human Factor | Perception Malfunc,Task-Envir. |
| Occupation | Machinery maintenance occupations |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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