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| Inspection Nr | 311661417 |
| Investigation Nr | 201763083 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Electric Shock |
| Part of Body | Chest |
| Source of Injury | Elec Apparat/Wiring |
| Event Type | Shock |
| Environmental Factor | Weather, Earthquake, Etc. |
| Human Factor | Defective Equipment In Use |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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