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| Inspection Nr | 307123091 |
| Investigation Nr | 200040830 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Concussion |
| Part of Body | Head |
| Source of Injury | Chem Liquids/Vapors |
| Event Type | Struck Against |
| Environmental Factor | Gas/Vapor/Mist/Fume/Smoke/Dust |
| Human Factor | Lockout/Tagout Proced Malfunc |
| Occupation | Machinery maintenance occupations |
| Degree of Injury | Non Hospitalized injury |
| Task Assigned | Task regularly assigned |
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