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| Inspection Nr | 120300686 |
| Investigation Nr | 201031465 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Bruise/Contus/Abras |
| Part of Body | Back |
| Source of Injury | Motor Vehicle(Indus) |
| Event Type | Struck Against |
| Environmental Factor | Flying Object Action |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Occupation not reported |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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