Injury Line: Ad-Out, Dba Perry Cook Signs
| Inspection Nr | 303903652 |
| Investigation Nr | 200920452 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Electric Shock |
| Part of Body | Multiple |
| Source of Injury | Elec Apparat/Wiring |
| Event Type | Other |
| Environmental Factor | Work-Surface/Facil-Layout Cond |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Laborers, except construction |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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