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| Inspection Nr | 310822820 |
| Investigation Nr | 201089521 |
| Line Nr | |
| Age | |
| Sex | |
| Nature of Injury | Concussion |
| Part of Body | Head |
| Source of Injury | Bodily Motion |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Work-Surface/Facil-Layout Cond |
| Human Factor | Malfunc In Securing/Warning Op |
| Occupation | Painters, construction and maintenance |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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