Injury Line: Smith-Rowe, Inc.
| Inspection Nr | 126606888 |
| Investigation Nr | 954404 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Concussion |
| Part of Body | Head |
| Source of Injury | Dirt/Sand/Stone |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Work-Surface/Facil-Layout Cond |
| Human Factor | Safety Devices Removed/Inoper. |
| Occupation | Construction trades, n.e.c. |
| Degree of Injury | Non Hospitalized injury |
| Task Assigned | Task regularly assigned |
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