Injury Line: Shop-Rite Carpet, Inc.
| Inspection Nr | 111765079 |
| Investigation Nr | 170169338 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Concussion |
| Part of Body | Head |
| Source of Injury | Furniture/Furnishing |
| Event Type | Struck By |
| Environmental Factor | Overhead Moving/Falling Obj Ac |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Stock and inventory clerks |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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