Injury Line: Tri State Construction Inc
| Inspection Nr | 124771171 |
| Investigation Nr | 170129878 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Other |
| Part of Body | Head |
| Source of Injury | Motor Vehicle(Indus) |
| Event Type | Caught In Or Between |
| Environmental Factor | Other |
| Human Factor | Insuff/Lack/Writn Wrk Prac Prog. |
| Occupation | Helpers, construction trades |
| Degree of Injury | Fatality |
| Task Assigned | Task not regularly assigned |
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