Injury Line: Loftin Business Forms
| Inspection Nr | 119995249 |
| Investigation Nr | 170159792 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Fracture |
| Part of Body | Wrist(S) |
| Source of Injury | Motor Vehicle(Indus) |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Materials Handlg Equip./Method |
| Human Factor | Other |
| Occupation | Truck drivers, light |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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