Injury Line: Coast Door Company Inc
| Inspection Nr | 112128244 |
| Investigation Nr | 170358329 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Electric Shock |
| Part of Body | Arm-Mult |
| Source of Injury | Elec Apparat/Wiring |
| Event Type | Fall(Same Level) |
| Environmental Factor | Materials Handlg Equip./Method |
| Human Factor | Position Inapropriate For Task |
| Occupation | Occupation not reported |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task not regularly assigned |
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