Injury Line: R & R Remodeling & Supply, Inc.
| Inspection Nr | 308721992 |
| Investigation Nr | 202355798 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Strain/Sprain |
| Part of Body | Back |
| Source of Injury | Working Surface |
| Event Type | Struck Against |
| Environmental Factor | Overhead Moving/Falling Obj Ac |
| Human Factor | Safety Devices Removed/Inoper. |
| Occupation | Occupation not reported |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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