Injury Line: S.S. Smith & Sons Masonry Inc.
| Inspection Nr | 302097795 |
| Investigation Nr | 200210300 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Concussion |
| Part of Body | Head |
| Source of Injury | Buildings/Structures |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Temperature +/- Tolerance Lev. |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Construction laborers |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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