Injury Line: Mac'S Convenience Stores Llc D/B/A Circle K
| Inspection Nr | 308566694 |
| Investigation Nr | 200271377 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Other |
| Part of Body | Chest |
| Source of Injury | Firearm |
| Event Type | Struck By |
| Environmental Factor | Flying Object Action |
| Human Factor | Insuff/Lack/Engineerng Controls |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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