Injury Line: Hubert Andrews Jr. Dba Roto-Rooter Sewer Service
| Inspection Nr | 300959459 |
| Investigation Nr | 201270386 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Bruise/Contus/Abras |
| Part of Body | Abdomen |
| Source of Injury | Dirt/Sand/Stone |
| Event Type | Struck Against |
| Environmental Factor | Overhead Moving/Falling Obj Ac |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Laborers, except construction |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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