Injury Line: South Florida Carpet D/B/A Florida Executive Build
| Inspection Nr | 305504532 |
| Investigation Nr | 200674182 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Concussion |
| Part of Body | Chest |
| Source of Injury | Buildings/Structures |
| Event Type | Struck By |
| 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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