Injury Line: J. W. Hill And Son Roofing Co.
| Inspection Nr | 314248733 |
| Investigation Nr | 200925907 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Cut/Laceration |
| Part of Body | Head |
| Source of Injury | Motor Vehicle (Hwy) |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Work-Surface/Facil-Layout Cond |
| Human Factor | Safety Devices Removed/Inoper. |
| Occupation | Roofers |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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