Injury Line: Jose O. Hernandez
| Inspection Nr | 311030357 |
| Investigation Nr | 202498713 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Strain/Sprain |
| Part of Body | Back |
| Source of Injury | Ladder |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Other |
| Human Factor | Misjudgment, Haz. Situation |
| Occupation | Painters, construction and maintenance |
| Degree of Injury | Hospitalized injury |
| Task Assigned | Task regularly assigned |
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