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| Inspection Nr | 306121401 |
| Investigation Nr | 201041324 |
| Line Nr | 3 |
| Age | |
| Sex | |
| Nature of Injury | |
| Part of Body | |
| Source of Injury | |
| Event Type | |
| Environmental Factor | |
| Human Factor | |
| Occupation | Occupation not reported |
| Degree of Injury | |
| Task Assigned |
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