Abstract: At approximately 12:57 p.m. on October 15, 2012, Employee #1, a foreman/carpenter, was installing window trim on residential condominiums. He set a ladder to the edge of gutters that were approximately 20 ft above grade. He extended the ladder approximately 3 ft above the gutters to access a narrow roof area below the windows to be trimmed. According Employee #1, he was making his first trip up the ladder, using both hands, to install a screw eye as an anchor point to tie off the ladder. When Employee #1 was approximately 14 ft above grade, the ladder became unstable and fell. A coworker saw Employee #1 hanging onto the gutter momentarily, and then falling to an asphalt surface. He was hospitalized at Stanford Hospital for a fractured ankle, a fractured wrist and other injuries. Document review and employee statements indicate that this was routine employer policy prior to the incident. Employee #1 did not recall what may have caused the ladder to fall. The employer's work practices for safe ladder use, including tie-off, were in place during the inspection of the job site. Employee #1 stated that the intended location for his anchor point did not require him to lean to either side of the ladder. Employee #1 indicated he had inspected the ladder prior to use and that it was not damaged and was placed on a level surface. The superintendent on duty stated that the ladder was inspected after the fall and there was no observable damage.