Abstract: On February 17, 2004, Employees #1 through #7 were taken by ambulance to University Hospital from the granite shop of Kitchens By Rutenschroer, Inc. for treatment of carbon monoxide poisoning. Four factors contributed to the carbon monoxide build up. 1. A fork lift being used in the building had a carburetor out of adjustment which produced very high levels of carbon monoxide. 2. On most days this fork lift is operated ten or fewer minutes out of each hour. On this day it was operated almost continuously for approximately three hours to rearrange and reorganize stock materials. 3. The two entry doors to this workplace were kept closed because of cold outdoor temperatures. 4. The only significant ventilation for this workspace, a large wall fan, was turned off. Even though employees breathed pure oxygen for approximately one hour before their blood sample was drawn, three employees had carboxyhemoglobin levels above 20 ppm. Only Employee #1 is listed as an injured employee. Employees #2 through #7 should also be listed.