Injury Line: Mid Valley Roofing & Supply Company Inc
| Inspection Nr | 798447 |
| Investigation Nr | 14543474 |
| Line Nr | |
| Age | |
| Sex |   |
| Nature of Injury | Other |
| Part of Body | Multiple |
| Source of Injury | Working Surface |
| Event Type | Fall(From Elevation) |
| Environmental Factor | Materials Handlg Equip./Method |
| Human Factor | Mater-Handlg Proced. Inappropr |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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