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| Inspection Nr | 310802210 |
| Investigation Nr | 200271880 |
| Line Nr | 1 |
| Age | |
| Sex | |
| Nature of Injury | Electric Shock |
| Part of Body | Upper Arm |
| Source of Injury | Elec Apparat/Wiring |
| Event Type | Shock |
| Environmental Factor | Overhead Moving/Falling Obj Ac |
| Human Factor | Insuf/Lack/Protcv Wrk Clthg/Equip |
| Occupation | Roofers |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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