Ronald Silver II, the Department of Public Works employee who died on his trash collection route last summer from a heat-related illness, had been sick for at least two days prior, according to a new report from the Baltimore inspector general’s office.

The report, the latest in a series from Inspector General Isabel Mercedes Cumming into the work conditions and lack of safety protocol for city trash collectors, gives the greatest detail yet into the events leading to Silver’s death.

It also lays bare the fear sanitation workers have over their job safety, with Silver expressing to his coworker a fear of being disciplined if he missed another day of work or left his shift early for feeling ill.

Throughout the day, Silver and another coworker complained of exhaustion and blurred vision, but management was not notified.

In response, all Department of Public Works employees in the solid waste division are undergoing mandatory training where they are instructed to call 911 anytime an employee is showing signs of illness.

“Mr. Silver’s passing is a stark reminder of the critical role safety must play in our daily operations, and it has fueled our resolve to build a stronger, more accountable safety culture within DPW,” Khalil Zaied, the public works director, wrote in response to the report.

An attorney representing Silver’s family did not immediately return a request for comment Tuesday.

Silver died on Aug. 2. Two days earlier, on July 31, he left his shift feeling ill, according to the report. The temperature that day had reached 95 degrees and the crew Silver worked on started their route later than usual, meaning their work was done during the heat of the day. A supervisor directed Silver to stay home and “hydrate himself” on Aug. 1 after he was late to the sanitation yard from which the trucks leave, according to the inspector general’s report.

He returned to work on Aug. 2, meeting the trash truck on the route, which is common for some employees, according to the report.

A fellow crew member, Travis Christian, told the inspector general’s office that Silver first began feeling ill around 11 a.m. and reported trouble walking. Christian said he told Silver to rest in the truck, but Silver was worried the driver would report him to management, according to the report.

Both men experienced blurred vision and felt exhausted throughout their shift, Christian said.

The temperature that day reached 100 degrees.

Both men drank water throughout their shift, with the trash truck driver telling the inspector general’s office that he observed Silver drinking water every five minutes or so. The report does not name the driver.

After the crew broke for lunch, Silver did sit out some of the shift in the cab of the truck, complaining of a right leg cramp, according to the report.

On the crew’s last stops of the day, an alley in the Barclay neighborhood, Silver fell to the ground. Christian told investigators he heard Silver yelling and came around the other side of the truck and saw Silver lying face down. He flipped Silver over and saw scrapes on his hands and elbows. Silver was going in and out of consciousness, the report said. This was around 3:50 p.m.

Christian was able to lift Silver into the truck’s cab, where Silver nodded at him, according to the report. Christian took that as meaning Silver was OK, and then Christian told the driver that he was “done” and would walk home.

Christian told the inspector general’s office he later collapsed and experienced vomiting and nosebleeds for days afterwards.

At no point in this first instance of Silver collapsing did the driver, who is considered the leader of a trash crew, call a supervisor or report either employee’s illness.

The driver told Silver he would take him to his car, which was parked in the 2000 block of Guilford Avenue.

Silver got out of the truck and then starting experiencing another episode. Disoriented and distressed, Silver knocked on the door of a house, according to the report. Someone answered the door and went to get Silver water and when they came back outside, around 4:10 p.m., Silver was on the ground.

The resident, also unnamed in the report, poured water over Silver at his request. They tried calling 911 but the line was busy. The truck driver, standing nearby, was on the phone with a supervisor at the facility.

The resident called 911 again, and this time was able to get through to an operator. A different neighbor, according to the report, noticed Silver was not breathing. The resident who originally answered the door for Silver begain performing CPR at the 911 operator’s instructions.

Paramedics arrived by 4:21 p.m., according to the report, or within minutes of the resident getting through to an operator. The driver apparently told the resident that Silver was “smoking blunts” throughout the day and that he thought Silver had been faking his earlier leg pain in an attempt to get out of working.

However, in interviews with the inspector general’s office, both the driver and Christian, the other worker, said no one was using any drugs.

Paramedics took Silver to a hospital, where he was pronounced dead at about 5 p.m., according to the report.

Earlier this month the state’s workplace safety agency cited the city and DPW for routinely exposing employees to dangerous heat and humidity on the job. Cumming’s office has found conditions have improved at DPW since Silver’s death.