Fond du Lac, WI —
OSHA Injury Report: Agnesian St. Francis Home
Injury · Other recordable case
At a glance
On , an injury at Agnesian St. Francis Home in Fond du Lac, WI 54935 resulted in other recordable case. Employee was certified Nursing Assistant LTC in nursing Care Facilities Skilled Nursing Facilities.
Where did this happen?
- Establishment
- Agnesian St. Francis Home
- Parent company
- SSM Health
- Street
- 33 Everett Street
- City
- Fond du Lac
- State
- WI
- ZIP
- 54935
- On-site location
- patient room
What was the outcome?
- Outcome
- Other recordable case (code 4)
- Type
- Injury (code 1)
Before the incident
A patient hit me hard enough to break off a tooth that was chipped. Then I went to my nurse on the floor told her and showed her the broken tooth part and the tooth in my hand
What happened
EE was providing patient care in [REDACTED] stand when patient struck EE in mouth chipping tooth
Injury or illness
Fracture
Object or substance involved
Struck by PATIENT
Summary line
A patient hit me hard enough to break off a tooth that was chipped. Then I went to my nurse on the floor told her and showed her the broken tooth part and the tooth in my hand
Employee and industry
- Job description
- Certified Nursing Assistant LTC
- SOC code
- 31-1131 — Nursing Assistants
- NAICS code
- 623110 — Nursing Care Facilities Skilled Nursing Facilities
- NAICS vintage
- 2012
- Avg employees
- 191
- Total hours worked
- 279848
- EIN
- 391029998
- Establishment ID
- 662786
- Employer case #
- WC175751
When (timing detail)
- Date of incident
- Shift started
- 22:06
- Time of incident
- 23:00
- Filing year
- 2024
- Submitted
- 08FEB2025:02:53:00
Source
Data from OSHA ITA Form 300/301 electronic submissions, filing year 2024. ITA Case Detail records are establishment-reported submissions, not OSHA inspections — no per-record IMIS deep link exists.