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
reattaching cord to recliner resident bedside table was being moved by another staff member water was spilled and fan from resident table came down on employee 's back. Staff stated fan hit right lower back.
What happened
reattaching cord to recliner resident bedside table was being moved by another staff member water was spilled and fan from resident table came down on employee 's back.
Injury or illness
Contusion
Object or substance involved
Falling Flying Object All Other
Summary line
reattaching cord to recliner resident bedside table was being moved by another staff member water was spilled and fan from resident table came down on employee 's back. Staff stated fan hit right lower back.
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 #
- WC177052
When (timing detail)
- Date of incident
- Shift started
- 14:00
- Time of incident
- 16:00
- 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.