Fort Wayne, IN —
OSHA Injury Report: 021-00410
Injury · Other recordable case
At a glance
On , an injury at 021-00410 in Fort Wayne, IN 46809 resulted in other recordable case. Employee was sTORE NIGHT CLERK in supermarkets and Other Grocery Except Convenience Stores.
Where did this happen?
- Establishment
- 021-00410
- Parent company
- Kroger Central KMA
- Street
- 7008 Bluffton Rd
- City
- Fort Wayne
- State
- IN
- ZIP
- 46809
- On-site location
- GROCERY FREEZER
What was the outcome?
- Outcome
- Other recordable case (code 4)
- Type
- Injury (code 1)
Before the incident
PULLING PALLET
What happened
EE was moving pallet into freezer and he slipped on thin ice and fell EE sustained a laceration to left elbow and pain to head neck and shoulder
Injury or illness
Strained Left Elbow Fall on ice snow ICEY SLIPPERY FLOOR
Object or substance involved
ICEY SLIPPERY FLOOR
Summary line
Strained Left Elbow Fall on ice snow ICEY SLIPPERY FLOOR
Employee and industry
- Job description
- STORE NIGHT CLERK
- SOC code
- 53-7065 — Stockers and Order Fillers
- NAICS code
- 445110 — Supermarkets and Other Grocery Except Convenience Stores
- NAICS vintage
- 2012
- Avg employees
- 107
- Total hours worked
- 145634
- EIN
- 311569568
- Establishment ID
- 963662
- Employer case #
- 872854
When (timing detail)
- Date of incident
- Shift started
- 22:30
- Time of incident
- 2:00
- Filing year
- 2024
- Submitted
- 25FEB2025:19:46:00
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.