Mesa, AZ —
OSHA Injury Report: 110063 Country Club Store
Injury · Job transfer or restriction
At a glance
On , an injury at 110063 Country Club Store in Mesa, AZ 85210 resulted in job transfer or restriction. Employee was donation Attendant in used Merchandise Retailer.
Where did this happen?
- Establishment
- 110063 Country Club Store
- Parent company
- Goodwill of Central and Northern Arizona
- Street
- 1046 S Country Club Dr
- City
- Mesa
- State
- AZ
- ZIP
- 85210
- On-site location
- backroom
What was the outcome?
- Outcome
- Job transfer or restriction (code 3)
- Type
- Injury (code 1)
- Days restricted or transferred
- 34
Before the incident
walking
What happened
[REDACTED] was walking in backroom when he temporarily lost his balance and upon catching himself felt a pull in his left shoulder
Injury or illness
left shoulder
Object or substance involved
no lost his balance
Summary line
[REDACTED] was walking in backroom when he temporarily lost his balance and upon catching himself felt a pull in his left shoulder
Employee and industry
- Job description
- Donation Attendant
- SOC code
- 9999 — Uncoded
- NAICS code
- 453310 — Used Merchandise Retailer
- NAICS vintage
- 2017
- Avg employees
- 34
- Total hours worked
- 45583
- EIN
- 860104415
- Establishment ID
- 1400151
- Employer case #
- C 21380
When (timing detail)
- Date of incident
- Time of incident
- 17:00
- Filing year
- 2024
- Submitted
- 03MAR2025:21:28:00
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.