BLAINE, TN ·
OSHA Injury Report: 619 FC BLAINE TN
Injury · Days away from work
At a glance
On , an injury at 619 FC BLAINE TN in 180 RUTLEDGE PIKE, BLAINE, TN 37709 resulted in days away from work. Employee was food Service Clerk in supermarket.
Where did this happen?
- Establishment
- 619 FC BLAINE TN
- Parent company
- K VA T Food Stores Inc
- Street
- 180 RUTLEDGE PIKE
- City
- BLAINE
- State
- TN
- ZIP
- 37709
- On-site location
- Deli prep
What was the outcome?
- Outcome
- Days away from work (code 2)
- Type
- Injury (code 1)
- Days away from work
- 31
Before the incident
Carrying pans to sink
What happened
Slipped on water in floor fell backwards onto back hit head
Injury or illness
Low back strain head contusion
Object or substance involved
Water
Summary line
Low back strain head contusion water
Employee and industry
- Job description
- Food Service Clerk
- SOC code
- 9999: Uncoded
- NAICS code
- 445110: Supermarket
- NAICS vintage
- 2022
- Employees at this establishment (2024 average)
- 145
- Hours worked at this establishment (2024 total)
- 198,199
- EIN
- 550421484
- Establishment ID
- 1293444
- Employer case #
- C-79068
When (timing detail)
- Date of incident
- Shift started
- 13:00
- Time of incident
- 19:55
- Filing year
- 2024
- Submitted to OSHA
- 2025-03-05
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Source
Data from OSHA ITA Form 300/301 electronic submissions, filing year 2024. ITA Case Detail records are establishment-reported submissions, not OSHA inspections, so no per-record IMIS deep link exists.
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