ELIZABETHTON, TN —
OSHA Injury Report: 631 FC ELIZABETHTON TN
Injury · Days away from work
At a glance
On , an injury at 631 FC ELIZABETHTON TN in ELIZABETHTON, TN 376432315 resulted in days away from work. Employee was food Serv Asst Mgr Over in supermarket.
Where did this happen?
- Establishment
- 631 FC ELIZABETHTON TN
- Parent company
- K VA T Food Stores Inc.
- Street
- 920 BROAD STREET VILLAGE SHOPPING C
- City
- ELIZABETHTON
- State
- TN
- ZIP
- 376432315
- On-site location
- Deli freezer
What was the outcome?
- Outcome
- Days away from work (code 2)
- Type
- Injury (code 1)
- Days away from work
- 3
- Days restricted or transferred
- 15
Before the incident
walking out of cooler
What happened
Tripped over black mat in floor fell
Injury or illness
L knee & left ankle contusion
Object or substance involved
black mat
Summary line
L knee & left ankle contusion black mat Tripped over black mat in floor fell
Employee and industry
- Job description
- Food Serv Asst Mgr Over
- SOC code
- 00-9900 — Insufficient Information - NIOSH
- NAICS code
- 445110 — Supermarket
- NAICS vintage
- 2022
- Avg employees
- 112
- Total hours worked
- 168765
- EIN
- 550421484
- Establishment ID
- 1293451
- Employer case #
- 80561
When (timing detail)
- Date of incident
- Shift started
- 13:00
- Time of incident
- 17:35
- Filing year
- 2025
- Submitted
- 16JAN26:21:04:00
Source
Data from OSHA ITA Form 300/301 electronic submissions, filing year 2025. ITA Case Detail records are establishment-reported submissions, not OSHA inspections — no per-record IMIS deep link exists.