LaceyWA, WA ·
OSHA Injury Report: Bonaventure of Lacey LLC
Injury · Other recordable case
At a glance
On , an injury at Bonaventure of Lacey LLC in 4528 Intelco Loop SE, LaceyWA, WA 98503 resulted in other recordable case. Employee was server in 623312 Assisted Living Facilities for the Elderly.
Where did this happen?
- Establishment
- Bonaventure of Lacey LLC
- Parent company
- MOUNTAIN WEST RETIREMENT CORP
- Street
- 4528 Intelco Loop SE
- City
- LaceyWA
- State
- WA
- ZIP
- 98503
- On-site location
- Woodland by Bonaventure
What was the outcome?
- Outcome
- Other recordable case (code 4)
- Type
- Injury (code 1)
Before the incident
She was walking into the kitchen area and there was aa rubber mat on the floor.
What happened
She stepped on the mat and it slipped out from under her. She did not fall to the ground but caught herself on the sink and on a dish strainer. and felt pain in her left wrist and back of her left hand 7 her right shoulder & in her lower back.
Injury or illness
Right Shoulder Pain Lower Back Right & Left Arms Left Hand & Left Wrist Injuries
Object or substance involved
wet rubber mat
Summary line
Right Shoulder Pain Lower Back Right & Left Arms Left Hand & Left Wrist Inju
Employee and industry
- Job description
- Server
- SOC code
- 35-3041: Food Servers, Nonrestaurant
- NAICS code
- 623312: 623312 Assisted Living Facilities for the Elderly
- NAICS vintage
- 2022
- Employees at this establishment (2023 average)
- 67
- Hours worked at this establishment (2023 total)
- 93,693
- EIN
- 205793200
- Establishment ID
- 1107957
- Employer case #
- BJ05447
When (timing detail)
- Date of incident
- Shift started
- 10:30
- Time of incident
- 12:45
- Filing year
- 2023
- Submitted to OSHA
- 2024-02-12
More injuries at Bonaventure of Lacey LLC
View Bonaventure of Lacey LLC's full OSHA safety record →
More injuries in this industry (NAICS 623312)
More injuries in WA
Source
Data from OSHA ITA Form 300/301 electronic submissions, filing year 2023. ITA Case Detail records are establishment-reported submissions, not OSHA inspections, so no per-record IMIS deep link exists.
Look up any company's OSHA accident reports by company, or browse severe injury reports by year, state, and company.