Beaver Dam, WI —
OSHA Injury Report: Charleston House
Injury · Other recordable case
At a glance
On , an injury at Charleston House in Beaver Dam, WI 53916 resulted in other recordable case. Employee was med Passer in assisted-living facilities with on-site nursing facilities.
Where did this happen?
- Establishment
- Charleston House
- Parent company
- Beaver Dam Al Operations LLC
- Street
- 104 Fakes Court
- City
- Beaver Dam
- State
- WI
- ZIP
- 53916
- On-site location
- Employee Training Room
What was the outcome?
- Outcome
- Other recordable case (code 4)
- Type
- Injury (code 1)
Before the incident
Attending a training with other employees.
What happened
Was rocking back on the legs of the chair and leg broke.
Injury or illness
Contusion on head concussion
Object or substance involved
Chair and wall
Summary line
Fell backwards in chair hit head on wall.
Employee and industry
- Job description
- Med Passer
- SOC code
- 31-1131 — Nursing Assistants
- NAICS code
- 623311 — Assisted-living facilities with on-site nursing facilities
- NAICS vintage
- 2022
- Avg employees
- 68
- Total hours worked
- 79054
- EIN
- 884009936
- Establishment ID
- 1120834
- Employer case #
- A00536719
When (timing detail)
- Date of incident
- Shift started
- 6:00:00.000
- Time of incident
- 13:10:00.000
- Submitted
- 12FEB24:20:43:00
Source
Data from OSHA ITA Form 300/301 electronic submissions, filing year unspecified. ITA Case Detail records are establishment-reported submissions, not OSHA inspections — no per-record IMIS deep link exists.