Waterloo, IA ·
OSHA Injury Report: Waterloo 1 - Main Store
Injury · Other recordable case
At a glance
On , an injury at Waterloo 1 - Main Store in 2834 Ansborough Ave, Waterloo, IA 50701 resulted in other recordable case. Employee was deliClerk in supermarkets and Other Grocery except Convenience Stores.
Where did this happen?
- Establishment
- Waterloo 1 - Main Store
- Parent company
- HY-VEE, INC.
- Street
- 2834 Ansborough Ave
- City
- Waterloo
- State
- IA
- ZIP
- 50701
- On-site location
- Bakery area near HMR case
What was the outcome?
- Outcome
- Other recordable case (code 4)
- Type
- Injury (code 1)
Before the incident
Employee was putting aways items from a pallet and cart when she backed up and tripped on the pallet and fell backwards
What happened
Employee was putting aways items from a pallet and cart- from a truck delivery [REDACTED]- when she backed up and tripped on the pallet and fell backwards- injuring her shoulder and lower buttock region. She has expressed that she fells pain from her right should down her right arm and right side under her arm. Also her right buttock was hurting.
Injury or illness
INJURY TYPE: Contusion || BODY PARTS AFFECTED: Body Systems Multiple Body Systems
Object or substance involved
floor
Summary line
Contusion to the right shoulder- right arm and right buttock from a fall when filling the HMR case.
Employee and industry
- Job description
- DeliClerk
- SOC code
- 00-9900: Insufficient Information - NIOSH
- NAICS code
- 445110: Supermarkets and Other Grocery except Convenience Stores
- NAICS vintage
- 2022
- Employees at this establishment (2025 average)
- 147
- Hours worked at this establishment (2025 total)
- 182,991
- EIN
- 420325638
- Establishment ID
- 1375057
- Employer case #
- 2025-1
When (timing detail)
- Date of incident
- Shift started
- 07:00
- Time of incident
- 09:43
- Filing year
- 2025
- Submitted to OSHA
- 2026-02-27
More injuries at Waterloo 1 - Main Store
View Waterloo 1 - Main Store's full OSHA safety record →
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Source
Data from OSHA ITA Form 300/301 electronic submissions, filing year 2025. ITA Case Detail records are establishment-reported submissions, not OSHA inspections, so no per-record IMIS deep link exists.
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