Shawano, WI —
OSHA Injury Report: Evergreen Health Services
Injury · Other recordable case
At a glance
On , an injury at Evergreen Health Services in Shawano, WI 54166 resulted in other recordable case. Employee was cNA in nursing homes.
Where did this happen?
- Establishment
- Evergreen Health Services
- Parent company
- Northshore Health Services
- Street
- 1250 Evergreen Street
- City
- Shawano
- State
- WI
- ZIP
- 54166
- On-site location
- Room 33
What was the outcome?
- Outcome
- Other recordable case (code 4)
- Type
- Injury (code 1)
Before the incident
going to charge a residents phone after putting resident on the toilet
What happened
Tripped on wheelchairs foot pedals and fell
Injury or illness
Fall
Object or substance involved
Wheelchair pedals
Summary line
Fell over wheelchair pedals
Employee and industry
- Job description
- CNA
- SOC code
- 31-1131 — Nursing Assistants
- NAICS code
- 623110 — Nursing homes
- NAICS vintage
- 2022
- Avg employees
- 56
- Total hours worked
- 69828
- EIN
- 843225166
- Establishment ID
- 880724
- Employer case #
- 1
When (timing detail)
- Date of incident
- Shift started
- 14:00:00.000
- Time of incident
- 18:30:00.000
- Submitted
- 19JAN24:20:13:00
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.