Evergreen, CO —
OSHA Injury Report: 620-00064
Injury · Other recordable case
At a glance
On , an injury at 620-00064 in Evergreen, CO 80439 resulted in other recordable case. Employee was c STORE ASST LE in supermarkets and Other Grocery Except Convenience Stores.
Where did this happen?
- Establishment
- 620-00064
- Parent company
- King Soopers
- Street
- 1173 Bergen Pkwy
- City
- Evergreen
- State
- CO
- ZIP
- 80439
- On-site location
- FUEL CENTER PATIO NEAR CABINET AREA
What was the outcome?
- Outcome
- Other recordable case (code 4)
- Type
- Injury (code 1)
Before the incident
CLEANING FUEL HOLSTER AT PUMP 5 6
What happened
The ee was cleaning flue and slipped on ice The ee sustained a strain on his left shoulders
Injury or illness
Strained Left Shoulders Fall on ice orsnow ICEY or SLIPPERY GROUND
Object or substance involved
ICEY SLIPPERY GROUND
Summary line
Strained Left Shoulder Fall on ice or snow ICEY or SLIPPERY GROUND
Employee and industry
- Job description
- C STORE ASST LE
- SOC code
- 53-7065 — Stockers and Order Fillers
- NAICS code
- 445110 — Supermarkets and Other Grocery Except Convenience Stores
- NAICS vintage
- 2022
- Avg employees
- 144
- Total hours worked
- 195282
- EIN
- 480196590
- Establishment ID
- 966527
- Employer case #
- 863996
When (timing detail)
- Date of incident
- Shift started
- 14:30:00.000
- Time of incident
- 22:00:00.000
- Submitted
- 28FEB24:21:04:00
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.