Sun Prairie, WI —
OSHA Injury Report: 1121 - SUN PRAIRIE WI
Injury · Job transfer or restriction
At a glance
On , an injury at 1121 - SUN PRAIRIE WI in Sun Prairie, WI 48823 resulted in job transfer or restriction. Employee was mGR STAFF in wholesale Grocer.
Where did this happen?
- Establishment
- 1121 - SUN PRAIRIE WI
- Parent company
- Costco Wholesale
- Street
- 2850 Hoepker Rd
- City
- Sun Prairie
- State
- WI
- ZIP
- 48823
- On-site location
- Bakery Pan Washer drain Pit
What was the outcome?
- Outcome
- Job transfer or restriction (code 3)
- Type
- Injury (code 1)
- Days restricted or transferred
- 17
Before the incident
putting a temperature tag in the pan washer
What happened
EE was putting a tag on the bakery pan washer and fell into the rinse pit
Injury or illness
Strain Sprain Foot Left Side
Object or substance involved
Floor Walking Surface
Summary line
Strain Sprain Foot Left Side Fall from Different Level Floor Walking Surface
Employee and industry
- Job description
- MGR STAFF
- SOC code
- 9999 — Uncoded
- NAICS code
- 455211 — Wholesale Grocer
- NAICS vintage
- 2022
- Avg employees
- 309
- Total hours worked
- 453440
- EIN
- 911223280
- Establishment ID
- 1217649
- Employer case #
- WC413F2188
When (timing detail)
- Date of incident
- Shift started
- 4:00:00.000
- Time of incident
- 4:53:00.000
- Submitted
- 04MAR24:19:25:00
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.