GRAND CHUTE, WI —
OSHA Injury Report: 1222 - GRAND CHUTE WI
Injury · Other recordable case
At a glance
On , an injury at 1222 - GRAND CHUTE WI in GRAND CHUTE, WI 44109 resulted in other recordable case. Employee was fORKLIFT DRIVER in wHOLESALE GROCER.
Where did this happen?
- Establishment
- 1222 - GRAND CHUTE WI
- Parent company
- Costco Wholesale
- Street
- 5401 W INTEGRITY WAY
- City
- GRAND CHUTE
- State
- WI
- ZIP
- 44109
- On-site location
- Parking Lot
What was the outcome?
- Outcome
- Other recordable case (code 4)
- Type
- Injury (code 1)
Before the incident
walking into building for shift
What happened
Slipped on ice coming into the building and fell back hard on concrete
Injury or illness
Strain Sprain Back Lower Right Side
Object or substance involved
Parking Lot
Summary line
Strain Sprain Back Lower Right Side Fall on Ice or Snow Parking Lot
Employee and industry
- Job description
- FORKLIFT DRIVER
- SOC code
- 53-7051 — Industrial Truck and Tractor Operators
- NAICS code
- 455211 — WHOLESALE GROCER
- NAICS vintage
- 2022
- Avg employees
- 253
- Total hours worked
- 381565
- EIN
- 911223280
- Establishment ID
- 1217701
- Employer case #
- WC413F4184
When (timing detail)
- Date of incident
- Shift started
- 4:00:00.000
- Time of incident
- 3:55:00.000
- Submitted
- 04MAR24:19:27:00
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.