MARYSVILLE, WA —
OSHA Injury Report: 0642 - MARYSVILLE WA
Injury · Other recordable case
At a glance
On , an injury at 0642 - MARYSVILLE WA in MARYSVILLE, WA 83201 resulted in other recordable case. Employee was mGR DEPT in wholesale Grocer.
Where did this happen?
- Establishment
- 0642 - MARYSVILLE WA
- Parent company
- Costco Wholesale
- Street
- 16616 TWIN LAKES AVENUE
- City
- MARYSVILLE
- State
- WA
- ZIP
- 83201
- On-site location
- TIRE SHOP
What was the outcome?
- Outcome
- Other recordable case (code 4)
- Type
- Injury (code 1)
Before the incident
mounting a tire in the tire shop
What happened
Stood up and was hit by tire mount arm being swung back
Injury or illness
Concussion Head
Object or substance involved
Tire Balancer
Summary line
Concussion Head Caught In or Between Tire Balancer
Employee and industry
- Job description
- MGR DEPT
- SOC code
- 41-1012 — First-Line Supervisors of Non-Retail Sales Workers
- NAICS code
- 455211 — Wholesale Grocer
- NAICS vintage
- 2022
- Avg employees
- 301
- Total hours worked
- 432153
- EIN
- 911223280
- Establishment ID
- 1217397
- Employer case #
- SX14830
When (timing detail)
- Date of incident
- Shift started
- 9:00:00.000
- Time of incident
- 12:45:00.000
- Submitted
- 04MAR24:19:36:00
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.