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MIDDLEBURY, VT —

OSHA Injury Report: NAI-0033-0033-01219 FAC-01219-MIDDLEBURY-VT

Injury · Other recordable case

At a glance

On , an injury at NAI-0033-0033-01219 FAC-01219-MIDDLEBURY-VT in 8 WASHINGTON ST., MIDDLEBURY, VT 05753 resulted in other recordable case. Employee was deli Clerk in supermarkets and Other Grocery (except Convenience) Stores.

Where did this happen?

Establishment
NAI-0033-0033-01219 FAC-01219-MIDDLEBURY-VT
Parent company
Shaw's Supermarkets, Inc
Street
8 WASHINGTON ST.
City
MIDDLEBURY
State
VT
ZIP
05753
On-site location
DELI

What was the outcome?

Outcome
Other recordable case (code 4)
Type
Injury (code 1)

Before the incident

PRODUCT TRANSFER MATERIAL HANDLING

What happened

EE was walking into the deli and tripped on the carpet that is laying across the flooring transition. She fell and hit her face

Injury or illness

Fracture Mouth Fall FLOOR

Object or substance involved

FLOOR

Summary line

EE was walking into the deli and tripped on the carpet that is laying across the flooring transition. She fell and hit her face

Employee and industry

Job description
Deli Clerk
SOC code
35-3023 — Fast Food and Counter Workers
NAICS code
445110 — Supermarkets and Other Grocery (except Convenience) Stores
NAICS vintage
2022
Avg employees
72
Total hours worked
101729
EIN
41123420
Establishment ID
1141702
Employer case #
78629

When (timing detail)

Date of incident
Shift started
6:52:00.000
Time of incident
10:00:00.000
Submitted
29FEB24:01:03:00

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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.