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Safety Incidents OSHA Severe Injury Reports · 2015–2025

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 5401 W INTEGRITY WAY, 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
Filing year
2023
Submitted
04MAR24:19:27:00

More injuries at 1222 - GRAND CHUTE WI

View 1222 - GRAND CHUTE WI's full OSHA safety record →

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Source

Data from OSHA ITA Form 300/301 electronic submissions, filing year 2023. ITA Case Detail records are establishment-reported submissions, not OSHA inspections — no per-record IMIS deep link exists.