Near Miss - Peña Mechanical

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Near-Miss

Filling out a “Near Miss” helps keep us all alert to safety hazards we see each day.

Your Name(Required)

Location of Near Miss(Required)

(Shop or Field Location)

Date of Near-Miss(Required)

MM slash DD slash YYYY

Approximate Time of Day(Required)

6:00am-9:00am

9:00am-Noon

Noon-2:00pm

2:00-3:30pm

Other

What Kind of Near Miss?(Required)

Slip/Trip/Fall

Personal Injury

Property Damage

Driving

Other

What happened and how can it be prevented?

Upload Photo (if applicable)

Max. file size: 512 MB.

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Peña Mechanical Contractors, INC.

(260) 622-1312 Office

(260) 622-4540 Fax