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Incident Report
 

The SafetyLetter is compiled from reports of real-world incidents reported to PEI by people just like you. Your identity will remain anonymous and we'll even provide you a special PEI gift! Use this form or call (888) NEAR MISS ([888] 632-7647).

 

Report an incident for possible inclusion in the SafetyLetter.



Select the gift you prefer






Describe the work being done at the time of the accident or near accident *


Describe the circumstances that caused or could have caused the accident


Who was injured, to what extent, and how many days (if any) were they off the job


Comment on how the accident could have been avoided or prevented


Company

Name *

E-mail *

Daytime Phone

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We won't publish your personal information–we just request it in case we need to contact you for more details on the incident or circumstances.

* = required fields


 
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