Form AC 3900-11 - Mike Monroney Aeronautical Center Non-Injury Mishap Form
Document Information
- Number
- AC 3900-11
- Title
- Mike Monroney Aeronautical Center Non-Injury Mishap Form
- Prescribing Order
- AC 3900.21J - Mike Monroney Aeronautical Center Occupational Safety and Health Program
- Status
- Active
- Edition date
- 2023-05-04
- Orientation
- Portrait
- Unit of issue
- EA
- Office of Primary Responsibility
- AMP-100
- Access Restriction
- FAA Network Only
- Description
-
The Aeronautical Center Non-Injury Mishap Form is required when an employee has a Motor Vehicle (Non-Injury), Near Miss, or Property Damage Mishap. The definitions for these items are below. If your mishap involves an injury, please complete an OSHA Form 301 in the ECOMP system: https://www.ecomp.dol.gov/#/
- Motor Vehicle (Non-Injury): An incident where a motor vehicle collides with another object. This includes other vehicles, structures, buildings, people or animals.
- Near Miss: An unplanned event that did not result in injury, illness, or property damage, but had the potential to do so.
- Property Damage: An incident that results in physical damage or destruction of real property, government property, or personnel property.
Form 3900-1 must be submitted to 9-AMC-AMP-100A@faa.gov and Jason.e.Palmeter@faa.gov within five working days of the Mishap.
- Contact information
-
Jason Palmeter
jason.e.palmeter@faa.gov
- Content
-
- AC 3900-11 (PDF)