Phoenix, AZ —
OSHA Injury Report: Forms + Surfaces Phoenix
Injury · Days away from work
At a glance
On , an injury at Forms + Surfaces Phoenix in Phoenix, AZ 85043 resulted in days away from work. Employee was assembler in ornamental metalwork manufacturing.
Where did this happen?
- Establishment
- Forms + Surfaces Phoenix
- Parent company
- Forms and Surfaces
- Street
- 1025 N 71st Avenue
- City
- Phoenix
- State
- AZ
- ZIP
- 85043
- On-site location
- Building 4
What was the outcome?
- Outcome
- Days away from work (code 2)
- Type
- Injury (code 1)
- Days away from work
- 3
- Days restricted or transferred
- 158
Before the incident
The employee was helping move a glass panel onto a frame.
What happened
While moving a glass panel onto a frame the employee stated that they heard a popping a sound. This was diagnosed as an umbilical hernia.
Injury or illness
Umbilical hernia
Object or substance involved
Glass panel
Summary line
Umbilical hernia from lifting a glass panel
Employee and industry
- Job description
- Assembler
- SOC code
- 51-2099 — Assemblers and Fabricators, All Other
- NAICS code
- 332323 — Ornamental metalwork manufacturing
- NAICS vintage
- 2012
- Avg employees
- 266
- Total hours worked
- 400670
- EIN
- 251476717
- Establishment ID
- 1064648
- Employer case #
- 5
When (timing detail)
- Date of incident
- Shift started
- 0:00
- Time of incident
- 3:00
- Filing year
- 2025
- Submitted
- 17FEB26:13:29:00
Source
Data from OSHA ITA Form 300/301 electronic submissions, filing year 2025. ITA Case Detail records are establishment-reported submissions, not OSHA inspections — no per-record IMIS deep link exists.