Information
ABB Ltd Robotics - Near Miss / Dangerous Occurence / Dangerous Action Report
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Document No.
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Incident Title
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Client / Site
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Conducted on
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Prepared by
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Location
This is a Near Miss ( something happened) or Unsafe Condition (something could happen) report form. These can also be reported using form 3BGB 300004 appendix 8 or online using RIVO. This section to be completed by person making report.
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Time and Place of Incident
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Location
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Enter Date & Time of Incident
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What are you reporting? Describe the Incident as fully as possible. Add photos if necessary.
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Add photograph.
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Add Sketch Drawing.
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How do you consider the situation for yourself & others now?
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Why is the situation Safe?
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Describe any actions you have taken?
Action Taken
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Describe how people may be at risk still. What actions have you taken to leave the situation as safe as you possibly can?
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Can you make the situation safe?
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Describe what you have done to make it safe.
Action Taken
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Enter Name of your Line Manager. Digitally sign this form. Once completed email to mike.thomas@gb.abb.com
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Name of Line Manager.
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Your signature.
