Anonymous

BBC - Near Miss

Identify potential hazardous before they become an accident, eliminate hazardous by identifying the root cause.

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Information

Document No.
Audit Title
Client / Site
Conducted on
Prepared by
Location
Personnel

Photo of Near Miss
Brief Description
Contractor Name
Was contractor responsive to near miss concerns?
What steps will be taken by the contractor to avoid the hazard in the future?
Select date
Inspector Signature
Contractor Signature Contractor acknowledges the near miss and will comply with the step referenced above to avoid this hazard moving forward.

Anonymous

BBC - Near Miss

Identify potential hazardous before they become an accident, eliminate hazardous by identifying the root cause.

Use this Template

Print as PDF

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