Near Miss

  • A Near Miss is defined as an unplanned event that did not result in injury, illness, or damage - but had the potential to do so. Reporting a Near Miss will help our team identify the root cause of the incident so we can try and prevent a reoccurrence.

General Information

  • Date & Time of Incident

  • Time Work Started

  • Specific Incident Location

  • List person(s) involved

Incident Details

  • Describe the Near Miss occurrence. If working and/or environmental conditions played a role in the incident, please add a description below. Include photos by selecting "Add Media" (if applicable).

  • Near Miss description

  • Working/environmental conditions (if applicable)

  • Action Taken?

  • Lessons learned?

  • Add media

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