A “close call” is a potential hazard or incident that has not resulted in any personal injury. Unsafe working conditions, unsafe employee work habits, improper use of equipment or use of malfunctioning equipment have the potential to cause work related injuries. It is everyone’s responsibility to report and /or correct these potential accidents/incidents immediately. Please complete this form as a means to report these close call situations.
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Information
DEPARTMENT/LOCATION of Close Call:
Conducted on
Prepared by
Location
Close Call
Take a picture of the close call
Description of the incident or potential hazards
Corrective action taken (Remove the hazard, replace, repair, or retrain in the proper procedures for the task)
Safety Director/Safety Contact Signature
Crystal Travis
“CLOSE CALL" FORM
A “close call” is a potential hazard or incident that has not resulted in any personal injury. Unsafe working conditions, unsafe employee work habits, improper use of equipment or use of malfunctioning equipment have the potential to cause work related injuries. It is everyone’s responsibility to report and /or correct these potential accidents/incidents immediately. Please complete this form as a means to report these close call situations.
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You should independently determine whether the template is suitable for your circumstances.