Title Page

  • EDGE SERVICES NEAR MISS REPORT

  • Date and time of incident

  • RIG NUMBER

  • Operation at time of Near Miss

  • Equipment Involved

  • Witness to incident

  • First reported to whom

  • Select date

  • Describe in full the details of the incident ( include what you were doing before the incident occurred and actions which could have been taken to avoid the incident

  • Recommended Corrective actions

  • Enter Date and Time

  • By signing this form I agree that all information giving in this near miss report it true to the best of my knowledge.

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