An unplanned event that doesn’t cause harm or damage but had the potential too if circumstances were different - once completed report on the H&S report Log template and attach this file.
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Title Page
Department
Name of involved person
Address/site where event occurred
Date and time of near miss
NEAR MISS
Description of near miss
Action taken at time of being reported
Detail any further action required
Managers name
Name of person reporting near miss
Signature of person reporting
EVOLVE - NEAR MISS REPORT FORM
An unplanned event that doesn’t cause harm or damage but had the potential too if circumstances were different - once completed report on the H&S report Log template and attach this file.
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