Adam Shackelford

Genie Hazard/Near Miss/Job Pause

A hazard is something that may harm you, another person or the environment. A near miss is an unplanned event that did not result in an injury but could have

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Title Page

Life Saving behaviours
Conducted on
Prepared by
Location
What state are you reporting from?
Notify
Type of report
What was the hazard?
What has been done to fix the hazard?
Is further action needed?
What was the near miss?
What was done to prevent the near miss from happening again?
What else needs to be done?
What caused you to pause the job?
What corrective action did you put in place?

Adam Shackelford

Genie Hazard/Near Miss/Job Pause

A hazard is something that may harm you, another person or the environment. A near miss is an unplanned event that did not result in an injury but could have

Use this Template

Print as PDF

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