Graham Roofing (GRH 044) Near Miss Report

• Near Miss

• Brief Description

• Site

• Recorded by

• Rate Potential of Harm

• Rate likelihood of re-occurrence

Date & time:

• Select date

  Date

• Where did it happen

• Details of Indecent

• Photographic evidence (if applicable):

  Media

Person Reporting

• Supervisor IMannformed

  Yes

  No

  N/A

• Are you a Graham Roofing Employee

  Employee

  Subcontractor

  Visitor

• Name

  Sign

Managers responce

• What have you done to prevent

• Manager

  Sign