Title Page
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Name
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Job Name:
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Reported:
Information
Near miss
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Was there a near miss?
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Site:
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Witness:
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Explain the near miss:
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Date and Time:
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Insert a photo: (Optional)
Incident Report
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Was there an incident?
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Site:
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Witness:
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Explain the incident
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Date and Time:
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Insert a photo: (Optional)
Opportunity for Improvement
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Is there an opportunity for improvement?
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Site:
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Explain the opportunity for improvement?
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Date and Time:
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Insert a photo: (Optional)
