Taylor Robinson

Hazard Identification / Near Miss

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Title Page

Site conducted
Conducted on
Prepared by

Hazard / Near Miss

Hazard or Near Miss?
Describe the hazard or near miss
Location of the hazard/near miss
Who observed the hazard/had the near miss?
What corrective measures were taken and/or are needed?
Does the hazard still exist in the workplace?
Are there any noticeable environmental concerns? (ex. spills, housekeeping)
What are the concerns?

Taylor Robinson

Hazard Identification / Near Miss

Use this Template

Print as PDF

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