Title Page
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Team on site
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Conducted on
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Prepared by
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Location
Detail of incident / occurence
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Definition of a Hazard
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A Hazard is anything with the potential to cause harm or damage.
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Definition of a Near Miss
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A Near Miss is an event or situation that could have resulted in injury, damage or loss.
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Team / persons involved (if applicable)
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ProGas Office must be notified
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ProGas Safety Manager Notified?
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Describe the Incident:
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What injuries or damage could have been caused?
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Who or what could have been harmed?
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Hazard?
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Near miss?
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What did you do about it:
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Further Action Required
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Add Photos
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Signature
