Hazard / Near-Miss Reporting

• Client / Site

• Reported by:

• HAZARD OR NEAR-MISS REPORTING?

  Hazard Reporting

  Near-Miss Reporting

HAZARD or NEAR-MISS IDENTIFICATION

Hazard/Near-Miss no. 1

• Select date

  Date

• Location of Hazard:

• Hazard/Near-Miss no. 1 description:

• Add media

  Media

• Follow up & closed?

  Rectified

  In-progress

  Pending client decision

• Select date

  Date

• Picture after follow up

  Media

HAZARD or NEAR-MISS IDENTIFICATION

Hazard/Near-Miss no. 2

• Select date

  Date

• Location of Hazard:

• Hazard/Near-Miss no. 2 description:

• Add media

  Media

• Follow up & closed?

  Rectified

  In-progress

  Pending client decision

• Select date

  Date

• Picture after follow up

  Media

HAZARD or NEAR-MISS IDENTIFICATION

Hazard/Near-Miss no. 3

• Select date

  Date

• Location of Hazard:

• Hazard/Near-Miss no. 3 description:

• Add media

  Media

• Follow up & closed?

  Rectified

  In-progress

  Pending client decision

• Select date

  Date

• Picture after follow up

  Media

HAZARD or NEAR-MISS IDENTIFICATION

Hazard/Near-Miss no. 4

• Select date

  Date

• Location of Hazard:

• Hazard/Near-Miss no. 4 description:

• Add media

  Media

• Follow up & closed?

  Rectified

  In-progress

  Pending client decision

• Select date

  Date

• Picture after follow up

  Media

HAZARD or NEAR-MISS IDENTIFICATION

Hazard/Near-Miss no. 5

• Select date

  Date

• Location of Hazard:

• Hazard/Near-Miss no. 5 description:

• Add media

  Media

• Follow up & closed?

  Rectified

  In-progress

  Pending client decision

• Select date

  Date

• Picture after follow up

  Media