Corey Crosby

ICS Near Miss/Hit Investigation

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Use this Template

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Title Page

Jobsite Name/Number
Time/Date of Near Miss/Hit
Employee(s) Involved
Prepared by
Location

Investigation Details

NARRATIVE: (Description & Result(s) of Near Miss/Hit Incident)
ROOT CAUSE: (Main factor(s) that caused Near Miss/Hit Incident)
CORRECTIVE/DISCIPLINARY ACTION: (Steps taken to prevent Reoccurrence)
TRAINING: (Is any New or Retraining needed for the employee(s) involved)
COMMENTS:

Corey Crosby

ICS Near Miss/Hit Investigation

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.