Information
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Client / Site
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Conducted on
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Prepared by
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Location
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Near Miss
Definition: An event that had a high likelihood of resulting in an injury, equipment, environmental, or property incident but did not.
This information will be used as a preventative measure for possible future incidents. -
Description of event:
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Suggestions for corrective action:
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Witness(es):
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Type of incident:
- Unsafe Act
- Unsafe Condition
- Action of Nature
- Actions of a third party
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Risk Potential:
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Severity:
- Major
- Serious
- Minor
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Probability:
- Frequent
- Occasional
- Rare
