KSR016 - Near miss

• Site conducted

  Select

• Site

• Conducted on

  Date

• Auditor

• Location
  Address

• 1. Check near miss board, is it up to date and all relevant information included, where is this loacted?

• Please take a photo of a near miss board

• How are near misses are communicated if no near miss is displayed

• 2. Check that near miss cards /See it Sort it are available at all points where boards are positioned

  Select Well Controlled Some improvement needed Significant improvement needed

  • Well Controlled
  • Some improvement needed
  • Significant improvement needed

• What's required to improve standards

• What improvements are required

• 3. Open up post box and check if cards are being removed, record details and findings from this action i.e. are there cards that are more than 24 hours old in the box?

  Yes

  No

• How are near miss cards are being managed and added to an action plan?

• 4. Are near miss incidents being recorded by site and how? Is there any communications to staff on the cards that are raised? Can this be communicated better? If so how?

• Please take a photo of staff communications

• 5. Are significant Near Misses being discusses at HS meetings/Senior level?

  Select Yes No

  • Yes
  • No

• Please describe near miss discussed at the HS meeting/Senior level

• Are there plans to include near misses at site HS meetings

• 6. Is it evident that staff on site understand the near miss / see it sort it proccess? If answer is YES how can you evidence this? If answer is NO what actions are required to remedy this?

  Select Yes No

  • Yes
  • No

• What actions is the site taking to remedy this?

• Please include evidence of this?

Overall Comments

• Overall Comments

Signature

• Signature

  Sign