Title Page
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Occurred on
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Prepared by
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Vessel name
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Location of the near miss inciddent
Near Miss Incident description
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Description - What happened, where, when and in what sequence?
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Who was involved?
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Suspected cause
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Weather conditions
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Was there any defect or fault with equipment?
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Did the near miss/hazard/observation involve a person?
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Did the victim had any health issues prior to the near miss/hazard/observation?
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Details
Resolution and conclusions
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Was a solution found?
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Description
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How long did it take to fix the issue after finding the solution?
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What is your recommendation to avoid such issues in the future?
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Comments
Signatures
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Signature of Cruise Director or Master
