A near miss is a potential hazard or incident that has not resulted in any personal injury. Unsafe working conditions, unsafe employee work habits, improper use of equipment or use of malfunctioning equipment have the potential to cause work related injuries. It is everyone's responsibility to report and / or correct these potential accidents/incidents.
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Information
Document No.
Date and Time of occurrence
Report completed by
Complete this form as a means to report near-miss situations
PLANON Number
Location
Address
Please tick all appropriate boxes
Unsafe Act
Unsafe Equipment
Unsafe Condition
Unsafe Use of Equipment
Risk of Environmental Damage
Description of incident or potential hazard
Any immediate action taken to mitigate / correct potential repeat occurance
Photo of area
Alan Jones
Mini Near Miss Report
A near miss is a potential hazard or incident that has not resulted in any personal injury. Unsafe working conditions, unsafe employee work habits, improper use of equipment or use of malfunctioning equipment have the potential to cause work related injuries. It is everyone's responsibility to report and / or correct these potential accidents/incidents.
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.
