Information

  • Near Miss Report No.

  • Conducted on

  • Employee Name:

  • Employee Job Title:

  • Instructions:
    1. Required to be completed when you observe a HSEQ good practice in the workplace
    2. To be completed in full and emailed to the Contract manager & the Health & Safety Dept.

  • Date & Time of observation:

  • Location of observation:
  • Describe the observation:

  • Photo/s (optional):

  • Reporting person's Name and Signature:

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.