Report

  • Department/Location

  • Date of Incident

  • Persons Involved and position

Investigation

A near miss is a potential hazard or incident that has not resulted in any personal injury. Unsafe working practices, unsafe employee work habits, improper use of equipment or use of malfunctioning equipment have the potential to cause Orkney related injuries. It everyone's responsibility to report these accidents and/ or correct these potential accidents/incidents immediately.

  • Description of near-miss condition

  • Photos if available/applicable

  • Location sketch

  • Causes (primary & contributing)

  • Unsafe Act

  • Unsafe condition

  • Unsafe Equipment

  • Unsafe Use of Equipment

  • Corrective action taken

  • Remove the hazard

  • Repair equipment

  • Replace equipment

  • Retrain staff on proper procedures

  • Comments

  • Completed by

  • Position

  • Date completed

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.