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
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.