• Near Miss Description

  • Did you take any actions at time of Near Miss

  • Describe action and outcome

  • How did the action taken work

  • Visual Evidance

Implementation of Change

  • Is there a practicable change that could be implemented

  • Description of change including documents and method of distributing information

  • Review Change
  • Review date of implimentation

  • Is implementation complicated and successful

  • Add new evidence and information to implement

  • Visual Evidance

  • Date and time for revew

Close investigation

  • H&S signature to close off

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