NEAR MISS (Occupational Safety Health Incident Report)

• SENSUS JOB REF

• SENSUS NEAR MISS (OCCUPATIONAL SAFETY HEALTH INCIDENT TEMPLATE) REPORT

• Conducted on

  Date

• Prepared by

• Location
  Address

Type of event/Issue

• Plant and equipment

• Environment

• Human

Brief description of the event details

• Describe. NEAR MISS EVENT

• Record image if relevant

  Media

Preventative action

• What action is required?

• Manager to be notified.

  Zane Taylor

• Please print your name and sign

  Sign

• This document should be signed and sent to your Project Manager, and/or the National Operational Zero Harm Advisor.
  
  This report is for events which have not resulted in harm, I.e. injury or damage. ,All injury events must be reported using the site injury report.