Gregg Barton

NEAR MISS REPORT

Reporting of any on site near Misses and actions taken to remove the hazard.

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Title Page

Site conducted
Conducted on
Prepared by
Signed by
Location

NEAR MISS REPORT

Name of operative reporting near miss incident.
Details of Near miss.
How has the hazard been removed.
Was any body injured in this near miss incident.
Details of any injuries sustained.
How could of this incident been avoided.

Gregg Barton

NEAR MISS REPORT

Reporting of any on site near Misses and actions taken to remove the hazard.

Use this Template

Print as PDF

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