Title Page
Near miss report
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Use this form to report events that had the potential to cause injuries, Ill health or damage and email it to your manager, supervisor or Cleshar HSQE department.
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Project:
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Location:
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Location type e.g. Track, construction site, office, station etc.
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Select date
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Please select near miss type:
- Near Miss
- Unsafe Condition
- Unsafe Act
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Describe what you have seen:
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Describe what could have happened:
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Describe what you were able to do about it or suggest actions:
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Lighting conditions:
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Your name (Optional)
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Position:
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Contact number or email (Optional).
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For all injuries and high potential incidents involving rail vehicles, please contact your site supervisor and Cleshar Manager immediately on 07816 659 957 (Kent) or 0208 733 8552 (HUB-Head Office)
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If you have any Health and Safety queries and to report this near miss by email contact HSQE@cleshar.co.uk
