PLEASE COMPLETE THE NEAR MISS SECTION BELOW

  • Site Details:

  • Near Miss Witnessed?

  • Near Miss
  • Location:
  • What Happened? (Please Detail the 'Near Miss' You have Witnessed):

  • When? (Time & Date):

  • Photographic Evidence Before:

  • Tell Us the Current Status of the Near Miss:

  • Photographic Evidence After:

  • Tell us what you have done to Remove the Risk?

  • WARNING - PLEASE NOTIFY THE SITE MANAGER OR ACTING SUPERVISOR IMMEDIATELY.

  • Has the Supervisor been Informed?

  • Who have you Informed?

  • How Were they Informed?

  • NOTIFY A SUPERVISOR IMMEDIATELY

SUBMITTED BY

  • THE NEAR MISS REPORT MUST BE EMAILED DIRECT TO THE CLIENT AND CORSAN OFFICE @ claire.kilby@corsan.co.uk

  • Please Inform Us of Your Status?

  • Print & Sign:

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