Information

  • Client / Site

  • Conducted on

  • Prepared by

  • Personnel involved

  • Type of near miss

  • PPE infraction

  • Equipment/vehichle

  • Safety equipment i.e. missing stinger, missing vac break, etc.

  • Other

  • Brief description of near miss

  • Employee designation

  • Is personnel involved a short service employee

  • Describe Corrective Action Taken

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.