Near Miss Reporting

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PLEASE COMPLETE THE NEAR MISS SECTIONS BELOW

• Site Details:

  Select St Ledger - Intake St Ledger - Wheatley CESP Doncaster St Ledger - Edlington, Doncaster St Ledger - Switch 2 Contract Chevin Housing -Wakefield Chevin Housing - Chapletown, Leeds Chevin Housing - Thornleigh Gardens, Leeds Chevin Housing - Airedale Mixenden, Halifax

  • St Ledger - Intake
  • St Ledger - Wheatley
  • CESP Doncaster
  • St Ledger - Edlington, Doncaster
  • St Ledger - Switch 2 Contract
  • Chevin Housing -Wakefield
  • Chevin Housing - Chapletown, Leeds
  • Chevin Housing - Thornleigh Gardens, Leeds
  • Chevin Housing - Airedale
  • Mixenden, Halifax

• What Happened (Please detail the Near Miss that you have Witnessed):

• Please include Photographic Evidence:

  Media

• Please inform us of your Status:

  Employee of Corsan

  Sub Contractor to Corsan

  Visitor

• When (Time/Date):

  Date

• Supervisor Informed?

  Yes

  No

  N/A

• Submitted By:

  Sign

• Thank you for reporting this near miss. Now we know about it, we can do something to avoid an accident in the near future. All reports submitted will be reviewed by Wates Supervision and where appropriate, action taken to remove or minimise risk. (Comments by The Manager):