Title Page
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Document No.
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We want you to work safely. To reduce the possibility of injury we are encouraging you to report near misses/hazards/close calls.
By letting us know, we may be able to prevent injury to someone else! -
Identified by:
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Conducted on
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Location
Details
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Hazard/Near Miss/Close Call?
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Category
- Slips, trips & falls
- Fumes Atmosphere
- Manual Handling
- Moving Vehicles
- Hand Tools/Equipment
- Site Conditions
- Public Nuisance
- Water/Air/Noise Pollution (Low Risk)
- Chemicals
- Working at Height
- Electrical/Mechanical
- High Pressure Water Jetting
- Lifting Operations
- Waste Management
- Spillage
- Excavations
- Confined Spaces
- Falling Objects
- Plant/Equipment
- Unsafe Access/Egress
- Water/Air/Noise Pollution (High Risk)
- Other - Identify
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You have selected a low risk category - Continue with the activity once approved PPE, actions and controls in place
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You have selected a medium risk category - Continue if you are competent and authorised to put corrective procedures in place
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You have selected a high risk category - if you cannot eliminate cause of near miss, STOP and seek guidance!
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Classify near miss type (high risk):
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Description of Near Miss/Hazard
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Action Taken
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Photos
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Closed?
