Mel Dawson

Visionstream Near Miss Reporting

Document to allow reporting of Near Misses

Use this Template

Print as PDF

Use this Template

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Title Page

Person reporting Near Miss

Location of Near Miss
Date and Time of Near Miss
Please provide details of what was observed
Please provide photos of the site (where applicable)
What type of activity was being undertaken?
- Maintenance
- Provisioning (Copper)
- UFB Build
- Provisioning (UFB Connect
- Build
- Unknown
Contractor/Technicians Name and Company
Please record actions taken on site/Conversation held on site.

Mel Dawson

Visionstream Near Miss Reporting

Document to allow reporting of Near Misses

Use this Template

Print as PDF

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.