Visionstream NZ Near Hit/Miss Report

• Service Order No.

• VPL NEAR HIT/MISS REPORT

• Conducted on

  Date

WHAT IS A NEAR HIT/MISS?

• A near hit/miss is any unplanned event that could have had the potential for injury, ill health, damage or other loss. Unsafe working conditions, unsafe employee work habits, improper use of equipment or use of malfunctioning equipment are contributors.
  
  
  
  
  Typhus equipment have the potential to cause work related injuries.
  It is everyone's responsibility to report and/or correct these potential accidents/incidents immediately.
  

HOW DO I REPORT A NEAR HIT/MISS?

• You have 4 options to report a Near Hit/Miss:
  1. Call 0800 333 008 or 09 3521111, select option 8 (available 24/7) or
  2. Email a Near Hit/Miss Incident report to your FM and shane.wigmore@visionstream.co.nz or
  3. Submit a Near Hit/Miss Incident report to a VPL or Chorus representative or
  4. Submit your report here using iAuditor and email it to your FM and shane.wigmore@visionstream.co.nz

INFORMATION REQUIRED

• Select date and time of potential incident/hazard :

  Date
• Address:
  Address

• Attach any supporting documents/photos:

  Media

WHAT TYPE OF NEAR HIT/MISS

• Human

• Environment

• Vehicle/Plant/Equipment

• Underground Services

• Description of Near Hit/Miss, enter here:

PREVENTATIVE ACTIONS:

• List any immediate action taken to make the area safe or eliminate reoccurrence.

• What would have made it safer?