Near miss form 2025

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The document outlines a Near Miss Reporting Form for health care workers, designed to document incidents that nearly resulted in harm. It includes sections for detailing the incident, personnel involved, witnesses, prevention strategies, corrective actions, and supervisor approval. The form aims to enhance safety by encouraging reporting and analysis of near misses to prevent future occurrences.

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Do near misses need to be reported to OSHA?

Workers must report all workplace incidents, hazardous conditions, near misses, and property and environmental damage to their immediate supervisor as soon as possible.

What is an example of a near miss on a ship?

A near miss on a ship could be a crew member working without a safety helmet near an overhead crane in the engine room or entering an enclosed space without ventilation.

How do you document a near miss?

In general, here is the information you should include in a near miss report: Date, time, and location of the incident. Department. Incident description. Root cause (behavior, equipment, etc.) Supporting documents (photos, hazard analyses, etc.) Next steps and specific action items.

What is a near miss form?

Near-Miss Incident Report Form. A near-miss is a potential hazard or incident in which no property was damaged and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred.

What qualifies as a near miss?

A near-miss is a potential hazard or incident in which no property was damaged and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred. Near misses also may be referred to as close calls, near accidents, or injury-free events.

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Which of the following is an example of a near miss?

For example, if an employee steps on condensation by a freezer and almost slips but theyre able to recover their balance before falling, its a near miss. If the employee fell and suffered an injury, that would be an incident or accident.

What is a good example of near miss?

During roof work, a worker nearly steps backwards off the edge but is called out by a coworker just in time. A tool is dropped from a height but doesnt hit anyone. On a construction site, a temporary guardrail is dislodged but noticed and fixed before anyone leans against it and potentially falls.

What is a near miss example?

Its an unpredicted event that had the potential of creating a mild to serious injury to an employee, though it didnt fully happen. For example, if an employee steps on condensation by a freezer and almost slips but theyre able to recover their balance before falling, its a near miss.