Near Miss Reporting Form Template 2025

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To recap: Incident: something did occur and harm was caused. Hazard: something could occur. Near Miss: something did occur but there was no harm caused.
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 are the five rules of incident report writing? Timeliness: Always report the incident as soon as possible. Accuracy: Make sure all information provided is accurate and detailed. Completeness: Be thorough and provide all important details. Confidentiality: Handle sensitive and personal information carefully.
It is the responsibility of Employees to: Ensure action has been taken to maintain safety and ensure safety of the area; Promptly report (within 24 hours) all incidents by completing the near miss report form (reporting only FACTS) and submit to a Manager or Human Resources; and Provide statements and participate
A near miss is an unintentional workplace incident that could have resulted in damage, injury, or death but was narrowly avoided. An incident, on the other hand, is any unintended event that could lead to or has led to damage, injury, or death. It includes both near misses and accidents.
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Near-miss reporting is proactive, aimed at preventing potential accidents by identifying and addressing vulnerabilities before they lead to actual harm. Conversely, incident reporting is reactive, focusing on documenting and responding to events that have already caused harm or damage.

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