Get the free Near Miss Incident Report Form - Campus Recreation

Near Miss / Incident Report Form University of North Carolina Asheville Campus Recreation Outdoor Programs Today's Date: Near Miss: Refers to any incident in which serious injury, or significant damage

How to fill out near miss incident report

How to fill out a near miss incident report:

1. Gather all relevant information: Start by recording the date, time, and location of the near miss incident. Include details about what was happening before, during, and after the incident.
2. Describe the near miss incident: Clearly explain what happened, focusing on the sequence of events and any contributing factors. Be specific and objective in your description, avoiding any personal opinions or assumptions.
3. Identify the potential hazards and risks: Analyze the situation and determine what could have gone wrong if the incident had not been a near miss. Consider both immediate and long-term consequences.
4. Document witnesses and their statements: If there were any witnesses to the incident, record their names, contact information, and their descriptions of what they saw. Their perspectives can provide valuable insights into the event.
5. Assess the root cause: Try to determine the underlying reasons for the near miss incident. Was it due to equipment failure, human error, or a combination of factors? Identifying the root cause can help prevent similar incidents from occurring in the future.
6. Make recommendations for improvement: Based on your analysis, suggest practical measures to prevent similar near miss incidents. These recommendations can range from implementing new procedures or training to modifying equipment or work environment.
7. Submit the report: Ensure that the completed near miss incident report is submitted to the appropriate person or department within your organization. This could be a safety manager, supervisor, or anyone designated to handle such reports.

Who needs a near miss incident report?

1. Organizations: Near miss incident reports are essential for organizations to identify potential risks and hazards in their operations. By documenting near misses, organizations can take proactive steps to prevent accidents and create safer work environments.
2. Regulatory bodies: Government agencies and regulatory bodies often require organizations to maintain records of near miss incidents. These reports help regulatory bodies assess compliance with safety standards and guide their enforcement actions.
3. Employees: In addition to being a regulatory requirement, near miss incident reports benefit employees by creating awareness of potential hazards and providing an opportunity to improve safety protocols. By reporting near misses, employees contribute to a culture of safety in the workplace.

By following these steps and understanding who needs a near miss incident report, you can help promote a safer and more proactive approach to preventing accidents in your organization.

For pdfFiller’s FAQs

How can I manage my near miss incident report directly from Gmail?

You may use pdfFiller's Gmail add-on to change, fill out, and eSign your near miss incident report as well as other documents directly in your inbox by using the pdfFiller add-on for Gmail. pdfFiller for Gmail may be found on the Google Workspace Marketplace. Use the time you would have spent dealing with your papers and eSignatures for more vital tasks instead.

How can I send near miss incident report to be eSigned by others?

To distribute your near miss incident report, simply send it to others and receive the eSigned document back instantly. Post or email a PDF that you've notarized online. Doing so requires never leaving your account.

How can I edit near miss incident report on a smartphone?

You may do so effortlessly with pdfFiller's iOS and Android apps, which are available in the Apple Store and Google Play Store, respectively. You may also obtain the program from our website: https://edit-pdf-ios-android.pdffiller.com/. Open the application, sign in, and begin editing near miss incident report right away.

What is near miss incident report?

A near miss incident report is a documented report of an event that could have resulted in injury, damage, or loss but did not.

Who is required to file near miss incident report?

All employees are required to file a near miss incident report if they witness or are involved in a near miss event.

How to fill out near miss incident report?

To fill out a near miss incident report, employees should provide detailed information about the event, including date, time, location, individuals involved, and description of the near miss.

What is the purpose of near miss incident report?

The purpose of a near miss incident report is to identify and address potential hazards or issues before they result in an actual incident or injury.

What information must be reported on near miss incident report?

Information such as date, time, location, individuals involved, description of the near miss event, and any corrective actions taken must be reported on a near miss incident report.