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SESAFETY.COM Company Name Job Name Date NEAR MISS How many times have you shrugged off a near miss? Never gave it a second thought? Next time, think twice. The difference between a near miss and an

How to fill out near miss

How to Fill out Near Miss:

1. Begin by providing your contact information: Start by filling out your name, phone number, email address, and any other relevant contact details on the near miss report form.
2. Date and time of the incident: Note down the exact date and time when the near miss incident occurred. This information helps in tracking and analyzing patterns.
3. Location: Specify the exact location where the near miss incident took place. This can include the department, specific area, or even the equipment involved.
4. Description of the near miss: Clearly describe what happened in the near miss incident. Include details such as the activities being performed, equipment involved, actions taken, and any potential hazards or risks identified. Provide as much information as possible to help understand the incident.
5. Causes or contributing factors: Identify any causes or contributing factors that led to the near miss incident. This could include inadequate training, lack of proper equipment, human error, or any other factors that may have played a role.
6. Potential consequences: Assess the potential consequences that could have resulted from the near miss incident. This may include injuries, property damage, environmental impact, or any other negative outcomes that could have occurred.
7. Recommendations for prevention: Provide recommendations on how to prevent the near miss incident from happening again in the future. These recommendations should be practical and actionable, focusing on eliminating or minimizing the identified causes or contributing factors.

Who needs near miss:

1. Employers: Employers need to be aware of near misses as they can provide valuable information on workplace hazards and risks. Understanding near misses allows employers to implement corrective measures and create a safer work environment.
2. Employees: Employees should be encouraged to report near misses as it helps raise awareness of potential hazards and promotes a culture of safety. By reporting near misses, employees contribute to creating a safer workplace for themselves and their colleagues.
3. Health and Safety Professionals: Health and safety professionals utilize near miss reports to identify trends, analyze data, and develop strategies to prevent accidents and injuries. Near miss information helps in designing effective safety programs and implementing appropriate controls.

In summary, filling out a near miss report requires providing contact information, documenting the incident details, identifying causes and potential consequences, and making recommendations for prevention. Near miss reports are valuable to employers, employees, and health and safety professionals in identifying workplace hazards and improving overall safety.

For pdfFiller’s FAQs

What is near miss?

Near miss is an unplanned event that did not result in injury, illness, or damage – but had the potential to do so.

Who is required to file near miss?

Employees who were involved in or witnessed the near miss incident are typically required to file a report.

How to fill out near miss?

Near miss reports can usually be filled out online or using a paper form provided by the organization.

What is the purpose of near miss?

The purpose of reporting near misses is to identify potential hazards and prevent future accidents or incidents.

What information must be reported on near miss?

Information such as date, time, location, individuals involved, description of the near miss incident, and any contributing factors must be reported.

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