Get the free Near-miss form packet Near-miss report - Matrix Service Company

Describe weather conditions at the time of the incident. Reference FM-MSC-HSE-0049 Rev 2 Issued Date November 15 2013 Matrix Service Company 2013 uncontrolled copy if printed. All rights reserved. Cause Explain what personal job and/or uncontrollable factor s caused this incident Supervisor s comments Include actions recommended to prevent similar incidents Corrective action s What has been done to control the recurrence of cause s Include dates for follow up to assure corrective action s are...

How to fill out near-miss form packet near-miss

How to fill out near-miss form packet near-miss

1. Obtain a near-miss form packet near-miss from your supervisor or the designated authority.
2. Read the instructions carefully to familiarize yourself with the form and the information required.
3. Begin filling out the form by providing your personal details such as name, employee ID, and contact information.
4. Identify the date and time of the near-miss incident.
5. Describe the location of the near-miss incident in detail.
6. Explain the nature of the near-miss incident and provide a clear description of what happened.
7. Identify the potential hazards associated with the near-miss incident.
8. Include any witnesses or individuals who were present during the near-miss incident.
9. Indicate if any safety measures were already in place or if any were violated.
10. Attach any supporting documents or evidence, such as photographs or diagrams.
11. Review your completed form for accuracy and completeness.
12. Submit the filled-out near-miss form packet near-miss to the appropriate authority or department.

Who needs near-miss form packet near-miss?

1. Any individual who witnesses or experiences a near-miss incident should fill out a near-miss form packet near-miss.
2. This includes employees, contractors, visitors, or anyone present at the time and location of the near-miss incident.
3. Filling out the form helps to document and report the near-miss, ensuring that appropriate measures can be taken to prevent future accidents or incidents.

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What is near-miss form packet near-miss?

Near-miss form packet is a document used to report incidents that almost resulted in an accident or injury.

Who is required to file near-miss form packet near-miss?

All employees are required to file a near-miss form packet when they witness or are involved in a near-miss incident.

How to fill out near-miss form packet near-miss?

To fill out a near-miss form packet, employees should provide details about the incident, including date, time, location, and description of what happened.

What is the purpose of near-miss form packet near-miss?

The purpose of a near-miss form packet is to identify potential safety hazards and prevent future accidents by addressing the root cause of near-miss incidents.

What information must be reported on near-miss form packet near-miss?

Information such as date, time, location, description of the incident, names of individuals involved, and any contributing factors must be reported on a near-miss form packet.