Get the free Near-Miss Supervisor s Report Form / Permit: NMSR 1 2

Authority President Policy Doc ACCINV Form / Permit NMSR Form 206 Page 1 of 2 Issuing Dept Safety Date Occurred NMSUPR Revision Date Time Occurred Date Reported Exact Location of Near Miss Who was notified Company person contacted etc Witnesses address and phone number Did you obtain witness statements Yes No Did you take photos What happened Objective Summary Diagram the scene on back if appropriate. SCAR SafetyManuals SafetyFormLibrary NearMissSupervisorReport. docx If yes was operator...

How to fill out near-miss supervisor s report

How to fill out near-miss supervisor s report

1. Step 1: Gather all necessary information about the near-miss incident, such as date, time, location, and description.
2. Step 2: Identify the individuals involved in the incident and obtain their contact information.
3. Step 3: Write a detailed account of the near-miss incident, including what happened, how it happened, and any contributing factors.
4. Step 4: Document any injuries or property damage that occurred as a result of the near-miss incident.
5. Step 5: Analyze the root cause of the near-miss incident and determine any corrective actions that need to be taken.
6. Step 6: Complete the supervisor's report form provided by your organization, ensuring that all required fields are filled out accurately.
7. Step 7: Review the report for any errors or omissions before submitting it to the appropriate department or supervisor.
8. Step 8: Keep a copy of the completed report for your records, as well as any supporting documentation.
9. Step 9: Follow up with any additional information or actions required by your organization in relation to the near-miss incident.
10. Step 10: Regularly monitor and review near-miss reports to identify any trends or patterns and implement proactive measures to prevent future incidents.

Who needs near-miss supervisor s report?

1. Supervisors or managers responsible for overseeing workplace safety.
2. Health and safety departments within organizations.
3. Regulatory authorities or inspectors conducting audits or investigations.
4. Insurance companies or risk assessors evaluating workplace safety practices.
5. Workers or employees who want to report a near-miss incident to their supervisors for appropriate action.
6. Safety committees or teams within organizations working towards continuous improvement in safety measures.

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What is near-miss supervisor's report?

Near-miss supervisor's report is a document that records details of incidents or situations that nearly caused harm or damage in the workplace.

Who is required to file near-miss supervisor's report?

All supervisors and managers are required to file near-miss supervisor's reports when incidents occur.

How to fill out near-miss supervisor's report?

To fill out a near-miss supervisor's report, provide details of the incident, including date, time, location, individuals involved, and a description of what happened.

What is the purpose of near-miss supervisor's report?

The purpose of near-miss supervisor's report is to identify potential hazards or risks in the workplace and prevent future incidents.

What information must be reported on near-miss supervisor's report?

Information such as date, time, location, description of incident, individuals involved, and any actions taken to address the near-miss must be reported on near-miss supervisor's report.