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Hazard / Near Miss
Reporting Form n g
t ti
NG
C h a time:Identify hazard / near miss: (What? Where?)
Risk Assessment
Consequences:CatastropicMajorModerateMinorWhat did you do to eliminate, isolate
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How to fill out hazard near miss p
How to fill out hazard near miss p
01
Begin by identifying the hazard or near-miss incident that needs to be reported.
02
Gather all relevant information about the incident, including the date, time, and location, as well as any witnesses or individuals involved.
03
Use the provided hazard near-miss p form to document the details of the incident. Be thorough and specific in your descriptions.
04
Make sure to include any contributing factors or root causes that may have led to the hazard or near-miss incident.
05
If applicable, suggest any corrective actions or recommendations that could help prevent similar incidents in the future.
06
Sign and date the hazard near-miss p form to acknowledge that the information provided is accurate.
07
Submit the completed form to the designated person or department responsible for hazard and near-miss reporting.
Who needs hazard near miss p?
01
Anyone who encounters or witnesses a hazard or near-miss incident needs to fill out the hazard near miss p form.
02
This includes employees, contractors, visitors, and anyone else who may be present at the time of the incident.
03
By reporting hazards and near-miss incidents, individuals can contribute to the overall safety and well-being of themselves and others in the workplace.
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