Get Near Miss Format 2020-2025

Filling out the Near Miss Format is an important step in ensuring workplace safety. This guide provides clear and concise instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully fill out the Near Miss Format online.

1. Click ‘Get Form’ button to access the Near Miss Format and open it in your preferred editor.
2. Begin by entering the name of the injured person(s) in the designated field. Be sure to provide accurate names to ensure proper follow-up.
3. Next, record the date of the accident, incident, or near miss. Use the date picker or type the date in the specified format.
4. Indicate the nature of the event by selecting the appropriate options, such as 'accident,' 'near miss,' 'undesirable occurrence,' or 'ill health.'
5. In the section detailing the incident or accident, describe what the injured person was doing at the time. Be thorough yet concise.
6. Explain how the injury or damage occurred and identify any contributing factors. This information is crucial for understanding and mitigating risks.
7. Describe the specifics of the injuries or damage that occurred. Include any ongoing problems that may require attention.
8. Outline any emergency measures that were implemented in response to the incident. This may include first aid or evacuation procedures.
9. List the names of any witnesses who observed the incident. Accurate witness accounts can assist in further investigations.
10. Record the name of the task leader in the area where the incident occurred. This provides accountability and oversight.
11. Detail any equipment involved in the incident, including the name, model number, and serial number if applicable.
12. Note any unusual conditions or problems present in the work environment that may have contributed to the incident.
13. Assess whether adequate safety procedures and risk assessments were in place and if they were followed at the time of the incident.
14. Indicate what personal protective equipment (PPE) was being worn by the injured party or those present.
15. Confirm if all parties understood the risk assessment and safety instructions. If applicable, state the first language of the involved individuals.
16. Provide any recommendations to reduce risks or eliminate hazards based on the incident analysis.
17. Complete the initial investigation section with the investigator's name (in capitals), date, and signature.
18. Use the designated field to indicate if further investigation is required by selecting Yes or No.
19. Finally, send a copy of the filled-out form to the specified email or mailing address for proper documentation and follow-up.

Ensure workplace safety by completing the Near Miss Format online today.