Get Near Miss Reporting Form

Filling out the Near Miss Reporting Form online is essential for documenting and addressing incidents effectively. This guide will lead you through each section of the form to ensure you provide accurate and comprehensive information.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor for completion.
2. Begin by entering the details of the incident including the expedition name, date, time, and location. Make sure all information is accurate and up-to-date.
3. Provide the GPS reference to pinpoint the exact location of the incident. This aids in future preventative measures.
4. Describe the site and the weather conditions at the time of the incident. These factors can provide essential context.
5. List the names and addresses of all individuals involved. Accurate identification will be vital for follow-up.
6. Document any injuries diagnosed, including by whom they were diagnosed and the treatment that was administered onsite. This should be detailed and thorough.
7. State what medication, if any, was provided, including the name of the person who administered it.
8. Assess the overall condition of the casualty. If the casualty was unconscious, indicate the level of unconsciousness.
9. Detail any actions taken, including how the casualty was evacuated, their state during evacuation, and final location.
10. Provide a full account of the accident or incident, noting any photographs taken, diagrams, or other relevant information.
11. List witness names, addresses, signatures, and any relevant notes they may have.
12. Include the contact information for the hospital or clinic that treated the casualty.
13. Record the names of trip leaders and obtain their signatures, confirming the details are accurate.
14. Provide supplementary information regarding whether the incident was preventable and recommendations for future prevention.
15. Confirm if the relevant office has been informed and include the name, signature, and date of the person completing the report.
16. For communications with the insurance company, provide the name of the company, policy number, and contact details for the individual who made the call.
17. Log the communication with the insurance company detailing the date and time of the first communication, along with case reference number.
18. Finally, save your changes, download the form, or print it for your records.

Start completing your Near Miss Reporting Form online now and ensure accurate reporting.