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Accident Incident and Near Miss Report Form. Form completed by Expedition Date Time Location GPS Reference Description of site Weather conditions Name s of person s involved Address es What injury was diagnosed by whom What treatment was given at the site and by whom What medication was given By whom Overall assessment of casualties condition If unconscious what level Action taken including description of how the casualty was evacuated state of casualty during evacuation and where evacuated to if applicable Full details of accident / incident and action taken were any photographs were taken and by whom Include a diagram if appropriate Any other relevant information relating to this accident / incident Names addresses and signatures of witnesses with any relevant notes Name address telephone number of hospital/clinic Names of Trip Leaders Signatures I / We confirm that this the details on this form have been correctly recorded Name s signature s of the person s in charge of the group Su....

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A near-miss is a potential hazard or incident in which no property was damaged and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred.

Near miss reporting procedures: Report the near miss incident, no matter how small or who it happens to. Make sure the scene of the incident is secured as fast as possible. Communicate the incident to supervisors and the safety department. Fill out a near miss report with the exact details of the incident.

Near-Miss Incident Report Form. A near-miss is a potential hazard or incident in which no property was damaged and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred.

All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.

Note 1 to entry: An incident where injury and ill health occurs is sometimes referred to as an “accident”. Note 2 to entry: An incident where no injury and ill health occurs, but has the potential to do so, may be referred to as a “near-miss”, “near-hit” or “close call”.

Workers must report all workplace incidents, hazardous conditions, near misses, and property and environmental damage to their immediate supervisor as soon as possible.

In law, you must report certain workplace injuries, near-misses and cases of work-related disease to HSE. This duty is under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations, known as RIDDOR.

Below are 10 examples of near misses that you might encounter in the workplace. A PIT driver runs into the side of pallet racking without causing damage. A worker trips over discarded boxes on the floor without sustaining an injury. Two workers throw tools across the workspace to each other and nearly hit a coworker.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232