Get Workforce Safety & Insurance Near Miss Report
That has not resulted in any personal injury . Unsafe working conditions, unsafe employee work habits, improper use of equipment or use of malfunctioning equipment have the potential to cause work related injuries. It is everyone’s responsibility to report and /or correct these potential accidents/incidents immediately. Please complete this form as a means to report these near-miss situations. Department/Location ________________________________ Date: _____________________ Time ___________ a.
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