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WORKPLACE SAFETY CONCERN OR INCIDENT REPORT FORM (20132014 SY) *** IMPORTANT *** WORKPLACE SAFETY CONCERNS OR INCIDENTS MUST BE VERBALLY REPORTED TO YOUR ADMINISTRATOR / SUPERVISOR PRIOR TO OR WITH.

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In general, here is the information you should include in a near miss report: Date, time, and location of the incident. Department. Incident description. Root cause (behavior, equipment, etc.) Supporting documents (photos, hazard analyses, etc.) Next steps and specific action items.

In general, here is the information you should include in a near miss report: Date, time, and location of the incident. Department. Incident description. Root cause (behavior, equipment, etc.) Supporting documents (photos, hazard analyses, etc.) Next steps and specific action items.

Near miss reports should contain the following: Date, time, and location of the near miss event. Hazard/s that triggered the near miss event. Description of how the near miss event occurred. Possible consequences avoided. Signature/s of the employee/s affected.

How to Write a Safety Incident Report Worker Characteristics. Injury / Illness Characteristics. Description and Sequencing of Events. Time factors and working conditions. Description of task(s) being performed when the. ... Characteristics of any equipment associated with the. ... Supervision information. Causal factors.

An incident report is a tool that documents any event that may or may not have caused injuries to a person or damage to a company asset. It is used to capture injuries and accidents, near misses, property and equipment damage, health and safety issues, security breaches and misconducts in the worksite.

A car almost hits a pedestrian in a crosswalk. An elevator door starts to close but opens again when someone steps in front of it. A piece of machinery breaks but does not cause any injuries. A gas leak is detected and fixed before it causes any harm.

A near miss, near death, near hit or close call is an unplanned event that has the potential to cause, but does not actually result in human injury, environmental or equipment damage, or an interruption to normal operation.

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.

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© Copyright 1997-2025
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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
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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