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Get Near-miss Report Form
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How to fill out the Near-Miss Report Form online
Completing a near-miss report form is essential for identifying and addressing potential safety hazards. This guide will provide you with detailed, step-by-step instructions on how to fill out the Near-Miss Report Form online to help ensure workplace safety at Texas Tech University.
Follow the steps to successfully complete the Near-Miss Report Form
- Click the ‘Get Form’ button to access the Near-Miss Report Form and open it for editing.
- Begin by filling out the 'Department' field with the relevant department name to identify where the near-miss occurred.
- In the 'Building' section, specify the building where the incident took place to provide clear location context.
- Indicate the 'Time of Incident' by selecting either am or pm from the provided options.
- Provide the 'Room #' where the near-miss incident occurred, if applicable, to help pinpoint the exact location.
- Enter the 'Date of Incident' to document when the near miss took place.
- Select your 'Designation' from the options provided, including Faculty, Staff, Student, or Other, to clarify your role.
- Check all appropriate conditions related to the incident, such as 'Near miss', 'Safety concern', 'Safety suggestion', or 'Other'.
- Identify the 'Type of concern' by selecting from options like 'Unsafe act', 'Unsafe condition', 'Unsafe equipment', 'Unsafe use of equipment', or 'Other'.
- Thoroughly describe the potential incident, hazard, or concern, including possible effects, in the provided space to ensure a comprehensive report.
- Optionally, provide your 'Name' and 'Date Reported' to help track the report.
- Fill in your 'Contact Information' for follow-up purposes.
- Once you have completed all sections, submit this form to Environmental Health & Safety as instructed. Remember to save your changes or download the form if needed.
Complete the Near-Miss Report Form online today to contribute to a safer environment.
Many near misses go unreported due to a lack of awareness or understanding of their importance. Some employees may feel that near misses are minor and not worth documenting. Educating teams about the value of the Near-Miss Report Form can encourage timely reporting and foster a stronger safety culture.
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