Get Near Miss Report Form

Filling out the Near Miss Report Form online is essential for documenting incidents that could have led to accidents. This guide provides step-by-step instructions to ensure accurate completion of the form, promoting safety and awareness in your workplace.

Follow the steps to complete the Near Miss Report Form effectively.

1. Click the ‘Get Form’ button to obtain the Near Miss Report Form and open it in your selected online platform.
2. Enter the club name in the designated field at the top of the form to identify your organization.
3. Fill in the date when the form is being completed.
4. Provide the details of the incident by entering the date and time when the incident occurred.
5. Specify the exact location of the incident on-site to help in further investigations.
6. List the name(s) of those who witnessed the incident in the 'Incident Witnessed By' section.
7. Complete the 'Incident Form Completed By' section with your name to ensure accountability.
8. In the 'Person Details' section, fill in the person's name, job title, and date of birth.
9. Select the gender of the person involved, if relevant.
10. Enter the name of the supervisor overseeing the individual involved in the incident.
11. Indicate the status of the person involved by selecting one of the options: employee, contractor, or visitor.
12. In the 'Incident Description' section, provide a detailed account of what transpired, including any treatment given.
13. Document any immediate corrective actions that were taken to prevent escalation of the situation.
14. Conduct a root cause analysis by checking applicable reasons in the list provided and commenting on the selected items.
15. Sign the declaration section with your name and the date.
16. Have the manager sign and date the form to finalize the report.
17. Once all fields are completed, save the changes, download the form, print it, or share it according to your needs.

Take a proactive step toward workplace safety by completing the Near Miss Report Form online today.