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Get Gi 6004 Supplement 1 - Near Miss Report Form Page 1 Of 1
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How to fill out the GI 6004 Supplement 1 - Near Miss Report Form Page 1 Of 1 online
Completing the GI 6004 Supplement 1 - Near Miss Report Form online can streamline the reporting process and ensure accurate documentation of incidents. This guide will provide you with clear, step-by-step instructions to help you effectively fill out the form.
Follow the steps to complete the form online.
- Click ‘Get Form’ button to obtain the form and open it for completion.
- Enter the date of the incident in the designated field. Ensure that the format is accurate and reflects the month, day, and year.
- Input the time of the incident in the provided field, using a 24-hour or 12-hour format as indicated.
- Fill in the location, plant, or equipment where the incident occurred, providing enough detail for clarity.
- Complete the department and organization code fields to specify the relevant department involved in the incident.
- In the division/unit section, enter the specific division or unit that pertains to the report.
- In the near miss description field, provide a thorough explanation of what transpired, and use attachments for more detailed accounts if necessary.
- Estimate the potential loss by describing possible injuries, property/equipment damage, environmental damage, or any other pertinent losses.
- In the analysis section, detail the factors contributing to the near miss, including any unsafe acts, conditions, wrong procedures, or inefficient equipment.
- List corrective actions that need to be implemented to prevent future occurrences of similar incidents.
- Fill in the reviewer information, including the name, title, and badge number of the supervisor or above who has reviewed the report.
- Select the appropriate distribution options, ensuring that original and copies are filed according to the established guidelines.
- Lastly, save the changes you made, then download, print, or share the completed form as needed.
Complete your GI 6004 Supplement 1 - Near Miss Report Form online today to ensure timely and effective reporting of incidents.
Related links form
Minor incidents/injuries that had potential to be more serious. Events where injury could have occurred but didn't. Events where property damage could have resulted but didn't. Events where a safety barrier was challenged, such as a worker bypassing a machine guard.
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