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  • Gi 6004 Supplement 1 - Near Miss Report Form Page 1 Of 1

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GI 6.004, Supplement 1 Near Miss Report Form Page 1 of 1 INCIDENT DETAILS Date: Time: Location/Plant/Equipment Dept: Org. Code Division/Unit Near Miss Description (Explain what happened use attachments.

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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.

A nurse comes to administer his medications, but inadvertently gives his pills to the other patient in the room. The other patient recognizes that these are not his medications, does not take them, and alerts the nurse so that the medications can be given to the correct patient.

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. The basics of recording near misses [with examples] fldata.com https://.fldata.com › near-miss-examples fldata.com https://.fldata.com › near-miss-examples

Employers must immediately report to Cal/OSHA any work-related death or serious injury or illness.

All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.

A near miss reporting form should contain the following: Date, time, and location of the near miss. Other details including the hazards involved. Person affected by the near miss and witnesses.

Near misses usually fall in one of the below categories: Slips and trips. Fall incidents. Narrow escapes. Working at heights. Improper hazard communication. Equipment operation & maintenance. Risky behaviour. Near Miss in The Workplace: All You Need To Know + Examples riskmach.co.uk https://.riskmach.co.uk › article › near-miss-in-the-... riskmach.co.uk https://.riskmach.co.uk › article › near-miss-in-the-...

Full Exemption: Federal And State-Regulated Industries Employers and employees who are regulated by the state or federal government are not subject to OSHA rules. For example, nuclear power plants and mining companies are regulated by government agencies, and they are not under the authority of OSHA.

Workers must report all workplace incidents, hazardous conditions, near misses, and property and environmental damage to their immediate supervisor as soon as possible. Near Miss Reporting Policy - OSHA Occupational Safety and Health Administration (.gov) https://.osha.gov › sites › default › files › Te... Occupational Safety and Health Administration (.gov) https://.osha.gov › sites › default › files › Te... PDF

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. Free Near Miss Report Form | PDF | SafetyCulture safetyculture.com https://safetyculture.com › checklists › near-miss-report safetyculture.com https://safetyculture.com › checklists › near-miss-report

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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
DMCA 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