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  • Near Miss Form

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    Edo-Abasi Ekere
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    MISS FORM: WHY THIS INCIDENT WAS CONSIDERED A "NEAR MISS" POSSIBLE INJURY / HARM(WHAT COULD HAVE HAPPENED) WHAT PREVENTED IT FROM HAPPENING? WAS THE INCIDNET DISCUSSED WITH PERSON(S) INVOLVED?

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    MISS FORM: WHY THIS INCIDENT WAS CONSIDERED A "NEAR MISS" POSSIBLE INJURY / HARM(WHAT COULD HAVE HAPPENED) WHAT PREVENTED IT FROM HAPPENING? WAS THE INCIDNET DISCUSSED WITH PERSON(S) INVOLVED?

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    8 views1 page

    Near Miss Form

    Uploaded by

    Edo-Abasi Ekere
    MISS FORM: WHY THIS INCIDENT WAS CONSIDERED A "NEAR MISS" POSSIBLE INJURY / HARM(WHAT COULD HAVE HAPPENED) WHAT PREVENTED IT FROM HAPPENING? WAS THE INCIDNET DISCUSSED WITH PERSON(S) INVOLVED?

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    MISS FORM

    NAME OF EMPLOYEE: DEPARTMENT: NAME OF SUPERVISOR: NATURE INCIDENT: WHY THIS INCIDENT WAS CONSIDERED A NEAR MISS

    POSSIBLE INJURY/HARM(WHAT COULD HAVE HAPPENED)

    WHAT PREVENTED IT FROM HAPPENING?

    WAS THE INCIDNET DISCUSSED WITH PERSON(S) INVOLVED?

    WHY OR WHY NOT?

    REMEDIAL ACTIVITIES 0R TRAINING RECOMMENDED TO PREVENT REOCCURRENCE

    DATE:

    SIGNATURE:

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