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RMP 7c Near Miss Form Issue 1
RMP 7c Near Miss Form Issue 1
This form should be completed by any employee who witnesses a near-miss incident, such
as collapsing shelves, items falling from height, charred or burnt electrical equipment or
furniture, or a slip on a slippery surface, where the person did not actually fall. Heads of
Departments may complete the form on behalf of the person who witnessed the near-miss.
Your name:
Location of near-miss:
Date of near-miss:
Time of near-miss:
Please send all completed forms to the HR & Health & Safety Officer.
RMP/7b
All near-misses will be reviewed by the College’s Health & Safety Working Group and retained for a
period of not less than 7 years.
RMP/7b