NEAR MISS REPORT

A near miss is an unplanned event which has not resulted in injury, illness or damage. The incident could however have had the potential to result in injury, illness, loss or damage and therefore the reporting of such incidents will assist in the monitoring of risks and enable the company to add additional control measures where applicable. Please note, where actual injury has occurred an Accident Report Form should be completed.

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DD slash MM slash YYYY
Person involved initials and date in DDMMYYYY format, i.e LT01012025
PERSON(S) INVOLVED*
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    PERSON COMPLETING THIS FORM*
    DD slash MM slash YYYY
    Clear Signature
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