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Near Miss Reports

PN
By Penno TeamCreated 2/5/2025
ReportsPolicies and ProceduresSafety and Compliance Documents

Near Miss Report Template

1. Report Overview

This section provides a brief overview of the near miss incident, including the date, time, and location.

  • Date: [Insert Date]

  • Time: [Insert Time]

  • Location: [Insert Location]

2. Description of the Incident

Detail the events leading up to the near miss, including any relevant actions taken by personnel.

Example: "On [Insert Date], at approximately [Insert Time], a near miss occurred when [describe the incident]."

3. Contributing Factors

Identify any factors that contributed to the near miss, such as equipment failure, human error, or environmental conditions.

  • [Factor 1]

  • [Factor 2]

  • [Factor 3]

4. Immediate Actions Taken

Document any immediate actions taken in response to the near miss.

Example: "Following the incident, [describe actions taken]."

5. Recommendations for Prevention

Provide recommendations to prevent similar incidents in the future.

  • [Recommendation 1]

  • [Recommendation 2]

  • [Recommendation 3]

6. Follow-Up Actions

Outline any follow-up actions that will be taken to address the near miss.

Example: "A follow-up meeting will be held on [Insert Date] to discuss further actions."

A structured template for documenting near miss incidents to enhance safety and compliance.
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This template is designed to help organizations document near miss incidents effectively, ensuring safety and compliance. It includes sections for incident description, contributing factors, immediate actions, recommendations, and follow-up actions.

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