It is important to complete this NEAR MISS Report Form after a near miss incident has occurred.
This form is
for Incidents or Accidents where a person is injured or there is a likelyhood of the incident causing a dangerous situation to persons on-site or the community at large.
Where the Near-Miss occurance is potentially hazardous and poses a risk to the well-being of personnel on-site or the community an Incident/Accident Report Form MUST be used. If the incident or near miss is serious – you are obligated to contact a the principle builder and Safe Work SA using the Incident/Accident Investigation Report Form.
This form is to be filled out the person witnessing the near miss occurance, and inform the Site Supervisor in charge or the person In-Charge of the work task or area of the occurance immediately.
The PCBU management staff
should be informed by providing a copy (on-line) of this report form.
All site stakeholder must be informed of the near miss occurance through a toolbox meeting. This is done to ensure all site personnel are aware of the potential risks/hazards involved and a heirachy of controls instigated to mitigate the problem.
Please fill out the below information: