Near Miss Report
Facility Info
Facility
Operations Manager
Incident Type
Near Miss
Recordable
First Aid
Reportable
Employee Name
Logged in as:
Employee ID
Address 1
Address 2
City
State
Zip
Department
Employee Category
Job Code
Job Start Date
Gender
Female
Male
Race
Date Of Birth
Employee Notes
Incident
Incident Date / Time
Date / Time of Employers Knowledge
Time Started Work
Time Ended Work
Reason For Accident
Severity
Recurrence Probability
Corrective Action URL
Corrective Action
Corrective Action Assessment
Corrective Action Status
Completed
Immidiate Action Completed
N\A