Chain of Responsibility - Hazard and Near Miss Reporting Form
This is an example form for capturing information when personnel experience near misses or identify hazards or opportunities for improvements. It has been designed to assist with identifying and documenting safety risks with the potential to cause loss or harm and identifying and documenting corrective actions to reduce or eliminate those risks.
This form is intended to provide feedback on potential issues before an incident/accident occurs. If there has already been an incident (e.g. injury, property damage) use the incident reporting form and not this form.