Near Miss

Near Miss

Use for All Workers
Name*

First NameLast Name
Date*

MonthDayYear
Date
Time*

:HourMinutes
Division*

AbandonmentCompletionsConstructionDrillingHSEOperationsWell Servicing
Operations Area*

Avon HillColevilleCore NorthCore SouthDodslandCarrot CreekEdgertonHoosierMaintenanceMidstreamPlato
Completions Area*

AB - CompletionsSK - Completions
Abandonment Area*

AB - AbandonmentSK - Abandonment
Core South Runs*

Core South Chauvin Run #10Core South Chauvin Run #11Core South Chauvin Run #12Core South Chauvin Run #13
Core North Runs*

Core North Chauvin Run #00Core North Chauvin Run #01Core North Chauvin Run #02
Edgerton Runs*

Edgerton OperationsCzar Operations
Midstream Area*

Chauvin - Midstream
Well Servicing Area*

AB - Well ServicingSK - Well Servicing
Construction Area*

AB - ConstructionSK - Construction
Drilling Area*

AB - DrillingSK - Drilling
Carrot Creek Area*

AB - Operations
HSE Area*

AB - HSESK - HSE
Chauvin Area*

Chauvin - Operations
Maintenance Area*

Chauvin - MaintenanceSK - Operations - Maintenance - James Elliott
Avon Hill Runs*

Avon Hill - 2-15Avon Hill - 2-18Avon Hill - 5-26Avon Hill - 7-5Avon Hill - 8-13/14-27Avon Hill - 8-14Avon Hill - KerrobertAvon Hill - NWSUAvon Hill - Plenty 2-34Avon Hill - StranraerAvon Hill - Whiteside
Coleville Runs*

Coleville - 3-14Coleville - Run #1Coleville - Run #2Coleville - Run #3Coleville - Run #4 10-30Coleville - Run #5Coleville - Run #6
Dodsland Runs*

Dodsland - Run #1Dodsland - Run #2Dodsland - Run #3Dodsland - Run #4Dodsland - Run #5Dodsland - Run #6Dodsland - Run #7Dodsland - Run #8
Hoosier Runs*

Hoosier - Run #20Hoosier - Run #22Hoosier - Run #23Hoosier - Run #24Hoosier - Run #25Hoosier - Run #26Hoosier - Run #27Hoosier - Run #28Hoosier - Run #29Hoosier - Run #31Hoosier - Run #7Hoosier - Run #8
Plato Runs*

Plato - 11-7Plato - 13-12 BtyPlato - 13-12 WestPlato - 14-19Plato - Run #1 4-7Plato - Run #2Plato - Run #3Plato - Run #4Plato - Run #5 11-12Plato - Run #6 SUTPlato - Run #7 13-18Plato - Run #8 Elrose
Surface Location*
Downhole Location (if applicable)
Near Miss - an unplanned event that did not result in injury, illness, or damage – but had the potential to do so. Only a fortunate break in the chain of events prevented an injury, fatality or damage; in other words, a miss that was nonetheless very near.
Description of Near Miss - Who, What, When , Why, & How (include photos)*
Photos*

Take Picture / Upload Photo

Cancelof
Was immediate action taken*

YesNo
(if "Yes" describe what, who, how and when)*
Photos

Take Picture / Upload Photo

Cancelof
(if "No" describe what needs to done)*
Was a potential spill or release prevented*

YesNo
Prevention / Suggestions
Should be Empty:

Near Miss

Near Miss - an unplanned event that did not result in injury, illness, or damage – but had the potential to do so. Only a fortunate break in the chain of events prevented an injury, fatality or damage; in other words, a miss that was nonetheless very near.