Good Catch Form

GOOD CATCH FORM

Azalea Springs 9300005
Project Name:
Project Number:
Date

MonthDayYear
Date
NEAR MISS:

An unplanned event which did NOT result in injury, illness or damage but had the potential to do so.

GOOD CATCH:

Unsafe conditions or opportunities for improvement.
Area/ Location:
Type:

Other
Description of Occurance:
Immediate Action(s) Taken:
Suggestions for Prevention:
Contact For Follow Up (optional)
Name:
Company:
Should be Empty: