Incident and Near-Miss Report Form

Significant hazard
Has a significant hazard been identified?*

YesNo
Details
Please investigate this hazard and update the Hazard Register in your department or section accordingly.
Chance of the near miss, incident or accident reoccurring:*

One offDailyWeeklyMonthly6 Monthly +
Prepared by
Reviewed by
Approved by
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Should be Empty:

Incident and Near-Miss Report Form - RCI