Good Catch / Near Miss Report Form
Date
*
-
Month
-
Day
Year
Date
Name
*
Location
*
Activity
*
Please Select
Drilling
Completions
Production
Workover
Midstream
Other (Specify)
Specify Other
Good Catch/Near Miss?
*
Good Catch (Nothing happened)
Near Miss (Something happened - but no injury or spill occurred)
Describe the Condition Found (Nothing happened)
*
Example: valve had a wet spot on it.
Describe the Near Miss (Something happened but no injury or spill occurred)
*
Example: Stair tread on walkover collapsed when it was stepped on.
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of
Was the situation corrected?
*
Yes
No
What Actions are needed?
What was done in order to prevent an incident from occurring?
Example: Caution tape, entered a work order for repairs, lockout/tagout until repairs can be made.
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