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Good Catch Form
Project
Company Name:
*
Date & Time
Incident Type
*
Good Catch = Unsafe conditions, opportunities for improvement
Near Miss = An unplanned event which did not result in injury, illness or damage but had the potential to do so
What type of Hazard?
*
Arc Flash
Batteries
Confined Space
Electrical
Environmental
Excavation and Trenches
Fall Protection
Fire/ Hot Work
Hand/ Power Tools
HazCom
Heavy Equipment
Housekeeping
Ladders
LOTO
Material Handling
Motor Vehicles
Operating Equipment
Personal Protective Equipment PPE
Walking/ Working Surfaces
Other
Description of Event:
*
Immediate Action Taken:
*
Suggestions to Prevent Similar Occurrence/ Corrective Actions:
*
Your Name (optional)
First Name
Last Name
Submit
Should be Empty: