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Near Miss Report

This near miss report describes a near miss incident that occurred on a project. It analyzes the incident in terms of substandard acts/practices, substandard conditions, personal factors, and job/system factors that may have contributed to the incident. Corrective actions are recommended to address these issues and prevent future incidents, including actions to be taken by specific individuals by set deadlines. The report is signed off by an HSE engineer and allows for additional comments.

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Rami Khedro
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320 views1 page

Near Miss Report

This near miss report describes a near miss incident that occurred on a project. It analyzes the incident in terms of substandard acts/practices, substandard conditions, personal factors, and job/system factors that may have contributed to the incident. Corrective actions are recommended to address these issues and prevent future incidents, including actions to be taken by specific individuals by set deadlines. The report is signed off by an HSE engineer and allows for additional comments.

Uploaded by

Rami Khedro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NEAR MISS REPORT

A Description C Analysis

Project: Company: Probability

Severity
Note: Refer to Risk Matrix

HSE Engineer Date: Substandard Acts / Practices


Operating equipment without authority
Failure to warn/secure
Corrective Actions / Recommendations Operating at improper speed
B Safety devices inhibited/removed/inoperable
Using defective equipment
Action/Recommendation By Whom When Failing to use PPE properly
Improper loading/ lifting
Improper replacement/ position for task
Servicing equipment in operation
Horseplay

Substandard Conditions
Inadequate guards / barriers/warning system
Inadequate or improper protective equipment
Defective tools, equipment or materials
Congestion or restricted action
Fire and explosion hazards
Poor Housekeeping /disorder
Radiation/noise exposure
Temperature extremes
Inadequate illumination/ventilation

Personal Factors
D Contractor Comments Inadequate capability-physical/mental
Lack of Knowledge
Lock of skill
Stress (physical/mental)
Improper motivation

Job/ System Factors


Inadequate Ieadership
Inadequate engineering
Signature: Date: inadequate tools, equipment materials
Inadequate maintenance
Abuse or misuse
E Comments inadequate supercision
Inadequate purchasing
Wear and tear

Signature: Date:

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