Near-Miss Report

A “NEAR-MISS” is a potential hazard or incident that has not resulted in any personal injury. Unsafe working conditions, unsafe employee work habits, improper use of equipment or use of malfunctioning equipment have the potential to cause work related injuries. It is everyone’s responsibility to report and/or correct these potential accidents/incidents immediately. Please, complete this form as a means to report these “NEAR-MISS” situations.
  • Select your location
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • :
  • (i.e.: Unsafe Act, Unsafe Condition, Unsafe Equipment, Unsafe use of Equipment)

  • (Remove the Hazard, Replace, Repair or Retrain in the proper procedures for the Task)
  • MM slash DD slash YYYY
  • MARC CAMACHO – HSE / Fleet Mgr.
    Cell: 956-874-4530