Near Miss Checklist

This checklist is used after a narrowly avoided accident, or ‘near miss’, that could have caused injury, illness or death to a person, or damage to property, given a slight shift in position or circumstance. With this checklist, you can record the date, time, location and description of the near miss incident, and include opinions on its probability of reoccurrence. This information can be used to prevent similar and potentially more serious accidents from happening again and for raising risk awareness within an organization.


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