INCIDENT FORM
FRM-011
NEAR-MISS REPORT
What almost happened, and what will change so it does not.
- DOCUMENT
- GOSPEL-FRM-011
- REVISION
- 01 CURRENT
- EFFECTIVE
- 2026-09-01
- OWNER
- GOSPEL Safety
- APPROVED BY
- GOSPEL
- REVIEW
- 2027-09-01
FILL THIS FORM — DOWNLOAD PDF →
WHEN
Same shift as the near miss.
CAPTURE
- Event
- What prevented the injury or drop
- Gear and conditions
- Suggested control
ROUTING
The supervisor or the employer the same day. See Report a Near Miss.
PROVENsin(). Current version on this site.