INCIDENT FORM
FRM-011FRM-011
NEAR-MISS REPORT
What almost happened, and what will change so it does not.
- TYPE
- FORM
- DOCUMENT
- PROVEN-FRM-011
- STATUS
- CURRENT
- REVISION
- 01
- EFFECTIVE
- 2026-09-01
- OWNER
- Proven
- APPROVED BY
- Proven
- REVIEW
- 2027-09-01
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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.
PROVEN. Current version on this site.