NEAR MISS
A near miss is an unplanned event that did not result in injury, illness, or damage – but had the potential to do so.
Name:
Location of near-miss:
Date of near-miss:
MM
/
DD
/
YYYY
Time of near-miss:
Time
:
Please describe the near-miss you witnessed:
Names of any other witnesses:
Submit
Never submit passwords through Google Forms.
This form was created inside of Lower Macungie Fire Department. Report Abuse