Near-Miss Report
MUSC Shawn Jenkins Children's Hospital and Women's Pavilion
Definition
A Near hit (sometimes called a Near miss) is an unplanned event that did not result in an injury, illness, or property damage - but it could if left uncorrected, so we report the issue.
CHECK APPROPRIATE LEVEL *
LOCATION: *
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YOUR NAME: (optional)
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COMPANY: *
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TIME: *
Time
:
DATE: *
MM
/
DD
/
YYYY
GROUND SURFACE (if applicable):
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WEATHER CONDITIONS (if applicable):
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REPORTED BY (optional):
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DESCRIBE NEAR HIT: *
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WHAT COULD HAVE BEEN DONE BETTER? *
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IDENTIFIABLE ROOT CAUSES: (optional)
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