Near miss report form
Sharing is caring and sharing near misses in the tall ships fleet will hopefully improve and sharpen routines and security for the international fleet. By reporting you help everyone to improve.

Purpose:
The general idea of the system is to improve safety at sea by aiding Training Ship operators to share knowledge about near misses.

How does the system work?
All reports are reviewed by the Near Miss group. The most useful of the reports are every three months compiled and published on the STI website. An important part of the form is, that the operator indicates whether the report should be anonymized before being publicized. The anonymized report will be approved by the operator before being put on the website. The operator keeps the ownership of the report and can remove it at any time.
Every year at the STI conference two or three reports which are especially interesting will be presented by the Near Miss
group. Whenever possible the report should be introduced by its author.

The Near Miss group:
The group is a working group operating under the ExCom. The members are appointed every year at the STI conference.
There should be representation from operators as well as mariners in the group.

Overall principles:
• The ownership to the reports and incidents resides and remains at the ship operator.
• Knowledge sharing is voluntary.
• The STI system of Near Miss reporting is based on a no blame approach.
• The Near Miss group, the ExCom and STI encourages reporting of near misses to aid safety at sea.

Why do we make Near Miss reports?
To motivate the filing of reports, it is essential that users know WHY the reports are valuable. And the reasons are:
1) Writing the report prompts the involved persons to reflect on what happened, why it happened and what they can do to prevent a similar situation from re-occurring, and
2) The report becomes even more meaningful when they share their experience, so others also can benefit from the lessons learned.

What is a Near Miss?
A Near Miss is an incident that could have led to an accident (e.g. injury or pollution) under slightly different circumstances.The exact definition is often debated, but the general view is as illustrated below. To keep things simple and to ensure inclusion of all relevant situations, STI recommend that you report the first three categories (i.e. unsafe condition, unsafe act and near miss) and simply call them all Near Miss.

Use of names in the reports
To build confidence in the Near Miss system and to ensure that the crew members feel trust the reporting set-up, we
recommend that the reports do not include names of the persons involved in the incident.

About making a Near Miss rapport
The text should be short, concise and just detailed enough to understand the key elements of the situation. The report
information should – to the extent possible – be clearly split into sections of facts, analysis and conclusion.

Email address *
Do you want your report to be anonymous? *
Name of vessel *
Your answer
Class of vessel *
Name of captain at time of incident *
Your answer
Name of report writer *
For potential clarification purposes. In the rest of the report, please only use ranks or titles, not individual names.
Your answer
Nationality of report writer *
For potential clarification purposes. In the rest of the report, please only use ranks or titles, not individual names.
Your answer
E-mail of report writer *
For potential clarification purposes.
Your answer
Telephone of report writer *
For potential clarification purposes.
Your answer
Date of incident: *
MM
/
DD
/
YYYY
Place *
Be as specific as possible, e.g. which port, where at sea, where on ship?
Your answer
Type of incident *
What work process was taking place? *
Your answer
How were the weather conditions (wind, visibility, swell)? *
Your answer
Where there any special challenges or unusual conditions? *
Your answer
Description of event *
Describe the near-miss situation and the events up to the situation, starting with the first deviation from normal, and ending with the hazardous situation. If helpful, you can make a timeline to show the sequence of events.
Your answer
Possible consequences of the situation *
Worst case scenario – what could have happened, e.g. fire or deadly injury, etc
Your answer
What caused the situation *
Look at the description above: When did thing first deviate from normal? What caused that deviation? Keep asking questions to the causes until you are at the bottom of the reasoning (e.g. he didn’t wear harness. WHY? Because he didn’t know about the harness. WHY? Because he was not attending the safety course. WHY? Because he was sick and not called in for an extra course. WHY? etc
Your answer
Corrective and preventive actions *
Corrective actions: Immediate actions to control the risky situation. Preventive actions: Forward-looking activity to prevent the situation from occurring again, e.g. adding a new task to the planned maintenance list. When evaluating the actions to be taken, make sure to consider actions on board and ashore; practical matters as well as administrative/system matters.)
Your answer
Lessons learned *
What have we learned from this – and what can others learn? E.g. “We need a structured approach to ensuring that everybody takes the safety course” or “We will not only check our own PPE, but also our colleagues’ PPE”.)
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service