PSKC Accident / Incident / Near Miss form
This form should be used to record any incidents, accidents or “near misses”. A separate form should be filled in by all those involved as soon as practicable after the incident has occurred.
Date of occurrence *
MM
/
DD
/
YYYY
Time of occurence *
Time
:
Location *
Your answer
Weather conditions *
Your answer
Individuals involved *
Your answer
Describe the event *
Your answer
Name other witnesses *
Your answer
Actions taken *
Your answer
Recommendations *
Your answer
Your name *
Your answer
Date *
MM
/
DD
/
YYYY
Submit
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