Unsafe Condition or Hazard / Near Miss
This form should be filled out by any Bus Operations staff when any unsafe condition or hazard exists that could potentially cause injury of person, damage to transportation system property or the environment.

Bus Operations staff driving any Rio Metro vehicles should complete this form whenever a Near Miss occurs (this is an incident WITHOUT injury to person or damage to property). If passengers, personnel or property were injured or damaged during the incident, DO NOT USE this form and use the ACCIDENT OR INCIDENT REPORT FORMS.

Unsafe Condition:
Is an unsatisfactory (unhygienic) physical condition that exists at the workplace especially immediately before an accident which had a crucial role in triggering the incident.

Hazard definition:
Is any real or potential condition that can cause injury, illness, or death, damage to or loss of the facilities, equipment, rolling stock or infrastructure of a public transportation system; or damage to the environment.

Near Miss Definition:
Is an accident or other safety incident that could have happened but did not. If ignored, near misses can lead to serious consequences. They are an opportunity to improve safety practices. Minor incidents are included in this definition.

Why should I report an Unsafe Condition or Hazard?
Information from your unsafe condition/hazard report makes the work environment safer and healthier for you and your co-workers. From your report, Rio Metro Regional Transit District (RMRTD) can identify and correct factors that contribute to accidents, incidents and/or injuries.

Why should I report a Near Miss? From your report RMRTD can:

• analyze near misses to identify trends in near misses and new sources of risk as well as preventive safety actions that address these trends and new sources of risk.
• disseminate reports on trends in near misses, new sources of risk, and preventative safety actions taken to increase safety for RMRTD operations.
• tracks RMRTD’s reports on preventative safety actions to measure RMRTD’s safety program’s impact on safety.

Can you be disciplined for reporting a Near Miss?
No action will be taken against any employee who communicates a safety condition through the RMRTD safety reporting program unless such disclosure indicates the following: an illegal act, gross misconduct or negligence, or a deliberate or willful disregard of RMRTD rules, policies, and procedures.

How do I report an Unsafe Condition or Hazard/Near Miss?
You can complete this report and give it your immediate supervisor. If you wish to remain anonymous, you can complete this report and drop it in the suggestion box at your location, call or text RMRTD’s Safety Hotline at 1-855-662-SAFE (1-855-662-7233) provide or enter ID Number 0711430663 (ID Number is required for making reports), or login to Rio Metro’s Intranet and in the Safety Section select this form to complete it and submit it and it will be sent to the appropriate personnel for review and investigation.

The employee’s Manager or Designated Person is responsible for investigating the unsafe condition/work practice. Management is also responsible for ensuring that this form is documented and tracked to resolution. A copy of the completed. The Unsafe Condition and Hazard/Near Miss form will be provided to the employee who submits it with the employee’s name. For anonymous submission, a copy of this form will be posted on the bulletin board for 30 days after management signs off.
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