Artifactory Incident(near misses) Report
This report helps in documenting the exact details of incidents or near misses to people or property while they are fresh in the minds of those who witnessed the event. Everyone has a duty to report incidents.

The Artifactory Committee will be in touch should further information or a followup on the incident be required.

Full Name *
Your answer
Contact email address / Phone Number *
Your answer
What happened? (or in the case of a near miss, what could have happened) *
Your answer
Who was involved? *
Your answer
Where did it happen? *
Your answer
When did it happen? (Date and Time) *
Your answer
Did anyone else witness the incident? If so please include contact details. *
Your answer
Were there any Injuries? (Description of injuries including parts/sides of the body affected) *
Your answer
Was there any damage to equipment/buildings/vehicles/etc? *
Your answer
What factors contributed to this incident? *
Your answer
Were there any immediate corrective actions taken at the time of the incident? *
Your answer
What controls could be put in place to prevent this from happening again? *
Your answer
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