Incident / Near Miss Reporting Form
Use this form to tell us about any incidents or near-misses. All information is shared with the management committee.
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Email *
Name of person completing this form
Email address *
Participants
What are you reporting?
Clear selection
Where did the Incident/Near Miss occur? *
Required
What risks were involved?
Clear selection
When did the incident/ near miss occur? *
MM
/
DD
/
YYYY
Please describe what happened *
Was anyone injured? Or was there a potential for injury? Please describe
Was there any damage to property or equipment or is there a potential for damage to property or equipment? Please describe.
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