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| Location : |
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| *Site/Responsible Department : |
This can be the department of your supervisor or site supervisor, or department of the contract holder
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Email ID (Optional): |
Email notification of the near miss report will be sent to the email address entered in this field.
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| Involved Contractor : |
Contractor involved in the near miss.
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| *HSE Categories : |
The HSE Category of the near miss reported.
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| Where did the Incident Occur ? |
| *Specific Location : |
(Maximum 200 Character is allowed)
The location where the near miss took place.
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| When did the Incident Occur ? |
| *Date/Time Occured : |
Enter Date and Time Which NearMiss Occured.
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Date Reported : |
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| Description |
*Event Description :
(Maximum 1320 Character is allowed)
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*Corrective Action Taken :
(Maximum 990 Character is allowed)
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Action taken to correct the near miss and prevent from escalating to a top event.
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