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Near Miss Report

Near Miss is an unplanned event that did not result in injury, illness, or damage – but had the potential to do so. Near Miss Reporting is the process of identifying and preventing an unSAFE act or unSAFE condition before it causes an injury or illness. This form is used to formally document the recognition of a hazard, the change that is made to prevent a reoccurrence of the hazard and to share the lessons learned with ONEMESA.

Your name*
Date/Time*
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SAFETY Section

What is the expected completion date of the corrective action?*
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