Back

Near Miss Checklist

MaintainX
10/24/2021

Near Miss Checklist

    Do workers reporting a near miss immediately complete a reporting form that captures:

    The job task that was being performed at the time of the incident?

    • Yes
    • No
    • N / A

    What happened?

    • Yes
    • No
    • N / A

    Where and when it happened?

    • Yes
    • No
    • N / A

    The equipment or material involved?

    • Yes
    • No
    • N / A

    The individuals who were present?

    • Yes
    • No
    • N / A

    Identify all factors that were involved in the incident, including (but not limited to):

    Equipment malfunction or failure

    Equipment in need of repair or maintenance

    Facility factors, like poor visibility, damaged walking/working surfaces, or slip-and-trip hazards

    Operator error

    Unauthorized personnel in a work area or performing a job task

    Production pressures

    Failure to take time to do the job properly

    Failure to inspect equipment or missed inspection items

    Horseplay

    Lack of training

    Note the following

    Any warning signs observed before the incident

    The consequences

    What the consequences might have been, including property damage, injury to workers, coworkers, or members of the public

Please note that any procedure, checklist, or other document available in the MaintainX Global Procedure Library is provided for general education and information only and does not constitute legal, medical, or financial advice. MaintainX makes the materials available AS IS and AS PROVIDED, without warranties of any kind. By downloading or using any such materials, you assume the risk that they may not be appropriate for your specific situation and agree that you are solely responsible for any such use, including compliance with applicable law and with meeting any conditions of product warranties.