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Near Miss Checklist

MaintainX
10/24/2021

Near Miss Checklist

18 steps
  • 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

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