Near Miss Log

Utilize the Near Miss Log to document near-miss incidents, identify factors involved in the accident, and implement preventive measures in workplaces.

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Manufacturing
Near Miss Log

Near Miss Log

Incident Factors

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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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Near Miss Log

Utilize the Near Miss Log to document near-miss incidents, identify factors involved in the accident, and implement preventive measures in workplaces.

1. Is the job task performed at the time of the incident documented?

2. What happened?

3. Where and when did it happen?

4. Is the equipment or material involved documented?

5. Are the individuals who were present at the time of the incident documented?

1. Is there equipment malfunction or failure?

2. Is the equipment in need of repair or maintenance?

3. Are there facility factors, like poor visibility, damaged walking/working surfaces, or slip-and-trip hazards?

4. Is there an operator error?

5. Are there unauthorized personnel in a work area or performing a job task?

6. Are there production pressures?

7. Is there a failure to take the time to do the job properly?

8. Is there a failure to inspect equipment or missed inspection items?

9. Is horseplay involved?

10. Is there a lack of training?

11. Any warning signs observed before the incident:

12. Are there consequences?

13. What were the potential consequences, including property damage, and injury to workers, coworkers, or members of the public?