1300 000 WBC (922)

Incident / Near-Miss Report Form

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Hazard, Near Miss, Incident & Accident Report Form

White Building Company requires all hazards, near miss’, incidents and or accidents to be reported as soon as practical. Please ensure that the site supervisor is notified of the undesired event as soon as possible.

CLASS OF INCIDENT(Required)
REPORTED(Required)
FURTHER ACTION REQUIRED

DETAILS OF INCIDENT

DD slash MM slash YYYY
Time of Incident(Required)
:
Max. file size: 80 MB.

INJURED PERSON/S (IF APPLICABLE)

DD slash MM slash YYYY

RECOMMENDED PREVENTIVE ACTION

COMPLETED BY

DD slash MM slash YYYY