Electrical Helps · Reporting

Near-miss & hazard report

Capture what happened and assign corrective actions without blame.

Project / company Jobsite / area Prepared by Date / revision

1. Event details

Date / time / exact location Reported by / contact (optional) Activity and people potentially affected What happened / factual sequence Immediate steps taken to secure the area

2. Review

Contributing conditions / equipment / communication Potential outcome and remaining exposure Supervisor notified / date and time

3. Corrective actions

Entry 1

Action Owner Due date Effectiveness / closure check

Entry 2

Action Owner Due date Effectiveness / closure check

Entry 3

Action Owner Due date Effectiveness / closure check

Entry 4

Action Owner Due date Effectiveness / closure check

4. Follow-up

Lessons shared with affected crews Reviewer / date Further reporting required under employer procedure