NEAR MISS REPORT

A Description C Analysis

Project: Company: Probability

Severity
Note: Refer to Risk Matrix

HSE Engineer Date: Substandard Acts / Practices

Operating equipment without authority
Failure to warn/secure
Corrective Actions / Recommendations Operating at improper speed
B Safety devices inhibited/removed/inoperable
Using defective equipment
Action/Recommendation By Whom When Failing to use PPE properly
Improper loading/ lifting
Improper replacement/ position for task
Servicing equipment in operation
Horseplay

Substandard Conditions
Inadequate guards / barriers/warning system
Inadequate or improper protective equipment
Defective tools, equipment or materials
Congestion or restricted action
Fire and explosion hazards
Poor Housekeeping /disorder
Radiation/noise exposure
Temperature extremes
Inadequate illumination/ventilation

Personal Factors
D Contractor Comments Inadequate capability-physical/mental
Lack of Knowledge
Lock of skill
Stress (physical/mental)
Improper motivation

Job/ System Factors

Inadequate Ieadership
Inadequate engineering
Signature: Date: inadequate tools, equipment materials
Inadequate maintenance
Abuse or misuse
E Comments inadequate supercision
Inadequate purchasing
Wear and tear

Signature: Date: