Near Miss Incident Report

General Information
Date and time of the Incident
Location (please be as accurate as possible)
Details Of Person Reporting
First Name
Surname
Category of Person – staff, student, contractor or visitor
If other, give more details
Name of the contractor (if applicable)
Incident Details
Description of the Incident
Describe what happened
What immediate actions were taken at the time
List additional actions which could be taken to prevent a similar occurrence
Photograph(s) of the area and/or results of the near-miss or incident
حداکثر اندازه فایل: 500 MB.
Additional comments / observations

خیابان کارگرشمالی کوچه چهارم‍ شماره ۳۸ واحد ۵ شمالی

02188220840-2 کد پستی:۱۴۱۳۶۹۳۸۹۵

۰۹۱۰۸۳۴۱۸۴۵-۶

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General Information