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Home | Sample Incident and Near Miss Report . . .

Sample Incident and Near Miss Reporting Policy
Updated May 2010
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I. Purpose

In order to ensure a safe, healthful, and efficient work environment for our employees, the Company has established the following incident and near miss reporting policy as a condition of employment and continued employment.

II. Required Conduct

Employees are required to report to their supervisor any job-related incidents of the following types:

  • Accidents: unplanned events that result in injury, illness, property damage, loss of materials, or environmental damage.

  • Exposures: contact with potentially harmful chemical or physical agents or biological hazards, whether or not these result in injury or illness.

  • Injuries or illnesses: Even minor ones, and even if the employee believes that the injury or illness may not be job-related (for example, signs and symptoms of ergonomic injuries, which may have more than one cause).

  • Near Misses: Events that could have, under slightly different circumstances, caused injury, illness, death, property damage, loss of materials, or environmental damage.

Accidents, exposures, injuries and illnesses, and near misses must be reported to the employee's direct supervisor or to the acting supervisor on-site immediately, or as soon as possible if they cannot be reported immediately (for example, providing emergency medical care can take precedence over reporting).

III. Enforcement

All employees are hereby advised that full compliance with this policy is a condition of employment at the Company. Any employee who violates this policy will be subject to discipline, up to and including discharge.

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