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APA/AIE Near Miss Reporting Form

APA and AIE Near Miss/Good Catch Reporting Form

This form allows APA members and AIE subscribers to anonymously report near misses and good catches while at job sites. These stories help inform others who can learn from each event and incorporate that knowledge into their own training and preparation.

Who was involved? (You may check more than one)
Time of incident
:
Was appropriate safety equipment provided at the job site?
Was the safety equipment in use at the time?
Is there a safety policy or procedure for this particular job?
In your opinion, if this were an actual incident would it have serious incident or fatality potential?
List