Near Miss Report Please enable JavaScript in your browser to complete this form.CHECK APPROPRIATE LEVELRED- STOP WORK AND REPORTYELLOW - USE CAUTION AND REPORTGREEN - CONTINUE AND REPORTLOCATION *TIMEDATEDEPARTMENT *CITY *STATE *GROUND SURFACE AND WEATHER CONDITION (IF APPLICABLE) *REPORTED BY (OPTIONAL) Layout yes, DESCRIBE SUPERVISOR REVIEW *DATEDESCRIBE NEAR MISSACTIONS TAKENROOT CAUSE ANALYSISROOT CAUSE(S)CHANGE ANALYSISWERE PICTURES TAKEN? (If yes, please send to tim.schleeve@scottequipment.com) YESNOSubmit
