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NEAR MISS REPORT
DID YOU SEE A NEAR MISS TODAY?
First Name :
*
Last Name :
*
Project Name :
*
Employee Id :
Date :
*
Time :
AM
PM
What did you see?
*
Action Taken to Correct/Prevent a Similar Incident :
*
Who did you talk with concerning the hazard?
N/A
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Foreman Email:
Other Email:
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