Near Miss Report Form Complete this form to report a Near Miss or unsafe situation on site, for prevention of future incidents. If you require any assistance, do not hesitate to contact Titan’s Health & Safety Advisers: HCS Safety Ltd – 02380 894 695Date of Near Miss:* DD slash MM slash YYYY Time of Incident (If relevant): : Hours Minutes AM PM AM/PM Site's Principle Contractor:*Site Address:*Full Name of Person(s) involved:*Contact's number (in case further info is required):Description of Near Miss or unsafe situation:Particular safety downfalls that may have led to the safety risk:Immediate Action taken to prevent further risk:Further preventative action needed to remove foreseeable risks:Upload PhotoMax. file size: 256 MB. Near Miss Form Completed by:Date* DD slash MM slash YYYY SignatureAny Other Comments:
