Near-Miss Incident Report

Please use the form below to report near-misses and assist us in preventing future incidents and making the Centerra Coop a safer workplace. You can upload images of the incident/area if you choose.

A printable form can be found HERE.

Near Miss Report

A near-miss is a potential hazard or incident in which no property was damaged and no personal injury was sustained, but where, given a slight shift in time or position, damage or injury easily could have occurred. Near misses also may be referred to as close calls, near accidents, or good catches. For the sake of a safe work environment, the company asks that all employees report any of these potential hazards immediately.
MM slash DD slash YYYY
Time of Incident
Describe the potential incident/hazard/ concern and possible outcome (please be detailed):
Recommendations/steps to take to prevent a similar incident:
Drop files here or
Max. file size: 25 MB.
    Please upload any photos of the incident/area if you think it will aid your description
    Name (optional)
    MM slash DD slash YYYY