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EHS Near-Miss/Close Call Reporter

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Welcome to the Near-Miss/Close Call Incident Reporting System!

A near miss is an incident where no property was damaged and no personal injury sustained, but where, given a slight shift in time or position, damage and/or injury or illness easily could have occurred. It can be thought of as a "close call." EHS encourages reporting of near-miss/close call incidents so that contributing factors can be identified and abated before they result in personal injury/illness or property damage. By reporting these circumstances you are contributing to a safer and healthier campus environment. We appreciate your participation and assure you that there is no risk of repercussions for reporting a situation or hazard.

Contact Name
Email Address
Contact Phone Number
Date of Near-Miss
Time of Near-Miss
: 

Name and contact information for other persons that may have additional information/insight:

Location of the near-miss incident (be as specific as possible):

Describe the near-miss incident (what happened):

Describe factors that you think contributed to this near-miss situation:

Describe actions that you think could abate this situation so that it does not result in an injury/illness or property damage in the future:

Describe actions, if any, that you took in response to this close call:

Additional Information/Comments: