Incident and Near Miss Report Form
v3.2
Purpose. Workers complete this form to report injuries, near misses, plant events, environmental incidents and hazards so that they are recorded, investigated and, where required, notified to the regulator.
1.When to use this form
Complete this form on the day for any injury, near miss, uncontrolled release of energy, fire, spill, licence exceedance, plant damage or hazard you cannot fix yourself. Your supervisor will enter it in the HSE Incident Register and HSE will decide whether it must be notified.
2.Immediate actions
Make the area safe and treat any injury first. Where plant has tripped or been damaged, tell the control room before you complete the form. Preserve the scene where you can so that the investigation can establish the facts.
3.Describing the event
Describe what happened in order, with plant identifiers, readings and times. Record who was present, what permits were open and what equipment was in use. Report facts, not blame.
4.Classification
Choose the event type that best fits. A plant event is a trip, a load rejection, a fire, an explosion or a release of steam, gas, oil or chemical. An environmental incident is any spill, exceedance or discharge outside the licence.
5.After submission
The supervisor must review the form within one shift. HSE must assign an investigation level within two working days. Notifiable incidents must be reported to the regulator within the time the law sets.