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Safety Concerns & Near-Misses
Use this form to report any general safety concerns and near-misses (a near-miss is an event that *could* have caused an accident, but didn't). DO NOT use this form to report an actual incident/accident.
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Today's Date
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DD
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Your Name
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Your answer
Who reported the concern?
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Your answer
Location
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Your answer
Description of Issue
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Your answer
Suggestions how to eliminate the problem (optional)
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