Personal Injury Near Miss Report Form

Who, what, when and where?
Please tell us when and who was involved.

01/19/2023
8:00 PM
6.2
Chris Williams
Charles Hawkins
*NOTE: The name entered in this box will be the name that receives credit toward their MBO
Chris Williams
C&C Marine Belle Chasse

Conditions at time of Near Miss
Try your best to select the conditions during the Near Miss.

Near Miss description
Give as much detail as you can.

Dropping barges and C&C Marine.  Tankerman was carrying his lines on the wrong shoulder and picked it up with his back to the water.
Talked to him about taking extra time to make sure he is aware of his surroundings.  I appreciate his hard work and wanting to get the job done but he has to realize the dangers of what could happen.

Near Miss evaluation
Select the best possible choices. You will have an opportunity below to give more detail and request to add categories or suggest improvements to this form.

About the Near Miss Reporting Program
Accident/Incident/Near Miss Investigation

One of the best ways to avoid further accidents is to understand how an accident occurred and how to avoid that type of accident in the future. The accident investigation is a tool.

The goal is not to lay blame.

ACCIDENT -an undesired event or sequence of events causing injury, ill-health or property damage.

NEAR MISS -near misses describe incidents where, given a slight shift in time or distance, injury, ill-health or damage easily could have occurred, but didn't this round.

INCIDENT -an incident is an unplanned, undesired event that hinders completion of a task and may cause injury or other damage.

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