Personal Injury Near Miss Report Form

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

01/23/2023
8:30 AM
279
BRIAN BAUSER
*NOTE: The name entered in this box will be the name that receives credit toward their MBO
HOUSTON LOPEZ

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.

WHEN TURNING LOOSE FROM THE SPAR BARGE BEFORE WE WERE TURNED LOOSE FROM THE OTHER BOAT SOMEONE SAID ALL GONE AND BEFORE THE LAST LINE WAS TURNED LOOSE THE OTHER BOAT STARTED TO PULL AWAY. THE DECKHAND THEN TOLD HIM ALL STOP, TURNED THE LINE LOOSE THEN TOLD THE CAPTAIN ALL GONE.
ALWAYS DOUBLE CHECK YOUR WORK ESPECIALLY WHEN OTHERS ARE INVOLVED.

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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