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PCR Global Ltd

Near miss or learning event report (Part 2)

To be completed by Site Management.

Note: This near miss or learning event must be logged onto the Accident Incident Site Register.
Company:
Project Title: Contract No:
Date: Location:
Reported by: Part 1 – date
received:
Classification: (tick)
Health Safety Security Environment Quality
Main contractor Sub-contractor Third party/public
Details of the learning event (including all relevant information)

Potential outcome (tick) Potential severity (tick)

Personal injury Negligible
Property or equipment damage Slight
Environmental issue Moderate
Security issue High
Other (state) Very high

Lessons learned (consider immediate and root causes) (tick)

Near Miss or Learning Event Report (Part Page 1 of 2

2)
Issue Level: 01 © PCR Global Limited
Issue Date: 01 03 20 ALL PRINTED COPIES ARE UNCONTROLLED
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PCR Global Ltd

Near miss or learning event report (Part 2)

Work environment
Defective workplace Design / layout
Housekeeping Lack of room
Lighting Noise / distraction
Weather Access / egress
Other (state)

Management
System of work Supervision
Training Communication
Management of change Other (state)

Plant / equipment
Construction / design Installation
Safety device Operation / use
Mechanical failure Maintenance
Other (state)

Human factors
Failure to follow rules Instructions misunderstood
Error of judgement Lack of experience
Unsafe attitude Undue haste
Horseplay Lapse of concentration
Fatigue Working without authorisation
PPE
Design Wrong type used
Maintenance Not provided / availability
Not used Other (state)

Other
Third party Under investigation
Other (state)
Follow up
Actions required Responsible Completed

Name Position Signature Date

Near Miss or Learning Event Report (Part Page 2 of 2

2)
Issue Level: 01 © PCR Global Limited
Issue Date: 01 03 20 ALL PRINTED COPIES ARE UNCONTROLLED