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Hazard & Near-Miss Reporting
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If you are unsure how to proceed, please contact PSW support at 1-866-724-6650 and press 4.
What's the difference between a Hazard and a Near Miss?
Hazard
Anything that has the potential to cause injury or disease to people or damage the environment, property or equipment.
Example: A slippery set of stairs is a hazard.
Near Miss
An occurrence that could have led to unintended and/or unnecessary harm to a person, and/or a complaint, loss or damage.
Example: Somebody slips on the stairs but is not injured.
Remember:
Near Miss
= an incident without injury
Near-Miss Incident Report
No.: New
Date Submitted:
02-10-25
SUBMITTER
Select Role
Employee
Student
Visitor
Select new
Adams, Wendy
Alexander, Jacob
Ater, Leah
Baker, Alex
Barnett, Molly
Basford, Katie
Boatman, Nathan
Brennfleck, Elizabeth
Brodt, Donna
Brown, Tacy
Burgess, Kimberly
Burns, Sherry
Combs, Emily
Comp mgt. melanie, Mco/tpa
Curry, Zoe
Daniels, Chrissy
Dingey, Mackenzie
Elliott, Tina
Ezmaint, Recipient
Fife, Bill
Fouch, Katie
Freeze, Jordan
Freshour, Jackie
Gardner, Cindy
Gilbert, Kimberly
Goodwin, Jennifer
Gray, Larry
Gregory, Tony
Haines, Nicole
Harmon, Kathy
Hayslip, Becky
Hicks, Jessica
Hidy, Tammy
Holsinger, Colista
Hopkins, Chris
Hottinger, Rebecca
Howard, Brittney
Howard, Danny
Itassist, Recipient
Janasov, Suzie
Johnson, June
Johnson, Kimberly
Justice, Agnes
Karnes, Renee
Loudin, Phil
Manor, Tammy
Marion, Kristina
Martin, Holli
Mcgowan, Melanie
Miller, Chelsea
Mitchell, Tommie
Moore, Lori
Penwell, Cassie
Peters, Roshell
Reno, Justin
Rhoads, Jessica
Routt, Sarah
Rusch, Bonnie
Scott, Brady
Smith, Melanie
Snyder, Ursula
Staggs, Paige
Stanfield, Jessica
Stewart, Tim
Tattersall, Janda
Thacker, Jacklyn
Tise, Shannon
Walters, Erin
Warnock, Molly
Washburn, Lynn
Weidman, Marilyn
Williamson, Kelli
Yarger, Casey
First Name
Last Name
Telephone No.
(optional)
Email Address
(required if email turned on below)
DESCRIPTION
Describe the Near-Miss Incident
Attachments
Add Attachment
Describe how the incident happened, including what you were doing before and at the time of the incident, personal protective equipment being used, and any tools, equipment or materials involved.
LOCATION OF NEAR-MISS INCIDENT
Site
Exempt Employee
Highco, Inc.
Highland County BODD
Highland Housing
Hills and Dales School
Transportation
Building
Where in the Building
It is important that you accurately describe where the near-miss incident occurred. This information may be valuable in correcting issues needed to avoid future accidents.
ASSIGNEE
Adams, Wendy
Alexander, Jacob
Ater, Leah
Baker, Alex
Barnett, Molly
Basford, Katie
Boatman, Nathan
Brennfleck, Elizabeth
Brodt, Donna
Brown, Tacy
Burgess, Kimberly
Burns, Sherry
Combs, Emily
Comp mgt. melanie, Mco/tpa
Curry, Zoe
Daniels, Chrissy
Dingey, Mackenzie
Elliott, Tina
Ezmaint, Recipient
Fife, Bill
Fouch, Katie
Freeze, Jordan
Freshour, Jackie
Gardner, Cindy
Gilbert, Kimberly
Goodwin, Jennifer
Gray, Larry
Gregory, Tony
Haines, Nicole
Harmon, Kathy
Hayslip, Becky
Hicks, Jessica
Hidy, Tammy
Holsinger, Colista
Hopkins, Chris
Hottinger, Rebecca
Howard, Brittney
Howard, Danny
Itassist, Recipient
Janasov, Suzie
Johnson, June
Johnson, Kimberly
Justice, Agnes
Karnes, Renee
Loudin, Phil
Manor, Tammy
Marion, Kristina
Martin, Holli
Mcgowan, Melanie
Miller, Chelsea
Mitchell, Tommie
Moore, Lori
Penwell, Cassie
Peters, Roshell
Reno, Justin
Rhoads, Jessica
Routt, Sarah
Rusch, Bonnie
Scott, Brady
Smith, Melanie
Snyder, Ursula
Staggs, Paige
Stanfield, Jessica
Stewart, Tim
Tattersall, Janda
Thacker, Jacklyn
Tise, Shannon
Walters, Erin
Warnock, Molly
Washburn, Lynn
Weidman, Marilyn
Williamson, Kelli
Yarger, Casey
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