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Near Miss Report - Detroit

Near Miss Report

1. Initial Information
This question requires a valid date format of MM/DD/YYYY.
calendar
Reporting Company? *This question is required.
Department? *This question is required.
Operations *This question is required.
Maintenance *This question is required.
Product Control *This question is required.
Did this situation have a high potential of causing a fatality, hospitalization or life altering * event ?  

*( significant changes to a person's life such as head injury/ amputation/ serious burns / disablement / catastrophic fracture ) *This question is required.
2. Location 
3. Was Stop Work Authority used? *This question is required.
4. Description & Corrective Actions *This question is required.
Follow-Up *This question is required.
Would you like someone to follow up with you?  *This question is required.