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Near Miss Report Card
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Near Miss Card
Location
Time
Hours
:
Minutes
AM
PM
AM/PM
Date
MM slash DD slash YYYY
RED
Stop Work and Report
YELLOW
Use Caution and Report
GREEN
Report
Unsafe Act
Unsafe Equipment
Unsafe Condition
Unsafe Use of Equipment
Near Miss Description
Was the hazard corrected?
Was the hazard communicated back to the site lead and PM?
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