Good Catch / Near Miss Report

Report Safety Observations to Help Prevent Incidents

🛡️ PROACTIVE SAFETY REPORTING

👤 Reporter Information

Your Name *

Date of Observation *

Company *

Location *

📋 Report Type

Good Catch: A potential hazard or unsafe condition that was identified and corrected before an incident occurred.
Near Miss: An unplanned event that did not result in injury or damage but had the potential to do so.

✅

Good Catch

Hazard identified & corrected before incident

⚠️

Near Miss

Event that could have caused harm but didn't

📝 Observation Details

Description of Observation *

Potential Consequences *

⚠️ SIF Potential Assessment

STKY = Stuff That Kills You
Help us identify events with serious injury or fatality potential, even if no one was hurt.

1. Was HIGH ENERGY present? *

(Falls/gravity, vehicles/motion, electrical, pressure, chemical, rotating equipment, temperature extremes)

Yes No

2. Did an uncontrolled energy release occur? *

(Object fell, contact made, pressure released, exposure occurred, vehicle struck something, etc.)

Yes No

3. Was a DIRECT CONTROL in place? *

Direct Controls = Barriers that work even if someone makes a mistake (guards, lockout, barricades, isolation)

Yes - Direct control was in place No - Only alternative controls (PPE, procedures, training, warnings) No controls were in place

🔧 Actions & Recommendations

Immediate Actions Taken

Recommended Corrective Actions

📎 Additional Information

Additional Notes

📷 Photo Documentation

Photo (Optional but Recommended)

📷 Tap to take or upload photos

Photos help others understand the observation