Action(s) taken Outcome(s) if known Section C– The Analysis Is this type of NEW OLD Is this type of event ONE-OFF ONGOING event (circle) Has this type of Have appropriate event been YES NO steps been taken to YES NO increasing? address this event? If what needs to be done? “NO,” Appendix J Example Near Miss Report Form –
Action(s) taken Outcome(s) if known Section C– The Analysis Is this type of event (circle) NEW OLD Is this type of event ONE-OFF ONGOING Has this type of event been increasing? YES NO Have appropriate steps been taken to address this event? YES NO If “NO,” what needs to be done? Appendix J – Example Near Miss Report Form
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