NEAR MISS – New Report Form for email submission as a PDF or to print and hand-in.

Near miss reports can be a valuable tool for experiential learning about laboratory safety. However, the data indicates such items not regularly reported, reviewed or disseminated at Pitt.

Online form for Near Miss electronic reporting – Anonymous

Research Lab/Other Department of Chemistry/EH&S Reporting – “Near Miss”

Date:	Time work/project Started:	Time of Near Miss:	Time work/project Ended:

Who?

Who else was there?

Who else does this – researchers or other groups?

Who is your supervisor?

What happened?

What else could have happened?

Your response to the situation and comments:

Other comments:

Other ideas or reminders:

Where did this happen?

Where else could this happen?

When did this happen?

When else could this happen?

Why did this happen?

Why else could it happen?

How else could this occur?

How can it be prevented?

How else can this be done safely?

Reports can be given to the Department of Chemistry Office, or Emailed to jcjst22@pitt.edu  Updated: 2020.2.14 J