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Today’s near miss is tomorrow’s injury

Near Miss Report

Near miss reporting lets us identify and prevent potential accidents.

Keep talking – if you see something that isn’t safe, tell us about it.

People First Go HomeSafe

Submitting NearMiss Report...

Your details

*Report anonymously? No Yes

*Your First Name

*Your Last Name

*Your Division

*Your Division Contract

*Physical and verbal abuse ? No Yes

Abuse details

*Type of Abuse

Verbal Abuse
Threatening Behaviour / Physical intimidation

Object thrown / weapon / vehicle aggression
Filming in confrontational manner
Actual physical harm (CC to be made aware)

*Aggressor Type

Driver / Passenger
Pedestrian
Cyclist
Motor bike / E Bike

Resident / Business Owner
Other third party (Contractor)
Multiple persons
Subcontractor

*Type of Work

Reactive

Planned

Emergency

*What do you think caused the abuse?

Discrimination
Noise / Dust / Vibration
Denied access (road closure)
Delay / Disruption

Confusion about diversion
Public refusing footway diversion
Public under influence of drink/drugs
Project concerns (i.e. ULEZ)
Provoked by FMC staff

Near miss details

*Incident Division

*Incident Division Contract

*Type of Incident Avoided

Working at Height
- Fall From Height
- Falling Objects
Occupational Health
- Noise and Vibration
- Exposure to Harmful Substance, i.e. Dust, Fumes, etc
- Fatigue
- Lifting and Handling Injuries
- Stress or Anxiety
- Physical Assault or Abuse
Lifting Operations
- Struck by Object
- Trapped by Something Collapsing
Isolation & Guarding
- Contact with Electricity
- Contact with Machinery
- Exposed to Stored Energy
Safe Digging Practices
- Contact with Electricity
- Exposed to Fire and Explosion

Temporary Works
- Struck by Object
- Trapped by Something Collapsing
Traffic/Pedestrian Interface
- Struck by Moving vehicle or Plant
- Physical Assault or Abuse
Confined Spaces
- Drowning or Asphyxiation
- Exposure to Harmful Substance, i.e. Dust, Fumes, etc
- Fatigue
Subcontractors
- Failure to Manage
- Subcontractor Failure
Occupational Road Risk
- Fatigue
- Physical Assault or Abuse
- Stress or Anxiety
Other Risk
- Welfare
- Slip, Trip and Fall Same level
- Environmental

*Description of Near Miss / Hazard:

Photo Upload:

Videos should not exceed 1.5 MB - approximately 10sec (otherwise they will be ignored)!

* Did you take action? No Yes

* Description of what you did:

*Did you inform an FMC member of staff? No Yes

* Who did you inform?

*Location of Near Miss / Hazard:

*Date of Near Miss / Hazard:

*Time of Near Miss / Hazard:

You have chosen to report anonymously

Next steps

*Do you require feedback? No Yes

* Contact telephone number:

* Contact email:

Today’s near miss is tomorrow’s injury

We operate a just health and safety culture. No action will be taken against a person or company for reporting an incident.

F M Conway Ltd, Conway House, Vestry Road, Sevenoaks, Kent, TN14 5EL.Registered Company: 706445

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