Hazard ID and Near Miss Report

One of the most important steps in any job is to identify the associated potential hazards. Hazards can exist in many forms; they can be visible or hidden, a condition or an act. Recognition and Control of hazards is necessary to ensure that corrective actions are completed on a timely basis.

Employees are expected to participate in Paragon’s proactive reporting program. It’s important for employees to report hazards identified in the workplace and share how they were controlled. All submissions are tracked in order to share commonalities amongst Paragon worksites.

Complete this form to share your leanings and get recognized in the process! Each month, Paragon will award one Paragon employee for their safety submission (80% company-wide participation is required).

Definitions:
Hazard ID: Unsafe acts and conditions that could result in a personal injury or a process upset.
Near Miss: Any event that in different circumstances could have resulted in harm to people, damage to property or loss to a process.

* 1. Who is completing this report?

* 2. Is this a Hazard ID or Near Miss?

* 3. When did this happen?

Date (MM/DD/YYYY)
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* 4. Where did this happen?*

*If this is a personal or OH item:
Owner-Client: NA or Paragon (if OH)
Location / site location: City/Intersection/etc. or Paragon Office (if OH; 14805 or 14830)
Project number: NA
Supervisor: NA

* 5. Describe the Hazard or Near Miss:

* 6. What was done to eliminate, mitigate or correct?

* 7. Was anyone else involved?

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