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Incident without Injury Report (Near Miss Form) Mobile App

Averted your third near-disaster this month? Don't let the next one catch you off guard by downloading the Incident without Injury Report (Near Miss Form). This mobile app can help track and locate potentially dangerous areas in the work place and lead to a safer work environment for all. It can easily be modified to assess additional points of interest in the work place that may be potentially hazardous and prevent future injuries.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Incident without Injury Report (Near Miss Form) Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    An "Incident Without Injury" (IWOI) is any incident or condition that has the potential of causin...

  • Ico date

    Date:

  • Ico time

    Time:

  • Ico gps

    Location:

  • Ico textbox

    Person initiating report: (May be anonymous, but supply enough information to form corrective act...

  • Ico dropdown

    Classify the type of incident reported:

  • Ico dropdown

    Identify all areas of concern:

  • Ico dropdown

    Potential Severity of the Incident:

  • Ico dropdown

    Probability of Re-Occurrence:

  • Ico multiline

    Recommended Corrective Actions:

  • Ico multiline

    Action Taken:

  • Ico textbox

    Person Responsible:

  • Ico date

    Date:

  • Ico textbox

    Resolved By:

  • Ico date

    Date:

  • Ico signature

    Signature:

  • ...and More!

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