This form should be completed if you have witnessed or been involved in a near miss. A near miss is an event or circumstance where injury could of occurred but has been prevented by chance e.g. something falling and landing next to you, a vehicle moving uncontrolled, burnt charred electrical equipment or a slipper surface but no one has fallen. Your Contracts Manager of Health and Safety Manager may complete this form on your behalf. You should report any near miss AS SOON AS YOU CAN as this may prevent an accident or dangerous occurrence from happening.