Near Miss Reports
Was there an accident?
*
YES
NO
Contact your supervisor to report accidents/injuries.
UGA safety reporting tool (Not FMD):
Insurance & Claims Reporting
Your Shop
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Date of Incident
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Incident Type
*
Near-Miss
Safety Concern
Type of Near Miss
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Type of Concern
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Description of "Other"
*
Do you want to report anonymously?
YES
NO
Your Name
*
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Comments (Briefly describe the incident.)
*
Location (Where did this happen?)
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