SD-FORM-003 Near Miss-Good Catch Report


Near Miss / Good Catch Report

Environmental Construction Service: ☐ MAS ☐ SAS ☐ SPS ☐ SLC

Near Miss

Good Catch

Date of Event:

Date Submitted:

Location of Event: Brief Description of Event:

Contributing Factors:

What changes, modifications, or actions will be implemented?

How will you implement these corrective actions?

Office Use Only: Date Received: ☐ Logged

Statistics Documented

Document Title


Approving Authority:

Joe Snorek

Origination Date:

March 12, 2015

Owner / Author:

Joe Snorek

Document Number:


Revision Level / Date:

REV 3 / August 30, 2018

SD-FORM-003 Near Miss Good Catch Report.dotx Page 1 of 2 - CONFIDENTIAL -

Near Miss and Good Catch Reporting Instructions


Good Catch – An unsafe condition or act was recognized, which if let unaddressed, could have resulted in an

injury, property damage, or outage. This could also be a positive recognition of a good work practice or behavior

which helped create a safer environment.

Near Miss – An incident occurred where no property was damaged, and no personal injury was sustained, but

where, given a slight shift in time or position, damage and/or injury could have occurred.


The intent of this document is to capture the Good Catch/Near Miss Event reports received from multiple

contractors on one standard document. This document is not intended to replace the contractor's own Good

Catch/Near Miss reporting process or documentation.


1. Once a Near Miss has occurred, or an unsafe condition or act has been recognized, an employee should

report it to their Supervisor or Safety & Compliance Representative per the guidelines of their own company's

reporting policy.

2. The Supervisor or Safety & Compliance Representative will record the Near Miss/Good Catch on the

company Good Catch and Near Miss Report and submit the form to:

3. Please fill out the form in its entirety. The report should include the following:

1. Date of Near Miss/Good Catch

2. Location of Near Miss/Good Catch

3. Contributing Factors (states, critical errors, other)

4. Also, it is highly important that suggestions or recommendations be made regarding what actions

will be taken

SD-FORM-003 Near Miss Good Catch Report.docx Page 2 of 2 - CONFIDENTIAL -

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