Near Miss / Good Catch Report
Environmental Construction Service: ☐ MAS ☐ SAS ☐ SPS ☐ SLC
☐ Near Miss
☐ Good Catch
Date of Event:
Location of Event: Brief Description of Event:
What changes, modifications, or actions will be implemented?
How will you implement these corrective actions?
Office Use Only: Date Received: ☐ Logged
NEAR MISS-GOOD CATCH REPORT
March 12, 2015
Owner / Author:
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
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: firstname.lastname@example.org
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 -