Gonzaga University

Gonzaga University

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Gonzaga University

Near Miss Form

Please complete this form within 24 hours for any incident that could have resulted in an injury. If you were injured, please do not fill out this form. Instead, complete the Accident Injury/Occupational Illness Request Form.

Reporter Info

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Location

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    Exact Location

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    General Information

    Involved Person/Persons Information

    Witness/Witnesses Information

    Investigation Section

    Add Supporting Documents

    Add files to upload as supporting documentation along with your incident.