[Luna County] Near-Miss Report Form

Near-Miss Report Form

The Near-Miss Report Form is for County staff and the public to use and report any near-misses that may have happened in the workplace or on county property. The County encourages the reporting of near-misses so we can eliminate the potential hazards that could cause injury to someone else.

Receipt

You will be provided with a Receipt upon submission.

First and Last Name (Optional)

Phone Number (Optional)

Location of Near-Miss

Date and Time of Occurrence

Specify how the Near-Miss occurred

Upload File(s) (Optional)

Click Here to Upload