Near-Miss Reporting Form & Quick Learning Loop

{"Title":"Near-Miss Report","IntroductionHtml":"

Non-punitive near-miss reporting. The goal is prevention, not blame. Capture what you know — short reports are fine. Reports may be anonymous. This form collects facts, immediate actions, a suggested countermeasure, an owner, and a simple verification plan so teams can close the learning loop.

","SubmitLabel":"Submit Near-Miss","SuccessMessage":"Thank you — your near-miss report has been recorded. If you provided contact info, the owner or Safety team may follow up.","DataType":"near_miss_report","SchemaVersion":"1.0","Fields":[{"Key":"report_anonymous","FieldType":"yesno","Label":"Report anonymously?","HelpText":"Select Yes to omit your name/contact from the stored report (owner will still be notified).","Required":false},{"Key":"reporter_name","FieldType":"text","Label":"Reporter name (optional)","HelpText":"Leave blank if reporting anonymously.","Required":false},{"Key":"reporter_contact","FieldType":"text","Label":"Reporter contact (email or phone, optional)","HelpText":"Optional — helps the owner follow up for clarification.","Required":false},{"Key":"date_time","FieldType":"text","Label":"Date and time of near-miss","HelpText":"Format: YYYY-MM-DD HH:MM (local time). If unknown, enter approximate.","Required":true},{"Key":"location","FieldType":"text","Label":"Location (workstation, line, area)","HelpText":"Be specific so teams can inspect the exact place.","Required":true},{"Key":"department","FieldType":"select","Label":"Department / area","HelpText":"Select the best match, or use Location for more detail.","Required":false,"Options":[{"Value":"production","Label":"Production"},{"Value":"maintenance","Label":"Maintenance"},{"Value":"quality","Label":"Quality"},{"Value":"shipping","Label":"Shipping / Receiving"},{"Value":"engineering","Label":"Engineering"},{"Value":"other","Label":"Other"}]},{"Key":"what_happened","FieldType":"textarea","Label":"Describe what happened (brief)","HelpText":"Include actions, equipment, materials and sequence. Focus on observable facts, not blame.","Required":true},{"Key":"witnessed","FieldType":"yesno","Label":"Was anyone else present?","HelpText":"Select Yes if others watched or were nearby.","Required":false},{"Key":"potential_severity","FieldType":"select","Label":"Potential severity","HelpText":"Estimate the worst reasonable outcome if not addressed.","Required":true,"Options":[{"Value":"none","Label":"No injury or damage likely"},{"Value":"minor","Label":"Minor injury or minor damage"},{"Value":"moderate","Label":"Moderate injury or equipment damage"},{"Value":"serious","Label":"Serious injury or major damage"},{"Value":"fatal","Label":"Life‑threatening or fatal potential"}]},{"Key":"likelihood","FieldType":"scale","Label":"Likelihood (1–5)","HelpText":"1 = extremely unlikely, 5 = very likely","Required":false},{"Key":"impact","FieldType":"scale","Label":"Impact (1–5)","HelpText":"1 = negligible, 5 = catastrophic","Required":false},{"Key":"immediate_hazard_present","FieldType":"yesno","Label":"Is an immediate hazard still present?","HelpText":"If Yes, take immediate action and notify supervision.","Required":true},{"Key":"immediate_action_taken","FieldType":"textarea","Label":"Immediate action taken","HelpText":"What was done right away to reduce risk (stop machine, isolate, cord removed, barrier placed, etc.)?","Required":false},{"Key":"suggested_countermeasure","FieldType":"textarea","Label":"Suggested countermeasure","HelpText":"What longer-term change would prevent recurrence? Be specific where possible (shielding, procedure change, training, replacement part, etc.).","Required":true},{"Key":"probable_root_cause","FieldType":"select","Label":"Probable root cause (best guess)","HelpText":"Choose the most likely underlying cause to help prioritize countermeasures.","Required":false,"Options":[{"Value":"equipment","Label":"Equipment / failure"},{"Value":"procedure","Label":"Procedure or work instruction"},{"Value":"training","Label":"Training or competency"},{"Value":"human_error","Label":"Human error or lapse"},{"Value":"supervision","Label":"Supervision / communication"},{"Value":"materials","Label":"Materials or part quality"},{"Value":"environment","Label":"Environment / housekeeping"},{"Value":"design","Label":"Product or process design"},{"Value":"other","Label":"Other"}]},{"Key":"owner","FieldType":"text","Label":"Proposed owner for countermeasure","HelpText":"Name or role who will take responsibility for implementing the fix.","Required":true},{"Key":"expected_verification_days","FieldType":"number","Label":"Expected verification (days)","HelpText":"Number of days until owner verifies the countermeasure is implemented and effective.","Required":true},{"Key":"notify_safety","FieldType":"yesno","Label":"Notify Safety / EHS team?","HelpText":"Select Yes to flag this report for formal EHS follow-up.","Required":false},{"Key":"follow_up_status","FieldType":"select","Label":"Status","HelpText":"Owner or Safety team will update this as work progresses.","Required":false,"Options":[{"Value":"open","Label":"Open"},{"Value":"in_progress","Label":"In progress"},{"Value":"verified","Label":"Verified"},{"Value":"rejected","Label":"Rejected"},{"Value":"escalated","Label":"Escalated"}]},{"Key":"verification_done","FieldType":"yesno","Label":"Verification done?","HelpText":"Select Yes once the countermeasure has been implemented and checked.","Required":false},{"Key":"verification_notes","FieldType":"textarea","Label":"Verification notes","HelpText":"What was checked and what evidence shows the fix works? (photos, test results, checklist references)","Required":false},{"Key":"lesson_learned_summary","FieldType":"textarea","Label":"Lesson learned / learning to share","HelpText":"Short note for toolbox talks or shift huddles. Keep it concise.","Required":false},{"Key":"tags","FieldType":"checkbox","Label":"Tags (helpful keywords)","HelpText":"Select tags to help categorize and later filter reports.","Required":false,"Options":[{"Value":"near_miss","Label":"Near miss"},{"Value":"hazard","Label":"Hazard"},{"Value":"equipment","Label":"Equipment"},{"Value":"procedure","Label":"Procedure"},{"Value":"training","Label":"Training"},{"Value":"ergonomics","Label":"Ergonomics"},{"Value":"chemical","Label":"Chemical"},{"Value":"slip_trip","Label":"Slips / trips"},{"Value":"electrical","Label":"Electrical"},{"Value":"lockout","Label":"Lockout / tagout"}]}]}