Wenatchee Valley College Hazard / Near Miss Report
Attention: Campus Safety Security and Emergency Management
Hazard: A haza
rd is any source of potential damage, harm or adverse health effects on something or someone under certain
conditions at work.
Near Miss: is an unplanned event that did not result in injury, illness, or damage – but had the potential to do so. Only a
fortunate break in the chain o
f events prevented an injury, fatality or damage; in other words, a "What almost happened?"
Any person who has experienced or witnessed a Near Miss or believes a hazard exists at WVC may submit a Hazard / Near
by completing this form entirely and turning it in to Campus Safety.
Type of Report:
Near Miss Hazard
Reported by: Name:
Phone (Work): Phone (Home):
Status: Employee (Staff / Faculty) Student Visitor Other:
Part I: HAZARD/ NEAR MISS INFORMATION:
Exact Location of
Hazard/ Near Miss:
Describe the Hazard/ Near Miss: